The role of antiseptic agents in atopic dermatitis

Abstract

The skin of individuals with atopic dermatitis has a susceptibility to be colonized with Staphylococcus aureus. This has been associated with increased frequency and severity of exacerbations of atopic dermatitis. Therefore, there is a growing interest in the use of antiseptic agents to target primary bacterial colonization and infection. Antiseptic agents have been found to be better tolerated and less likely to induce bacterial resistance as compared to antibiotics. There is also a wide variety of antiseptic agents available. The efficacy of antiseptic agents has yet to be established as the studies reviewed previously have been small and of suboptimal quality. This review discusses the rationale behind targeting S. aureus with antiseptic agents and presents findings from a review of studies assessing the efficacy of antiseptics in atopic dermatitis in the last five years. Four studies were found, including a bleach bath study which has already been reviewed elsewhere. The remaining 3 studies assessed the efficacy of sodium hypochlorite containing cleansing body wash, sodium hypochlorite baths and 1% triclosan in leave on emollient. These studies suggested some benefit for the inclusion of antiseptic use with the mainstay management of atopic dermatitis, including a potential steroid sparring effect. However, there are many limitations to these studies which therefore warrant further investigation on the impact of antiseptic use in atopic dermatitis.

Atopic dermatitis in adults: An Australian management consensus

“…While available studies suggest some benefit to the use of such agents in AD management, good‐quality clinical data supporting their use are limited, particularly with regard to long‐term outcomes. Available data support the daily use of emollients and topical corticosteroids as a strategy to reduce colonisation . Regulatory authorities in Europe and the United States have removed triclosan from personal care soap products.…”

“…20 Topical anti-staphylococcal agents are increasingly used as ancillary therapy for the management of AD, either clinically to manage existing infection or prophylactically in individuals who are at risk of colonisation or infection. 21 While available studies suggest some benefit to the use of such agents in AD management, good-quality clinical data supporting their use are limited, particularly with regard to long-term outcomes. Available data support the daily use of emollients and topical corticosteroids as a strategy to reduce colonisation.…”

“…Available data support the daily use of emollients and topical corticosteroids as a strategy to reduce colonisation. 21 Regulatory authorities in Europe and the United States have removed triclosan from personal care soap products. Given the ongoing regulatory debate, consensus on the use of antimicrobial agents as ancillary therapy in the management of AD was not formally collected.…”

The efficacy of very low-density sodium hypochloride washes in preventing healthcare-associated infections in pediatric intensive care units

“…We gave weekly 0.005% NAOCl washes. Several studies have reported that 0.005% NaOCl showers were effective and safe in reducing S. aureus (including MRSA) infections and colonization in patients with atopic diseases (AD) [6][7][8][9][10]. NaOCl has been safely used in environmental cleaning and disinfection.…”

“…At concentrations of 0.025-0.5%, NaOCl is used for treatment of wounds, burns, and decubitus ulcers [6]. Several studies have shown that NaOCl is safe at the concentration of 0.005% [6][7][8][9][10].…”