The most important message I can give you is the following, “dilute the dilemma®”. Another expression is, “dilution is the solution”. This means when you see a rash or almost any acute skin injury you must soak it.

 

Use the following formula:

 

    1    Dissolve 1 teaspoon of baking soda in 2 cups of water

    2    Soak a washcloth in the solution

    3    Soak the affected areas for 30 minutes three times a day 

 

Baking soda compresses are especially effective in solving eyelid rashes (for example) because baking soda doesn’t irritate the eyes. 

 

For more widespread severe rashes, dissolve 2 cups of baking soda in a tub of warm water and soak as much as needed (1 hour, 2-3 times a day). Most simple eruptions will improve within 7-10 days using this simple buffering solution.

 

Never use topical antibiotics like neomycin or triple antibiotic salves because of their significant allergic properties. They have NO proven efficacy and often cause exacerbation of skin systems. In nearly 50 years of clinical practice, I have NEVER used them. Often when I am called to consult on a patient’s rash that is worsening I always ask about the use of topical antibiotics and stop them immediately.

 

Even if you use topical antibiotics on rashes and wounds and it heals, it’s not because of the antibiotic effect. 

 

Petrolatum would work just as well. Although soaking with the baking soda formula almost always works and buys time until the skin heals itself.

 

A common event I see is when a patient is hospitalized for presumed cellulitis (skin infection) especially in the lower extremities that is not responding to systemic antibiotics. Once I stop the topical antibiotics (which are usually being used) and institute soaks the skin eruption usually resolves.

 

My usual protocol with hospitalized patients who have rashes or wounds that will not heal and perplex their physicians is to start normal saline soaks (4 teaspoons of salt in 4 cups of water) using a washcloth applied to skin for one hour 3-4 times daily. The old adage that salt water heals everything seems to be true.

 

Salt and baking soda contain sodium which creates a hypertonic solution. As we all know such solutions cause osmosis of water out of cells to dilute the extracellular salts. Therefore bacteria, viruses and inflammatory cells collapse as they become dehydrated. Its simple chemistry you learn in high school. Using these concepts makes it easy for the healthcare professional and patients to deal with most skin dilemmas.

 

My favorite statement to physicians or patients is to go to the grocery store to get your baking soda or salt and not the “harmacy”.

 

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Recommended Home Approach for Oral Lesions and Mouth Irritations

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For most oral lesions or other mouth problems I encounter, my initial recommendation is a simple, safe home remedy using baking soda:

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• Dissolve one teaspoon of baking soda in a cup of water.

• Use this solution to rinse your mouth as frequently and for as long as possible throughout the day.

• Brush your teeth and tongue with the baking soda solution, then leave a small residue along the gum lines (do not rinse immediately after brushing).

• Adjust the frequency and duration based on the severity of your symptoms—more intensive use for more bothersome issues, less for milder ones.

 

Most oral lesions are more challenging to diagnose precisely than to manage symptomatically. This approach helps “dilute the dilemma” by providing gentle, soothing relief while buying time for further evaluation if needed. It is generally harmless, and many patients appreciate a straightforward home remedy that makes sense and feels proactive.

 

Consistency and diligence are key to seeing potential benefits.

 

Important note: If symptoms persist despite this regimen, additional evaluation—including specific treatments and likely a biopsy—may be necessary. Always continue your diagnostic workup as appropriate and consult your healthcare provider for personalized advice.

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Advice for Children’s Rashes

 

This advice is important, especially for children and infants presenting with troublesome (enigmatic) skin eruptions, especially diaper rashes. Disposable (plastic) diapers are the main culprit. 

 

Soak the child often in warm water with baking soda. Use ½ cup of baking soda in a small tub or basin. This allows the baby to play while being treated. Topical prescriptions may not be needed. 

 

This simple step gives anxious parents something practical to do while a proper diagnosis is being made—it helps “dilute the dilemma.” Baking soda is a safe, simple, and effective buffering compound and will not irritate the eyes. Parents love straightforward solutions like this. While it may not cure every condition, I see no contraindications for its use.

