Should providers recommend bleach baths without conclusive evidence of their benefits?
Click Here to Manage Email Alerts
According to research published in Trends in Microbiology, patients with atopic dermatitis, or AD, are commonly colonized with Staphylococcus aureus during flares. Bleach baths are one way clinicians are trying to reduce S. aureus colonization in AD patients and subsequently reduce disease severity.
A randomized controlled trial published in Pediatrics in 2009 suggested that prolonged use of bleach baths in combination with other decolonization strategies can decrease the clinical severity of AD in pediatric patients. However, a systematic review and meta-analysis published in 2017 found that bleach baths were no more effective than water baths alone.
Infectious Diseases in Children asked Anna B. Fishbein, MD, is an attending physician in allergy and immunology at the Ann & Robert Lurie Children’s Hospital of Chicago and assistant professor of pediatrics at Northwestern University’s Feinberg School of Medicine, whether clinicians should recommend bleach baths despite conflicting evidence supporting efficacy.
Bleach baths might seem like a funny treatment for AD, but since the landmark 2009 study published in Pediatrics, they are considered a mainstay of eczema care, particularly in children with moderate to severe disease. The dilute bleach may improve disease control, decrease eczema flares and decrease the itch.
Although it is not clear if it is the good bathing practices vs. the bleach itself that is effective, we routinely recommend household bleach baths (1/4 to 1/2 cup) in a full tub (40 gallons) of water two to three times per week. I used to tell families that bleach baths kill the bad bacteria and leave the good.
In AD, the “bad bacteria” is Staphylococcus aureus. However, a recently published study suggests the mechanism of these dilute bleach baths in improving eczema has little to do with actually killing bacteria. Pilot data from an ongoing clinical trial suggest the same thing. The dilute bleach is safe in the bath and on the skin, but it is not strong enough to actually kill Staph bacteria.
Although it is not clear how dilute bleach baths work, they are safe, and if they can promote good bathing practices, I’m all for it! Some people find that the bleach can sting a little, so we sometimes substitute with apple cider vinegar.
So... keep up the bleach baths for AD but don’t forget that they won’t replace good bathing practices, moisturizers, topical corticosteroids or other maintenance therapies!
- References:
- Chopra R, et al. Ann Allergy Asthma Immunol. 2017;doi:1-/1016/j.anai.2017.08.289.
- Geoghegan JA, et al. Trends Microbiol. 2018;doi:10.1016/j.tim.2017.11.008.
- Huang JT, et al. Pediatrics. 2009;doi:10.1542/peds.2008-2217.
- NIH. Clinical trials: Bleach bath treatment of adults with atopic dermatitis. https://clinicaltrials.gov/ct2/show/NCT01996150. Accessed July 23, 2019.
- Sawada Y, et al. J Allergy Clin Immunol. 2019;doi:10.1016/j.jaci.2019.01.009.
Disclosure: Fishbein reports no relevant financial disclosures.
Editor's note: To read our August cover story, click here.