Bleach Baths for Reducing S. Aureus in Atopy Underused

MAUI, HAWAII — Bleach baths are a greatly underused tool for reduction of Staphylococcus aureus skin colonization in patients with atopic dermatitis, pediatric dermatologists said at the annual Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation.

Dr. Ilona J. Frieden asked for a show of hands as to how many physicians in the large hall have their atopic dermatitis (AD) patients regularly take bleach baths. Perhaps one-quarter of the audience raised their hands. "I certainly do, and I find it a great way to decrease the need for systemic antibiotics," commented Dr. Frieden, director of pediatric dermatology at the University of California, San Francisco.

"Clorox may be more than just a whitener," added Dr. Sheila Fallon Friedlander of the University of California, San Diego.

She cautioned there is as yet no published definitive proof of efficacy. However, a soon-to-be-published study from Texas Children's Hospital, Houston, did find bleach baths plus regular application of mupirocin in the nares for a year by atopic dermatitis (AD) patients who were chronic carriers of S. aureus resulted in a 90% reduction in skin infections requiring antibiotic therapy, compared with the previous year. And the anecdotal experience at the pediatric dermatology centers in which bleach baths have been tried has been quite favorable.

The formula generally used is one-quarter to one-half a cup of regular Clorox bleach—the 6% sodium hypochlorite strength—or an equivalent product in a full tub of water. The concentration is similar to a chlorinated swimming pool. The exposure time is 10-15 minutes two or three times per week.

Dr. Sarah L. Chamlin of Children's Memorial Hospital, Chicago, explained that the antimicrobial effect of the dilute bleach results from hypochlorous acid molecules diffusing through the microbe cell wall and inactivating triosephosphate dehydrogenase, thereby destroying the pathogen's capacity to metabolize carbohydrates. It's the same therapeutic principle as the use of Dakin's solution, a time-honored dermatologic therapy.

Audience members observed that avoidance of excessive bathing—and consequent drying out of atopic skin—is a hallowed principle of AD management. Dr. Friedlander replied that she considers it important to apply an emollient immediately after the bleach baths.

Audience member Dr. Robert A. Moraru, a dermatologist in private practice in New York who uses bleach baths in his AD patients, shared an alternative method of combating the drying effect: Add about a cup and a half of mineral oil to the bath for moisturizing.

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The basic formula is one-quarter to one-half a cup of regular Clorox bleach to a full tub of water. DR. FRIEDEN

Written by: Bruce Jansen

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