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Do Bleach Baths Reduce Atopic Dermatitis Severity?

Ann Allergy Asthma Immunol; 2017 Nov; Chopra, et al

Bleach baths are effective in decreasing atopic dermatitis (AD) severity; however, they do not appear to be more effective than water baths alone. This according to a systematic review and meta-analysis evaluating the efficacy of bleach baths vs water baths for AD. 5 studies were included in the review with populations ranging from 18 to 40 patients. Among the details:

  • 4 studies reported significantly decreased AD severity in patients treated with bleach on at least 1 time point.
  • However, of 4 studies comparing bleach with water baths, only 2 found significantly greater decreased in AD severity with bleach baths, 1 found greater decreases with water baths, and 1 found no significant differences.
  • In pooled analyses, there were no significant differences observed between bleach vs water baths at 4 weeks vs baseline for the Eczema Area and Severity Index or body surface area.

Citation:

Chopra R, Vakharia PP, Sacotte R, Silverberg J. Efficacy of bleach baths in reducing severity of atopic dermatitis: A systematic review and meta-analysis. Ann Allergy Asthma Immunol. 2017;119(5):435-440. doi:10.1016/j.anai.2017.08.289.

Commentary:

Atopic dermatitis (AD) is a common problem which is usually treated with topical corticosteroids. Long-term corticosteroid use can lead to skin atrophy, hypopigmentation of skin, and sometimes, skin scarring. In patients with severe AD, large areas of their body are often affected. Not well appreciated is that AD is associated with a high prevalence of epidermal Staphylococcus aureus colonization compared with controls who do not have AD (>70% vs 10-20%).1 Bleach (sodium hypochlorite, NaClO) baths have been shown to have antibacterial and anti-biofilm properties.2

An initial randomized controlled trial (RCT) of bleach baths as treatment for moderate-to-severe AD showed positive effects, and bleach baths have since become recommended as one of the treatments for AD.2 This review, showing that water baths are as effective as bleach baths, throws this intervention into question. It appears that attention to bathing, with application of emollients and/or topical corticosteroids after bathing, may be a more palatable, comfortable, safe, and effective choice compared to bleach baths. —Neil Skolnik, MD

  1. Totte JE, van der Feltz WT, Hennekam M, et al. Prevalence and odds of Staphylococcus aureus carriage in atopic dermatitis: a systematic review and meta-analysis. Br J Dermatol. 2016;175:687e695.
  2. Huang JT, Abrams M, Tlougan B, et al. Treatment of Staphylococcus aureus colonization in atopic dermatitis decreases disease severity. Pediatrics. 2009;123:e808ee814.

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