Efficacy and safety of sodium hypochlorite (bleach) baths in patients with moderate to severe atopic dermatitis in Malaysia

Abstract

Staphylococcus aureus is frequently found in patients with atopic dermatitis (AD) and contributes to disease exacerbation. The objective of this study was to evaluate the efficacy and safety of bleach baths as an adjunctive treatment in AD patients. Patients between 2 and 30 years old with moderate to severe AD were enrolled in a prospective, randomized, placebo-controlled study. Patients soaked in diluted bleach or distilled water baths for 10 min, twice a week for 2 months. Efficacy assessments included the Eczema Area and Severity Index (EASI) scores and S. aureus density was determined using quantitative bacterial cultures. Patients in the treatment group showed significant reductions in EASI scores. A 41.9% reduction in S. aureus density from baseline was seen at 1 month further reducing to 53.3% at 2 months. Equal numbers of patients in both groups experienced mild side-effects. This study demonstrates that diluted bleach baths clinically improved AD in as little as 1 month. No patient withdrew from the treatment arm because of intolerance to the baths.

The Role of the Skin Microbiome in Atopic Dermatitis

“…In 2013, a study in Malaysia revealed that dilute bleach baths performed twice a week for 2 months decreased both AD severity and S. aureus colonization [92]. Although bleach baths have potential to successfully treat AD through clearance of S. aureus, more studies need to be conducted to confirm the current results with or without antibiotic activity.…”

The role of antiseptic agents in atopic dermatitis

“…Wong et al [67] performed a 2-month prospective randomized, double-blinded, placebo-controlled study assessing the efficacy of 0.005% sodium hypochlorite baths in 36 patients aged between 2 and 30 years old with uninfected moderate to severe AD. Patients were given either 100mL of 5% sodium hypochlorite (bleach treatment arm) or distilled water (placebo arm) and instructed to add this into 100 L of water.…”

“…Aqueous cream as soap was provided to standardize their bathing regimen. Follow-up was performed at baseline, week 2, week 4, and week 8 (end) of treatment [67]. Response to treatment was assessed using the EASI score, a validated composite score of BSA from four regions (head and neck, upper limbs, trunk and lower limbs) and a physician's assessment of erythema, edema/induration/papulation, excoriation and lichenification on a 4-point scale.…”

“…Patients' assessment of overall response and intensity of itch was assessed using visual analog scale and bacteriological assessment was performed by calculating SA density from a swab of the worst affected sites. Safety based on clinical adverse events reported by patients or observed by the physician was also assessed [67]. Overall, the study reported that the use of diluted bleach baths resulted in clinically improved AD from 1 month and was tolerated by patients.…”

“…The improvement in EASI scores in the treatment group also corresponded to a significant reduction in percentage BSA affected at 2 months ( p = 0.002). These improvements appeared to be evident across all age groups [67]. The use of bleach baths was also associated with a reduction in density of SA over time, although this was not statistically significant.…”