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Most rashes respond within 7-10 days, if not sooner.

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I firmly believe that routine bathing with any soap in infants can damage their developing acid skin barrier and prevent the normal skin microbiome from establishing properly. This disruption invariably contributes to eczema.

 

The science supporting this view is growing and being published regularly. See next article.​​

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Cetaphil® Regimen in Atopic Dermatitis Patient Instructions

 

The following is a handout I often give to my patients: 

 

AVOID EXCESSIVE SWEATING. Itching is increased by excessive sweating, especially when the skin is inflamed. So dress lightly, preferably in cotton clothing and avoid vigorous exercise in hot weather.

 

AVOID CONTACT WITH WOOLEN MATERIALS. The prickly wool fibre in contact with your skin may trigger itching (and scratching). Do not wear woolen clothing next to your skin, play on woolen rugs or sit on wool covered chairs.

 

AVOID THE USE OF SOAP. Soap is irritating to atopic skin so do not bathe in soap and water. This means

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NO BATH until the eczema has cleared. Instead, cleanse and lubricate the skin with Cetaphil Lotion.

 

THE CETAPHIL ROUTINE. Apply Cetaphil Lotion to the entire body, pouring a liberal amount in your hand and rubbing it vigorously onto the skin until a lather is formed. Wipe off the lather gently with a soft cloth (such as a diaper). Only if the skin is very dirty is it necessary to wipe vigorously, in which case apply more Cetaphil Lotion. The purpose is not only to cleanse, but also to leave a thin film of Cetaphil on the skin. This cleansing-lubricating routine should be done at least twice daily.

 

SHAMPOOING THE SCALP. During the period of soap and water avoidance, shampooing the scalp may be a problem. If there is no eczema of the face a soap and water shampoo is permissible, providing the neck and body are protected by adequate draping with towels. If there is eczema of the face and neck you can cleanse the hair by soaking it with Cetaphil Lotion, working up a lather and then drying with a soft towel.

 

WHEN YOUR ECZEMA IMPROVES. Once the eczema is under control, you may tentatively try one water bath a week. This should be brief, in lukewarm water and followed by the application of Cetaphil Lotion. You will continue the once weekly bathing and twice daily use of Cetaphil Lotion application for many months.

 

USE OF A CORTICOSTEROID CREAM OR LOTION. This is prescribed along with the Cetaphil routine to help control the inflammation and itching of eczema. Use the cream or lotion sparingly two or three times daily, and whenever there is itching apply a little more cream or lotion to the itching area so that the desire to scratch is relieved.

 

ORAL MEDICATIONS. (A) Sometimes it is necessary to use an anti-histamine medicine at bedtime: This will be prescribed only if indicated to reduce itching and promote restful sleep. (B) In the presence of secondary skin infection an oral antibiotic may be prescribed. This will be continued for at least ten days and you should take the full course even though you may feel the infection has gone.

 

QUESTIONS. If you have a question or don't understand any part of this routine make a point of asking me about it.

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PRINTABLE HANDOUTS FOR YOUR PATIENTS

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Dilute The Dilemma Handout​

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Cetaphil Protocol Handout

 

(this can be handed out to patients with atopic eczema or adults with eczema)​

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The following are two recent articles in JAAD confirming what I’ve known for years - that salt water cures most everything, not just warts.

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Seeking a treatment for recalcitrant plantar warts worth its weight in salt

Warren R. Heymann, MD wrheymann@gmail.com

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Every dermatologist sees patients frustrated by their recalcitrant plantar warts (PWs). Pesky verrucae can hurt and make life miserable. When standard approaches are unsuccessful, an inordinate array of therapeutic options is available—with a list this long, it is safe to assume that none are overwhelmingly effective. These include “diverse treatments” including hypnosis, garlic extracts, duct tape, destructive therapies (including surgery, curettage often with cautery, chemical cautery, salicylic acid, cantharidin, cryosurgery, hot water, exothermic patches, ultrasound hyperthermia, radiofrequency ablation, microwave energy, infrared coagulation, laser ablation, and photodynamic therapy), antimitotic therapies (including bleomycin, podophyllin, podophyllotoxin, and retinoids), antivirals (including topical glutaraldehyde, formaldehyde, and formic acid), immunotherapy (including oral zinc, allergic contact sensitizers, intralesional mumps or candida antigen, intralesional interferon, 5-fluoroucil, cimetidine, levamisole, 5% imiquimod cream, and topical Bacillus Calmette-Guérin), vaccines (most new strain-specific human papilloma virus vaccines), and any combination of the above.1

