Diluted Bleach Baths can improve
Atopic Dermatitis

Diluted Bleach Baths can improve Atopic Dermatitis

Atopic dermatitis is a very common disease that mostly affects children. One of the factors contributing to the flares of this condition is Staphylococcus aureus skin infections. In fact this children’s skin is very often colonized by S. aureus. This is mainly due to a defective epidermal barrier and a reduction of endogenous antimicrobial peptides in patients with atopic dermatitis. In addition, S. aureus superantigens can induce proinflammatory cytokines that contribute to disease flares.

In a recent study published in the May 1st, issue of Pediatrics a group of researchers from the United States studied the role of diluted bleach baths versus placebo in 31 children (22 completed the study) with moderate to severe atopic dermatitis. All the children received first an oral course of cephalexin, and were instructed to use intranasal mupirocin ointment during the study. The children in the treatment arm had to soak in diluted bleach baths (half a cup of bleach in a tub) for five to 10 minutes, twice a week; while the control (placebo arm) had to do the same with plain water. The children were evaluated at 1 to 3 months for different parameters of eczema severity and S. aureus colonization. The researchers found that children treated with the diluted bleach baths had a reduction in eczema severity that was five times greater than those in the placebo group, with improvements only seen in the body (submerged in the bleach baths) but not the head and neck. The bleach baths were very well tolerated.

This study demonstrates that bleach baths can improve atopic dermatitis, possibly by suppressing the colonization of the skin by S. aureus in these patients.

Treatment of Staphylococcus aureus Colonization in Atopic Dermatitis Decreases Disease Severity

Huang JT, et al.

Pediatrics 2009;123:e808–e814

OBJECTIVES. The goals were to determine the prevalence of community-acquired methicillin-resistant Staphylococcus aureus colonization in patients with atopic dermatitis and to determine whether suppression of S aureus growth with sodium hypochlorite (bleach) baths and intranasal mupirocin treatment improves eczema severity.

METHODS A randomized, investigator-blinded, placebo-controlled study was conducted with 31 patients, 6 months to 17 years of age, with moderate to severe atopic dermatitis and clinical signs of secondary bacterial infections. All patients received orally administered cephalexin for 14 days and were assigned randomly to receive intranasal mupirocin ointment treatment and sodium hypochlorite (bleach) baths (treatment arm) or intranasal petrolatum ointment treatment and plain water baths (placebo arm) for 3 months. The primary outcome measure was the Eczema Area and Severity Index score.

RESULTS The prevalence of community-acquired methicillin-resistant S aureus in our study (7.4% of our S aureus–positive skin cultures and 4% of our S aureus–positivenasal cultures) was much lower than that in the general population with cultures at Children’s Memorial Hospital (75%–85%). Patients in the group that received both the dilute bleach baths and intranasal mupirocin treatment showed significantly greater mean reductions from baseline in Eczema Area and Severity Index scores, compared with the placebo group, at the 1-month and 3-month visits. The mean Eczema Area and Severity Index scores for the head and neck did not decrease for patients in the treatment group, whereas scores for other body sites (submerged in the dilute bleach baths) decreased at 1 and 3 months, in comparison with placebotreated patients.

CONCLUSIONS Chronic use of dilute bleach baths with intermittent intranasal application of mupirocin ointment decreased the clinical severity of atopic dermatitis in patients with clinical signs of secondary bacterial infections. Patients with atopic dermatitis do not seem to have increased susceptibility to infection or colonization with resistant strains of S aureus.

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Written by: Dr. Mascaró