Comparison of bleach, acetic acid, and other topical anti‐infective treatments in pediatric atopic dermatitis: A retrospective cohort study on antibiotic exposure

Abstract

Background/Objectives Skin infection is common in atopic dermatitis (AD), often necessitating treatment with systemic antibiotics. Topical adjunctive therapies such as dilute bleach baths are increasingly recommended, and topical dilute acetic acid (AA) has not been widely studied. The objective of this study was to evaluate whether various topical anti‐infective bathing recommendations were associated with decreased systemic antibiotic exposure in pediatric AD, as well as evaluate topical anti‐infective recommendations over time within our institution. Methods Clinical data were extracted from charts of pediatric patients from 1/1/2000 to 12/31/2005 and 1/1/2009 to 12/31/2014 who visited outpatient dermatology clinics at Mayo Clinic, Rochester, a tertiary referral center. Recommendations for topical anti‐infectives (dilute AA, dilute bleach, other, or none) at any time after patient had clinically proven or suspected AD superinfection were recorded as exposures to topical anti‐infective. Primary outcome was the number of systemic antibiotic courses in a 1‐year period. Results Of 1111 patients with AD, 753 met inclusion criteria (303 in 2000‐2005; 450 in 2009‐2014). Of these, 351 (46.6%) had culture‐proven or clinically suspected superinfection. Topical anti‐infective recommendations increased between the time periods (23.3% to 79.2%; P < 0.001) and number of courses of systemic antibiotics decreased (1.9 per year vs 1.5 per year, P = 0.010). Number of systemic antibiotic courses did not differ between those who received bathing recommendations and those who did not, nor between different anti‐infective groups (P = 0.398). Conclusions Practice behaviors have changed, and topical anti‐infectives are now commonly recommended. Neither dilute AA nor bleach baths were associated with fewer subsequent exposures to systemic antibiotics in the treatment of pediatric AD.

The infectious complications of atopic dermatitis

“… 27 Dilute bleach at 0.005% was not suppressive of S aureus growth or toxin production. 51 Acetic acid (apple cider vinegar) has been used as an antimicrobial bathing additive for AD, 52 , although its efficacy in S aureus clearance in AD has not been established. Another study reported that 0.5% acetic acid daily bath for 14 days did not improve skin barrier function or acidity in patients with AD, as compared with plain water baths.…”

Systematic review about 10 interventions in dermatitis. A document from the Latin American Society of Allergy, Asthma, and Immunology

“…Using hypochlorite during bath could reduce colonization of some bacteria. 79,80,81 Using comfortable, loose and preferably cotton-made clothing seems to prevent skin exacerbation.…”

Topical and Oral Therapies for Childhood Atopic Dermatitis and Plaque Psoriasis

“…Some studies have suggested that the effects of bleach baths reduce severity and decrease staphylococcal colonization, thereby reducing total use of topical steroids and exposure to systemic antibiotics [12,13]. A recent meta-analysis concluded that bleach baths were no more efficacious than water alone [14], while another study demonstrated no decrease in use of systemic antibiotics [15].…”