Emollient Bath Additives

Emollient bath additives are oils or emulsions poured into bath water, or applied in the shower, to leave a thin oily film on the skin. Some also contain antiseptics or anti-itch ingredients, such as Colloidal Oatmeal. UK guidance describes three ways to use emollients: leave-on products, Soap Substitutes, and bath additives (Nursing in Practice; Emollient Therapy). Before 2018 bath additives were prescribed routinely for children with eczema, and they cost the NHS in England more than £23 million a year. The idea seemed reasonable but had never been tested. The AAD guideline points out that the amount of emollient a bath leaves on the skin is probably much smaller than direct application, and that no RCT had tested bath emollients added to leave-on emollient (AAD 2014).

Emollient Bath Additives [part-of] Emollient Therapy Colloidal Oatmeal [part-of] Emollient Bath Additives

The BATHE trial. The BATHE Trial (Santer et al., BMJ 2018) was a pragmatic RCT in 96 GP practices in England and Wales. It enrolled 483 children aged 1–11 with eczema, mean age 5 and mostly moderate. Children were given bath additives for 12 months or told to use none. Both groups kept their usual leave-on emollients and steroids, and all families got written advice to wash with leave-on emollient as a soap substitute. The weekly POEM score over 16 weeks was 7.5 with additives and 8.4 without. After adjustment the difference was 0.41 points, far below the 3-point minimal clinically important difference. There were also no differences in flares, eczema over one year, quality of life, cost-effectiveness or adverse effects. The authors could not rule out a small benefit in children bathing more than five times a week or in children under 5, but judged any such effect too small to be clinically useful. Their conclusion was to put effort into leave-on emollients and soap substitutes.

BATHE Trial [contradicts] Emollient Bath Additives Soap Substitutes [supports] Emollient Therapy

Policy change. In 2019 NHS England added “bath and shower preparations for dry and pruritic skin conditions” to its list of items that should not routinely be prescribed in primary care, citing BATHE. Its advice is: do not start them for new patients, deprescribe them for current patients and switch to a leave-on emollient used as a soap substitute, and tell families who still want them to buy them over the counter (NHS England via Lincolnshire PACEF). Prescribers can still use their discretion. In 2023 NICE CG57 added “do not offer emollient bath additives” for children under 12. The AAD had already said in 2014 that bath additives “cannot be recommended” because the evidence was too thin. The NHS and NES now say bath and shower oils are “rarely offered” on prescription. The NES does note that bath oils can help people with sensory issues who cannot stand the feel of leave-on emollient, which applies to some toddlers who fight being creamed.

NHS England [opposes] Emollient Bath Additives NICE CG57 [opposes] Emollient Bath Additives American Academy of Dermatology [opposes] Emollient Bath Additives

Conflict: [Santer et al., BMJ 2018] say a small benefit “cannot be excluded” in children under 5 or those bathed more than five times a week, which describes many toddlers. [NHS England 2019 / NICE CG57 2023] advise not prescribing or offering bath additives to any child, with no age carve-out. [National Eczema Society, n.d.] says bath oils can still help children who will not tolerate leave-on emollient. Unresolved — add to open_questions.

Toddler safety. The main practical hazard is slipping. Oily additives and emollient washes make the bath, shower tray and tiled floor very slippery, for the child and for the adult lifting them. The NHS advises a non-slip mat, towel or sheet on the floor and cleaning the bath afterwards with hot water and washing-up liquid. The NES suggests white vinegar or a bath cleaner, grab rails, and a baby bath support for babies under 6 months. Nursing in Practice notes that grease build-up also blocks drains and harbours skin debris. Additives that contain antiseptics, fragrance or oat can sting or sensitise broken skin (see Colloidal Oatmeal, Allergic Contact Dermatitis). BATHE found no difference in adverse events. Bath oils with high paraffin content add to residue on towels and clothes (Emollient Fire Risk). Parent-experience reports (evidence: anecdotal) were not gathered for this note this round.

Emollient Bath Additives [relates] Bathing Frequency Emollient Bath Additives [relates] Emollient Fire Risk

What parents report (evidence: anecdotal). Reports are mixed. One UK parent doubts the prescribed Oilatum-type additive “does much as he only spends 5-10 mins in the bath”. Another calls Oilatum bath oil “wonderful”. An adult who had eczema as a child says she was “allergic to Oilatum” (Mumsnet 2022, 2025). This matches the BATHE trial’s finding of no added benefit. See Parent Experiences.

Emollient Bath Additives [relates] Parent Experiences

Connections

• Emollient Therapy — no added benefit, source: BATHE (BMJ 2018)
• Bathing Frequency — additives add little; the soak plus leave-on emollient matters, source: BATHE 2018; Cardona 2020
• BATHE Trial — 483 children 1–11, POEM diff 0.41 vs MCID 3, source: Santer BMJ 2018
• NICE CG57 — “do not offer” (2023), source: NICE CG57
• NHS England — not for routine prescribing (2019); deprescribe, buy OTC, source: Lincolnshire PACEF
• American Academy of Dermatology — bath additives “cannot be recommended”, source: AAD 2014 Part 2
• Soap Substitutes — the recommended alternative for washing, source: BATHE; NHS England
• Colloidal Oatmeal — common additive ingredient, source: NES emollients factsheet
• POEM — BATHE primary outcome, source: BMJ 2018
• Parent Experiences — parent reports (anecdotal), source: round-10 forum threads