23 responses to “"Bleach baths" and atopic dermatitis – help from under the kitchen sink”

  1. Was using this in practice at 1/4 cup per tub. Hard to say what a full tub is and with a small child the tendency would be to use less water in the tub.

  2. very informative

  3. I look after a population that is heavily colonized with MRSA.
    No access to bathtubs and water is rationed.

  4. Would like to see results on affected head and neck from washing that area at the same time as bathing the rest of the body. Closure of the eyes should be sufficient for protection from irritation.

  5. Interesting approach. Will give it a try with next patient

  6. will try on my resistant atopic dermatitis patients and will inform after use.

  7. A larger sample size with perhaps a cross-over approach would be important to add strength to this small study and make more general recommendations. Double-blind would be difficult.

  8. Is this study so strongly positive that a larger one is not needed?

  9. I have a number of treatment resistent patients with AD. There are multiple factors but I do like this very basic approach – certainly as an adjunct to usual tx.

  10. Its intresting.will start doing this approach.

  11. this is a simple adjunct for those difficult cases-good to see the research (and experience)supports use of bleach.

  12. This is an old practice that has come around again. Years ago Dettol was used in the same way and with the same efficacy.

  13. Good information to try on at risk population especially if there is minimal side effects.

  14. What about nasal mupirocin administration (dose, frequency, duration), effect on AD and effect on bacterial resistance?

  15. Sounds so simple but is there no danger from splashes into the eyes by accident?

  16. Great suggestion-as significant AD is distressing to families.

  17. This info is too “loose”. What does a full bathtub mean?. The fact that participants were also given another treatment, i.e. intanasal bactroban, totally confounds the study. Moreover, I thought there recently was an advisory not to use bactroban intranasally.
    Nevertheless, it is interesting information and I may wnat to try using bleach.

  18. Replies by Dr. Joseph Lam:
    In practice, I add 1/4 to 1/2 cup to an adult tub that is anywhere from 1/3 to 1/2 full. In fact, earlier studies looking at the concentration needed to kill methicillin-resistant Staph aureus (MRSA) used higher concentrations (1/2 cup in 1/4 adult tub of water) (see Fisher et al below). For facial eczema, I advise patients to soak a washcloth in the bathwater to apply to the face (and ensure they rinse). However, this is not addressed by the study.

    Fisher RG, Chain RL, Hair PS, Cunnion KM.Hypochlorite killing of community-associated methicillin-resistant Staphylococcus aureus. Pediatr Infect Dis J. 2008 Oct;27(10):934-5. (http://www.ncbi.nlm.nih.gov/pubmed/18756186)

    This is not a new practice, and has been done by many practitioners, most often pediatric dermatologists and dermatologists. However, the study adds some support (and renewed interest) in bleach (a cheap and effective adjunct to treatment).

    The study itself, however, isn’t perfect. The intervention group used both nasal mupirocin and bleach baths. There was no bleach bath arm alone. As well, although the study arms were blinded in theory, in reality, the smell of bleach will give away which group the patients were randomized to.

    With regards to the nasal mupirocin, this was applied intranasally twice daily for 5 consecutive days of each month. However, the role of the nasal mupirocin is unclear (as suggested by the differential improvement in only the submerged areas).

  19. I think that this is worth trying out in my patients with AD. I would appreciate more specifics re exact amount of household bleach to what size tub, and how long to soak. I would think the facecloth soaked in the bath water applied to the face neck or scalp would be a helpful tip.

  20. What role does treating for two weeks with Cephalexin prior to the baths play?

  21. very interesting, worth a try especially on these really severe cases of AD

  22. I hope that more studies with a larger sample size and cross-over design would be done to confirm this interesting treatment approach. If truly effective, it would be a very helpful adjunct for treatment-resistant AD due to its inexpensive ingredients.
    I have doubts about the intranasal mupiricin being contributory.
    I would certainly try it on some of my patients.

  23. Might also help in severe cases where parental anxiety & avoidance of “high dose” topical corticosteroids may be contributing/exacerbating the problem.

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