WATER study

Summary: Atopic dermatitis (AD) is a common disease in children. There is much uncertainty on how frequent children with AD should shower because of lack of scientific evidence. In the Dutch guidelines for AD no advice is given on this topic, because of lack of evidence. The European guidelines advice daily showering/bathing, but do this based on expert opinion due to lack of trials.The American guidelines conclude that randomized controlled trials to better determine optimal bathing techniques, including controlled studies on frequency, duration, and the effects of bathing and use of bath emollients are a significant gap in research in the management of AD.



Countries of recruitment: Patients will be recruited in The Netherlands.

Daily showering followed by immediate application of emollient is better for the clinical outcome of mild to moderate AD in children, when compared to once weekly showering followed by immediate application of emollient.

At the start (day 1) and the end (day 28) of the study

Each patient is assigned a randomization number according to a computer generated randomization. Randomization will be performed with a 1:1 allocation. One group will shower once daily every day according to a standard protocol for 4 weeks; the other group will shower once weekly according to a standard protocol for 4 weeks. All patients will use emollients daily and will be allowed to continue topical medication (except tar ointments) as prescribed by their dermatologist.

Patienst will be evaluated at the start and end of the study. During these visits the severity of AD will be scored, 4 questionnaires on AD symptoms and quality of life will be obtained, non-invasive skin measurements of transepidermal water loss and skin capacitance will be performed, and tape strips will be obtainen. This interventions are painless. In week 2 of the study a telephone consultation will take place to discuss possible questions etc. the patients may have.