Are there any special considerations or recommendations?
The most important consideration when bathing is cleansing your skin without negatively impacting the barrier function of your skin. It is beneficial to avoid taking long showers. The use of warm water is also less drying to the skin than hot water. Washcloths and loofahs can further strip the skin of its natural moisture barrier, so soap and hands alone are best. Soap should be used locally to the armpits and groin. It is key to moisturize your skin with a cream or an ointment immediately after taking a shower or bath. Baths can also be therapeutic under the guidance of your physician, through the use of bleach, or as part of a soak and smear method. Bleach baths can help reduce bacteria on the skin as well as inflammation. Soak and smear is a technique to enhance application of moisturizers for skin hydration or topical steroids. You soak in a tub of warm water for 20 minutes and upon getting out, smear a moisturizer or topical steroid to the affected areas. This technique maximizes absorption of the respective topical agent. Ultimately, bathing can be relaxing, cleansing and therapeutic all in one.
Answer provided by:
Sara Samimi, MD
Department of Dermatology
University of Pennsylvania
Patients with mycosis fungoides are at greater risk for carrying Staphylococcus aureus on their skin. This was well-established and reported in the British Journal of Dermatology in 2008 by Madeleine Duvic et.al. The rates of staph carriage is similar to patients who suffer from atopic dermatitis/eczema.
Drawing from data for reduction of staph in patients with eczema, the addition of bleach to the bathwater and intermittent use of mupirocin to the nostrils can reduce staph colonization rates and flare ups of disease. This was well established by Paller et.al.in the journal Pediatrics in 2009.
When seeing patients with open sores or raw, itchy skin, I usually recommend the addition of a diluted bleach bath, where approximately a 1/2 cup of bleach is added to a full cup of water. The person can soak for 10 to 15 minutes, then rinse with plain water and then apply a liberal coating of bland unscented moisturizer.
If the person's skin is clear, then we recommend use of soap only in the armpits, groin, face, and behind the ears, with avoidance of over scrubbing other body sites or areas affected by cutaneous lymphoma. This helps to avoid over drying the skin, which can worsen itch and cause the area to become more inflamed.
Answer provided by:
Heather Goff, M.D., M.P.H.
Assistant Professor, Dermatology
UT Southwestern Medical Center