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Baths are good; more baths are better. Despite popular belief, dry skin does not lack oil it, lacks water. Baths put the water back into the skin, soften scale so it can be scrubbed off without too much difficulty, and are also great splashy playtimes for you and your little one. Keep in mind that soaps rob skin of essential oils, so they should be used sparingly or avoided altogether. Speak to your dermatologist about how much soap you should use.  Some types of ichthyosis respond better to the steam in a comfortably warm shower than to complete immersion in a bath.  Experiment to see what works best for your child.

You might also consult your dermatologist about which bath additive might be best for your child’s skin. Doctors often recommend oatmeal-based additives, which you can buy at the grocery store or drugstore, or make at home if you have a food processor to finely grind whole oats. For patients who are at risk for infection, doctors sometimes recommend adding a few drops of antibacterial soap or even bleach (e.g. Clorox®) to the bath. Some shampoos can help reduce scale on the scalp.

If your baby has large raw areas on his or her skin (as many babies with EHK do), put a dab of petroleum jelly on the raw areas before the bath. This helps alleviate the pain of the first contact with the bath water.

Once your child has had time to play and soak, scrub the loose skin off gently with a your palms, a wash cloth, or a specially made product designed to loosen skin cells. (Nail salons often carry several kinds of nail filing blocks that are gentle to the skin.) You can also try a loofah or a pumice stone if your child has thick calluses.  You will learn with experience how much to scrub. Moderation is the key. If too much skin is removed, there will be tender (sometimes very red or even raw) skin beneath. It is especially important not to overdo scrubbing off the scale in babies.  Some topical medications may be absorbed internally if the skin is overly abraded or raw.  Excessive scrubbing can also cause blisters in children with EHK.  And scrubbing of any type is not recommended in Netherton Syndrome.

After a bath, thoroughly dry the creases under the neck, under arms and in the diaper area to guard against maceration, which are sores resulting from over-moisturized skin in creases and folds. Only pat dry the rest of the body to keep the skin moist. Immediately apply cream or lotion to seal in that precious moisture.

How often should you give your child a bath?  It depends on the condition of the skin and the weather.  If you live in a climate with dry, windy, or cold weather, you may have to give your child more frequent baths.  If your child is in air-conditioned environments, he or she may also need more frequent baths.