Do Bleach Baths Make Eczema Better?

Bleach baths may be part of a regular regimen for eczema

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The skin has a normal protective layer. This layer keeps our skin hydrated by locking in moisture and preventing water from evaporating. It also prevents allergic chemicals and infectious organisms from entering. In eczema this protective layer does not work well and the skin becomes “leaky." This is why the skin in eczema is often dry and more prone to infection. Additionally, people with eczema have a weakened ability to fight off skin infections.[1] In other words, people with eczema face a double-disadvantage: they are more likely to get skin infections and have a harder time fighting infections.

Staphylococcus aureus (S. aureus) is a bacteria that commonly lives on the skin of people with eczema and has been shown to cause eczema flares.[2,3] In fact, up to 90% of adults with eczema are colonized with large numbers of S. aureus on their skin, whereas only 5% of the normal population carry S. aureus.[2,3] Traditionally, bacteria are controlled with topical and oral antibiotics. However, one of the risks of antibiotic overuse is the development of antibiotic-resistant bacteria, such as methicillin-resistant S. aureus (MRSA).[4,5]

An alternative to the use of antibiotics is bleach. Bleach can be used as an antibacterial. It contains chlorine, or sodium hypochlorite (NaOCl) and has been used as a disinfectant and antiseptic for wounds, burns, and ulcers since the 18th century.[6] It is an economic and convenient way to decolonize the skin without increasing bacterial antibiotic-resistance, and it has been shown to be effective in preventing eczema flares and controlling eczema-related skin infections. One study showed that regular use of bleach baths can help improve eczema.[7] In this study, people with eczema were asked to take bleach baths for 5-10 minutes twice a week. They also applied mupirocin (antibiotic) ointment in both nostrils twice daily for 5 consecutive days of each month. The researchers found that this method can decrease eczema severity and bacterial infection. Furthermore, there was no increase in the infection or colonization of antibiotic-resistant strains of S. aureus.

 

How Do I Make a Dilute Bleach Bath?

Mix ¼ cup of household bleach (typically contains 3-6% chlorine at the time of manufacture) into a full adult bathtub of water (40 gallons). Bleach baths should last approximately 10 minutes and should be done two to three times weekly. The skin should be thoroughly rinsed with plain water at the end of the soak. After gently patting the skin dry, apply a moisturizer within 2-3 minutes to retain moisture in the skin.

 

What Should I Watch Out for When Buying Bleach from the Store?

Pay attention to the concentration of chlorine in the active ingredients section on the containers. Some U.S. manufacturers make “concentrated” versions that may contain as high as 8.25% of chlorine. In Australia, bleach products sold from supermarkets may contain up to 63% chlorine.[8] Be careful when mixing bleach baths to not get any into the eyes, nose, or mouth. Bleach may lose its activity over time. Check the expiration date on the containers before using.

 

What if I Do Not Have a Bathtub?

A modified bleach bath can be made by mixing 1-2 teaspoons of bleach in 3 gallons of water in a tub or bucket. Alternatively, a wet compress can be made by soaking gauze in the dilute bleach solution and applying the soaked gauze to the skin.

 

Is Bleach Irritating to the Skin?

The safety of dilute bleach baths relies on mixing the correct concentration of bleach and bath water. When mixed correctly, a dilute bleach bath has similar chlorine concentration as a swimming pool and is well tolerated. A recent clinical study has proven that a 10-minute bleach bath does not negatively affect the function of the skin’s protective layer any more than bathing with tap water alone, and this is true for both eczema and normal subjects.[9] None of the subjects reported skin irritation during or after bleach bath. We now know that dilute bleach bath is safe and not harmful to the sensitive skin of people with eczema.

 

* This Website is for general skin beauty, wellness, and health information only. This Website is not to be used as a substitute for medical advice, diagnosis or treatment of any health condition or problem. The information provided on this Website should never be used to disregard, delay, or refuse treatment or advice from a physician or a qualified health provider.

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References

1.    Ong PY, Ohtake T, Brandt C, et al. Endogenous antimicrobial peptides and skin infections in atopic dermatitis. N Engl J Med.2002;347(15):1151-1160; PMID: 12374875.

2.    Jinnestal CL, Belfrage E, Back O, et al. Skin barrier impairment correlates with cutaneous Staphylococcus aureus colonization and sensitization to skin-associated microbial antigens in adult patients with atopic dermatitis. Int J Dermatol.2014;53(1):27-33; PMID: 23879225.

3.    Roll A, Cozzio A, Fischer B, et al. Microbial colonization and atopic dermatitis. Curr Opin Allergy Clin Immunol.2004;4(5):373-378; PMID: 15349036.

4.    Paintsil E. Pediatric community-acquired methicillin-resistant Staphylococcus aureus infection and colonization: trends and management. Curr Opin Pediatr.2007;19(1):75-82; PMID: 17224666.

5.    Ong PY. Recurrent MRSA skin infections in atopic dermatitis. J Allergy Clin Immunol Pract.2014;2(4):396-399; PMID: 25017526.

6.    Peck B, Workeneh B, Kadikoy H, et al. Spectrum of sodium hypochlorite toxicity in man-also a concern for nephrologists. NDT Plus.2011;4(4):231-235; PMID: 25949487.

7.    Huang JT, Abrams M, Tlougan B, et al. Treatment of Staphylococcus aureus colonization in atopic dermatitis decreases disease severity. Pediatrics.2009;123(5):e808-814; PMID: 19403473.

8.    Barnes TM, Greive KA. Use of bleach baths for the treatment of infected atopic eczema. Australas J Dermatol.2013;54(4):251-258; PMID: 23330843.

9.    Shi VY, Foolad N, Ornelas JN, et al. Comparing the Effect of Bleach and Water Baths on Skin Barrier Function in Atopic Dermatitis: A Split-Body Randomized Controlled Trial. Br J Dermatol.2016;10.1111/bjd.14483PMID: 26875771.