There have been numerous reports of the possible benefit of water softeners to childhood eczema, and research continues around the country among adults and children. Here, Tony Frost — an independent consultant with over 35 years’ experience in water treatment design, supplies and services — reviews the historical evidence and benefits.
Atopic eczema is a common, chronic and often debilitating skin condition which results in dry skin, itchiness, inflammation, and weeping.
“It affects 20% of children aged up to 11 years old and 8% of teenagers and adults,” says Julie Van Onselen, an independent dermatology nurse. “Damage by scratching often leads to open sores which bleed and skin infections. It can be very distressing to the child, teenager, and adult with eczema and for their families. Eczema can affect people’s quality of life due to many factors including sleep loss, poor concentration and psychological distress.”
Atopic eczema is a genetic condition, which can be triggered by environmental factors, which are other common irritants (for example soaps, detergents and heat). Sometimes, eczema may also be triggered by stress and some allergens, including food allergy (which can affect a small number of children, generally under 2 years).
Eczema is a long term condition with no cure, however many children often get better as they get older. Atopic eczema for the majority is managed by use of emollients and topical treatments (topical steroids and topical calcineurin inhibitors) to ease the symptoms and control flare-ups. Some people with eczema may require antibiotics to treat infection. People with severe eczema are usually referred to hospital for phototherapy or systemic drugs, which need careful monitoring and specialist care.
It has been suggested that hard water can exacerbate eczema due to use of excessive amounts of soap for washing, or due to skin contact with the soap scum, which results from a reaction of the soap with the hardness minerals. Also, reactions could occur due to scum particles on the surface of laundry (clothes and bedding) causing irritation when it comes into contact with the skin.
In an eczema study published in the Journal of Allergy and Clinical Immunology 33% of eczema sufferers said their work/school/home life is affected by being ashamed, embarrassed and scratching. Studies have indicated that the incidence of eczema can be related to water hardness, with one study in Nottingham indicating that primary school children living in hard water areas are almost 50% more likely to have eczema than those living in a softer water area.
Similar mapping studies carried out in Spain and in Japan have found higher incidence of eczema in areas of the country which are supplied with hard water than in naturally soft water areas.
Hard water is identified as an environmental trigger in the NICE (2007) Guidelines on Atopic Eczema in children 12 years and under. Hard water areas are common with more than 60% of households in England and Wales affected. There are also many anecdotal records by doctors and eczema sufferers, of eczema conditions improving, or completely disappearing, when the patient moves into a soft water area or when water softeners are fitted to homes in hard water areas.
This prompted a government funded clinical trial — the SWET Trial — organised by the University of Nottingham Centre of Evidence based Dermatology, to compare the possible improvement in eczema in children when a water softener was fitted into their home for a 12-week period. It was a very comprehensive trial involving 336 children but it failed to show any primary benefit, based on the nurse’s formal, routine monitoring of the eczema condition. It did however, show a small benefit based on the opinion of the patient and the patient’s family.
While this trial did not provide the supporting evidence expected, 66% of home owner participants opted to purchase the water softener after the trial. In addition, water softener suppliers continue to receive customer reports of improvement in eczema conditions after a water softener has been installed.
The Talkhealth Kinetico Product Trial
Water treatment system company Kinetico commissioned Talkhealth to conduct an independent product trial and survey. The survey was carried out between August and December 2011 and was promoted to talkhealth members. 339 people completed the prequalification questionnaire and 23 participants were selected to have Kinetico water softeners installed in their homes for a three month period. The participants then completed a questionnaire at the end of each month, over a three month period. The quantitative and qualitative results were analysed and published in a report.
Participants who had a Kinetico water softener fitted found that:
* 91% recorded less itchiness;
* 83% maintained that the water softener reduced the severity of their eczema;
* of the 78% regularly applying emollients or steroid cream, 67% were using less;
* 96% noticed smoother skin and softer hair;
* 91% are using less soap and shampoo;
* 83% used less washing powder and detergent;
* 83% noticed softer feeling towels and clothes;
* 87% saw less scale on taps, showers and tiles.
“In our experience, eczema is often managed with a combination of approaches, individual responses to treatment vary enormously, what works for one person may not necessarily work for another,” says Deborah Mason, Director of talkhealth.
“The use of water softeners is often cited as helping to relieve the symptoms of eczema and other dry skin conditions, and we were interested to see that those who took part in the product trial experienced some improvement.”
“The most positive result is that people with eczema felt their skin was smoother and less itchy,” adds Julie van Onselen. “The vicious scratch-itch cycle is often the hardest symptom to deal with. Dry skin is itchy skin and itchy skin is scratched, which leads to damage and often a “flare-up’ of eczema. Therefore, if skin is less itchy, scratching and skin damage will reduce and eczema ‘flares’ will reduce.
“People with eczema should use emollients for washing and moisturising on an on-going daily basis to constantly repair their skin barrier (which is compromised in atopic eczema), soap should be avoided, as it is an irritant to eczematous skin.
“Those respondents who regularly applied emollients or steroid creams reported that they were using less of these products as a result of the trial. This indicates that a reduction in eczema treatment is possible. Soft water is certainly very helpful to reduce the amount of washing detergents needed and softer towels and clothes will be more comforting for people with eczema. We do know that people with eczema experience the need for extra laundry, bathing and clothes, which add to the cost of atopic eczema.”
Hard water and its effects
Hard water is caused by limestone dissolving into the natural “raw” water (e.g. rain water or water from lakes and rivers) as it passes through the ground and accumulates in aquifers (underground water) and reservoirs. Limestone is mainly calcium carbonate — magnesium is also prevalent in some areas — and it is this hard, white deposit which forms in boilers and kettles when the water is heated. It also reacts with soap and detergent causing scum which deposits on the skin, bath, shower, sinks and in the laundry. In the UK there are over 13 million homes situated in a hard water area.
The limescale deposits in boilers reduces their energy efficiency and therefore increases fuel usage and fuel cost — and increasing carbon dioxide emissions. It uses more soap and detergent by up to 70% — also with consequent cost. Scum around the bath, shower and sink is difficult to clean, and the water feels hard — hence its name.
How it works
The water softener contains tiny beads of “ion exchange resin” which are preloaded with sodium and, as the water passes through the resin, the calcium (and magnesium) swaps places with the sodium, therefore the calcium is retained on the resin and sodium goes into the softened water. The resin eventually becomes saturated with calcium and needs to be regenerated — usually every few days. The water softener does this automatically by measuring the amount of water that has been softened and starting this process after a pre-set quantity of water has been softened. The regeneration process uses salt (sodium chloride) and the sodium pushes the calcium off the resin and goes to drain. The sodium is retained on the resin ready to be put back into service. The only attention needed is to regularly check and replenish the salt.
The possible benefit to eczema sufferers is frequently reported by water softener users. Some, but not all, studies have indicated a benefit and greater understanding will be gained by the additional research and clinical work already under way. The Kinetico survey clearly showed majority customer opinion that the water softener improved their eczema condition. The benefits and cost savings of softened water are well established in terms of scale reduction, boiler efficiency, soap and detergent savings, etc. and the Kinetico talkhealth survey demonstrates customer satisfaction in that respect.
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Published February 2017.