 

Salt has been used therapeutically for dermatologic disorders since antiquity; Manoharan and Kaliaperumal 2 thoroughly review its diverse uses in traditional and modern medicine. Based on the previously reported use of salt for treating umbilical granulomas, and the presumption that the hyperosmolar milieu from salt causes desiccation and shrinkage of tissue, Daruwalla and Dhurat 3 reported the successful use of common table salt in 5 patients with a pyogenic granuloma. Complete resolution of the lesions occurred within 7 to 14 days, depending on the lesion size. 3 (I would not recommend using this therapy unless you are 100% convinced the lesion is a pyogenic granuloma, not an amelanotic melanoma or squamous cell carcinoma.)

 

In this issue of the Journal of the American Academy of Dermatology, Xu et al 4 performed a single-arm clinical trial on 17 participants with PWs recalcitrant to standard treatments, who underwent daily 30-minute saturated saline immersion for 8 weeks. The saturated saline solution was prepared in a foot-sized basin containing 2 cm of tap water, gradually adding edible standard refined while stirring until achieving visual saturation (ie, undissolved salt crystals persist after 5 minutes of agitation). After saturated saline immersion treatment, 98.3% of lesions (232/236) cleared, and 88.2% of participants (15/17) achieved complete remission (95% confidence interval: 63.3%-97.4%) at week 8 compared with baseline. No recurrences occurred during the 6-month follow-up. The authors hypothesize that “hypertonic sodium chloride solution therapy for PWs acts through synergistic pathways centered on restoring endogenous antimicrobial peptide activity and enhancing immunity.” The conclusion was that daily saturated-salt-water immersion achieved high PW clearance with no short-term recurrence. Randomized controlled trials are warranted to confirm these findings. 4

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Saturated hypertonic saline solution was effective within 4 weeks in treating recalcitrant facial flat warts in 3 children (aged 9-15 years) who were initially unresponsive to retinoic acid alone, combined with retinoic acid 0.05%. 5

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Until randomized, controlled trials are conducted, we should approach these studies with a grain of salt. Regardless, given my therapeutic ineptitude with treating PWs, I look forward to prescribing saline soaks. How ironic it would be if the treatment for PWs worth its weight in salt, were salt itself.

 

Conflicts of interest

None disclosed.

 

References

1. Hekmatjah, J. ∙ Farshchian, M. ∙ Grant-Kels, J.M. ...

The status of treatment for plantar warts in 2021: no definitive advancements in decades for a common dermatology disease

Clin Dermatol. 2021; 39:688-694

Google Scholar

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2. Manoharan, P. ∙ Kaliaperumal, K.

Salt and skin

Int J Dermatol. 2022; 61:291-298

Google Scholar

 

3. Daruwalla, S.B. ∙ Dhurat, R.S.

A pinch of salt is all it takes! The novel use of table salt for the effective treatment of pyogenic granuloma

J Am Acad Dermatol. 2020; 83:e107-e108

Google Scholar

 

4. Xu, Y. ∙ Li, T. ∙ Liang, X. ...Saturated saline immersion for the treatment of refractory plantar warts: an open-label, one-arm, single-center trial

J Am Acad Dermatol. Published online October 8, 2025;

Google Scholar

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5. Mukhtar, M. ∙ Mukhtar, N.

Wet table salt and its saturated hypertonic solution for treating retinoic acid resistant plane viral warts on face

J Cutan Aesthet Surg. 2024; 17:160-161

Google Scholar

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See also:

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Saturated saline immersion for the treatment of refractory plantar warts: An open-label, one-arm, single-center trial

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