Bleach baths, frequently recommended for patients with atopic dermatitis (AD), are no more effective than plain water baths to alleviate symptoms, and they can cause unpleasant adverse effects including burning and stinging, a systematic review and meta-analysis indicates.
“Bleach baths are commonly recommended because they are inexpensive, relatively safe, and easily accessible,” Rishi Chopra, MS, from Northwestern University Feinberg School of Medicine, Chicago, Illinois, and colleagues write. “[And while we found that] bleach baths are effective in decreasing AD severity, they do not appear to be more effective than water baths alone,” they add.
The study was published online November 13 in the Annals of Allergy, Asthma and Immunology.
The authors identified four studies that compared bleach baths with plain water baths on eczema severity. “All 4 demonstrated significant decreases in the bleach group in at least 1 time point,” they write. “However, of the 4 studies comparing bleach with water baths, only 2 found significantly greater decreases in AD severity with bleach baths, 1 found greater decreases with water baths, and 1 found no significant differences.”
When investigators then asked whether there were any differences between bleach baths and normal baths, using several indices of disease severity, analyses revealed no significant differences between the two at 4 weeks in either the Eczema Area and Severity Index (EASI) or the Body Surface Area (BSA) score. “In other words, of the aggregated 15 severity assessment evaluations at 4 weeks, only 3 assessments demonstrated that bleach baths were more effective than water baths, 11 reported no difference, and 1 reported regular water baths to be more effective,” the researchers note.
They also conducted a pooled analysis where they were able to assess EASI and BSA endpoints at 4 weeks in at least three studies. For bleach baths, both endpoints had decreased at week 4 from a mean EASI of 24.9 at baseline to a mean EASI of 11.0 at week 4 and from a mean BSA of 49.8 at baseline to a mean BSA at week 4 of 42.8. Similarly, mean EASI scores dropped from 25.2 at baseline to 14.2 at week 4 for water baths, and mean BSA scores dropped from 45.6 at baseline to 41.1 at week 4.
However, differences between EASI and BSA scores from baseline to study endpoint were not significantly different between bleach and water baths. Adverse events from bleach baths and cleansers include stinging and burning, xerosis, erythema, urticaria, and oozing. There were no differences in rates of adverse events between bleach and normal baths. Three studies also noted a decrease in Staphylococcus aureus density after bleach and water baths, but again, differences in S aureus density were not different between the two groups.
“[D]ilute bleach baths have been proposed to suppress epidermal S aureus load and ultimately decrease AD severity,” the authors explain. As the severity of AD frequently correlates with the density of S aureus on the skin, bathing in a dilute bleach solution is intended to reduce colonization of S aureus on the skin.
However, findings from this study call this recommendation into question, senior author Jonathan Silverberg, MD, assistant professor of dermatology at Northwestern University Feinberg School of Medicine in Chicago, Illinois, pointed out in a news release. He emphasized that submerging the body in water alone will effectively wash away most of the bacteria from the skin, after which patients should apply ample amounts of moisturizer. “I don’t know if [this study] throws the baby out with the bathwater, but bleach baths lack the evidence to support how commonly they are being recommended,” Dr. Silverberg said.
“The water baths appear to be doing most of the heavy lifting,” he added. “If bleach is adding any benefit, it’s quite modest,” he concluded.
Research was funded by the Agency for Healthcare Research and Quality and the Dermatology Foundation. The authors have disclosed no relevant financial relationships.
Ann Allergy Asthma Immunol. Published online November 13, 2017. Full text
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