Eczema or atopic dermatitis is a chronic, relapsing inflammatory skin disorder affecting 15%-20% of children and 1%-10% of adults in the U.S. and worldwide. Deficiencies in the skin barrier and immune system dysfunction contribute to eczema, resulting in dryness and itching. Eczema patients are predisposed to to skin infections and patients have a high concentration of Staphylococcus aureus (a bacteria commonly found on the skin) colonization compared to non-eczema patients (70% vs. 10-20%). Eczema flares can be correlated to increased S. Aureus overgrowth in the skin. Antibacterial treatments have been considered for managing eczema. However prolonged use of oral or topical antibiotics may be impractical because of potential concerns of increased antibiotic resistance. Bleach baths (sodium hypochlorite, NAOCl) are inexpensive, easily accessible, alternative antibiotic treatment. Bleach bath demonstrate antibacterial properties, are associated with very few side effects and do not cause antibiotic resistance. Dilute bleach baths have been proposed to suppress epidermal bacterial skin colonization and ultimately decrease eczema severity. Past studies have shown promising results for moderate to severe eczema. However follow up studies have shown conflicting results. Nevertheless, bleach baths have been recommended in clinical practical guidelines.
In in article published in the November 2017 issue of Annals of Allergy, Asthma and Immunology, a review of whether bleach baths are effective in decreasing atopic dermatitis severity was studied.
The review found that bleach baths and water baths both significantly decreased atopic dermatitis severity. Water baths were as effective as bleach baths at the 4 week mark. There was no difference in S Aureus density in patients treated with bleach vs. water baths. The results suggest that much of the efficacy of bleach baths at decreasing eczema severity is attributable to water baths and less to bleach. Application of emollients and/or topical anti-inflammatories after the bath can improve the skin as well.
Current primary care provider recommendations advocate for infrequent bathing in atopic dermatitis. However this study indicates that regular bathing and emollient use is an effective treatment for eczema and better than infrequent bathing. In conclusion, although bleach baths are effective in decreasing atopic dermatitis severity, they do not appear to be more effective than water baths alone. As always speak to your eczema doctor what would be the best treatment for you or your child. Every person is different and certain treatments may be right for someone but not for others.
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