To Bleach Bath or Not to Bleach Bath?

Bleach baths, or adding a very small amount of bleach to water and bathing in it, has been hypothesized to decrease the severity of atopic dermatitis (AD). Bacterial infections can easily occur when the skin barrier is broken or an individual has issues with their immune system, both of which may accompany AD. Specifically, the bacteria Staphylococcus aureus (S. aureus) can overgrow and colonize the skin, leading to increased severity of AD or an AD flare. Antibiotics can be used to help treat infections, like those caused by S. aureus, however, long-term antibiotic use can lead to antibiotic resistance and other side-effects. For this reason, other non-antibiotic treatment options, such as bleach baths, have been investigated for AD.

A look at the research

Bleach (sodium hypochlorite, NaOCl) is widely available and inexpensive. It also has antibacterial properties, while causing few adverse events when well diluted. In the past, results on the effectiveness of bleach baths in reducing the severity of AD have been conflicting, and studies have been small and sparse. Recently, a group of researchers from the Department of Dermatology at Northwestern University’s Feinberg School of Medicine have reviewed all existing studies evaluating the efficacy of bleach baths for AD. The studies included in their review came from studies in major research databases that included individuals with S. aureus infection of any age, who were treated with bleach and/or water baths, and were published before June 5, 2017.

Five studies were included in the final review, and of those, four reported that AD severity was significantly decreased for those who underwent a bleach bath at least once. Four out of the five total studies compared bleach baths to water baths. Of the comparison studies, one found no significant difference between bleach and water baths at decreasing AD severity, two found significantly greater decreases in AD severity with bleach bathing, and the remaining one found a greater decrease in severity with water baths. The contrasting results of these individual studies were then combined and analyzed using a complex analysis process, and the results were quite surprising to the researchers.

Research findings

Using measurements like the Eczema Area and Severity Index, the researchers found that overall, at the four-week mark, there was no significant difference between water baths and bleach baths at decreasing AD severity. Further, there was no difference in the density and extent of S. aureus in each group at the four-week mark as well. Although bleach baths seem to be effective in decreasing AD severity, this study suggests that they are no more effective than water baths, and it may even be the water in the bleach bath that is providing the AD relief. The researchers suggest that water may be just as effective of a disinfectant agent as the bleach as water (on its own) can wash away crust and scale.

Research limitations

The authors acknowledge that there are limitations to their review and conclusions. Some of these include using a small number of studies with a low number of participants in each, using studies with varying protocols, and a wide variation of individuals involved (such as those on medications, using topical treatments, and of wide-varying ages). The writers suggest that additional, larger studies need to be completed to affirm their results.

These results are particularly interesting because bleach has the potential to be an eye and skin irritant when handling, as well as stain clothes or give off fumes that can exacerbate respiratory conditions like asthma. The potential of eliminating the use of bleach from baths while experiencing similar results may cut down on some of the potential issues that can come along with using the chemical, and lead to safer treatment. Much more research is needed, however, these results may help lead to changes in the AD treatment landscape in the future.

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