History

History of Bleach Baths

Prior to the era of antibiotics, wound infections, especially those acquired during wars which were contaminated and complicated by necrotic devitalized tissue, were often fatal.  Most of these infections were caused by Clostridia and were manifest as tetanus and gas gangrene.  Joseph Lister was a pioneer in the use of antiseptic solutions to clean surgical instruments and irrigate wounds using primarily phenol.  One disadvantage of phenol is that it loses its potency in the presence of blood and serum.  In efforts to improve efficacy, the British chemist Henry Dakin in collaboration with French surgeon Alexis Carrel developed the Carrel-Dakin method of wound treatments which consisted of intermittently irrigating the wound with Dakin's solution, a highly diluted antiseptic consisting of 0.4% to 0.5% sodium hypochlorite and 4% boric acid.  This had the advantage of not being inactivated by body tissues and fluid although it was unstable and had to be made prior to administration.  Dakin’s solution has been used to sterilize and cleanse chronic wounds and ulcers such as those induced by chronic stasis for many years since its first use in World War I.  Higher concentrations of bleach solutions have also been used for decades in endodontics to sterilize the pulp of teeth during root canal procedures.

It is unclear who should be first credited with using bleach to treat atopic dermatitis (AD) or cutaneous infections although several pediatric dermatologists began mentioning anecdotal reports of patients with atopic dermatitis improving during the summer months after swimming in chlorinated pools.  As a consequence, a number began recommending the use of dilute bleach baths for their atopic patients.  Amy Paller and others have been strong advocates of the use of bleach baths and have published papers demonstrating their efficacy in improving atopic dermatitis.  Patients with AD develop bacterial infections that worsen the condition, especially Staphylococcus aureus, and as bleach is very effective at killing bacteria, its efficacy is almost certainly due to its antibacterial qualities.  While AD is the disorder that has been shown to improve with bleach bathing, there have been other studies that demonstrate it is effective in diminishing carriage of S. aureus and in treating bacterial induced furunculosis and folliculitis.

“Eczema”

Eczema is a general term that refers to a skin condition characterized by itching, scaling, oozing, redness and crusting.  It is often used synonymously with a condition known as atopic dermatitis although others apply it to other inflammatory skin conditions such as seborrheic dermaitis, allergic contact dermatitis and nummular dermatitis.  The term “atopic” refers to a tendency for a person to be hypersensitive to certain stimuli such as exposure to allergens and irritants.  Atopic individuals not only develop atopic dermatitis but also often have asthma and hay fever.

Atopic dermatitis is quite common and affects between 10-30% of the U.S. population. It is most common in young children and infants. Many affected infants outgrow it by their second birthday although some individuals have the condition for life.  It is virtually always itchy and in many cases, itching develops before the dermatitis which has resulted in the condition being known as the “itch that rashes.”  The most common sites of involvement include face, especially around the eyes, the folds of skin in front of the elbows (antecubital fossa), the folds of skin behind the knees (popliteal fossa), the hands and feet, although any body site may be involved.  Affected areas usually appear dry, thickened or scaly and usually initially appear pink or red and eventually dark brown and leathery.  There is often oozing and crusting and there may be secondary bacterial infections most commonly with Staphylococcus aureus which worsens the condition, making it harder to treat.  In darker-skinned patients, pigmentation is often altered resulting in the skin appearing lighter or darker.

A number of factors may cause the eruption to flare including contact with rough, coarse materials such as wool, exposure to hot or cold, very low humidity environments, exposure to soap or detergent or coming into contact with animal dander.  Occasionally stress and some foods may cause the condition to worsen.  Although there is no cure, most people can manage the disorder with medical treatment and by avoiding irritants.  The condition is not contagious and cannot be spread from person to person although secondary bacterial infection may be.  Bleach baths have been shown to be effective at improving atopic dermatitis and they are thought to cause improvement by treating the secondary bacterial infection.  It is possible that they may work in other ways, as well, such as altering the hyperactive local immune response.