Staphylococcus aureus ("Staph") colonization and infection is a common complication of atopic dermatitis (AD), due to defective epidermal barrier and decreased antimicrobial peptides. Also, Staphylococcus aureus superantigens worsen the inflammation of atopic dermatitis.
Comprehensive approach to atopic dermatitis care
The diagram below shows the comprehensive approach to atopic dermatitis care:
1. Exacerbation management. The top part of the diagram includes the treatment of exacerbations (flares) with topical steroids or steroid-sparing cream (for example, Elidel).
2. Maintenance. The bottom part of the diagram shows the maintenance treatment with daily bath, twice a day moisturizers, and weekly diluted bleach baths.
Atopic Dermatitis Treatment - Illustrated (click here for full size image).
Evidence supporting the elimination of Staphylococcus aureus colonization
In a 2009 study, 31 children (aged months–17 years) with AD and signs of bacterial skin infection received 2 weeks of cephalexin (an oral antibiotic). Then, the treatment group bathed twice weekly in dilute bleach (0.5 cup of bleach to 40 gallons of bathwater) for 5 to 10 minutes.
At baseline, S. aureus was cultured from 87% of skin and 81% of nares (7% of skin bacteria and 4% of nares bacteria were methicillin resistant [MRSA]).
In the study, all patients received cephalexin at 50 mg/kg per day (maximum of 2 g/day), divided into 3 daily doses, for 2 weeks to treat their Staphylococcal infections. Patients were instructed to add either 0.5 cup of 6% bleach (final concentration: 0.005%; treatment arm) or water (placebo arm) to a full bathtub of water (40 gallons). The amount of administered bleach solution or water was adjusted by the family on the basis of the bathtub size and estimated height of bathtub water. Patients were instructed to bathe in the dilute bleach bath or placebo bath for 5 to 10 minutes twice weekly.
Irrigation with dilute bleach was first used for infected wounds and as a perioperative antiseptic during World War I. The concentration used in this study was only 0.005%, more dilute than swimming pool water. Clorox (R) bleach concentration is is 5.95% sodium hypochlorite.
The Eczema Area and Severity Index scores body sites submerged in the dilute bleach baths decreased at 1 and 3 months, in comparison with placebo-treated patients. Chronic use of dilute bleach baths with intermittent intranasal application of mupirocin ointment decreased the clinical severity of atopic dermatitis in patients with clinical signs of secondary bacterial infections.
How To Use Diluted Bleach Baths To Treat Atopic Dermatitis
- Add 1/2 cup (118 milliliters, 0.5 cup) of bleach to a 40-gallon (151-liter) bathtub filled with warm water
- Soak the affected areas of skin for 5-10 minutes
- Dry your skin and apply a thick layer of moisturizer (Eucerin in AM, Aquafor in PM)
- Take a bleach bath no more than twice a week
A Spray Bottle for Diluted Bleach Application
A spray bottle can be used instead of the bleach bath. Add one (1) milliliter of bleach to 1.5-liter bottle with warm water. Transfer to a spray bottle. Spray the affected areas of skin at leave it on for 5-10 minutes. Avoid spraying the face and stay away from the eyes, nose and mouth. Follow the directions above.
Apple cider vinegar in bath water
You can use apple cider vinegar in bath water instead of bleach for AD. It may have antifungal activity as well compared to bleach. Apple cider vinegar may also help skin because it is acidic.
Dosing in bath for bleach or apple cider vinegar: start at 1/2 cup per entire bath, target: 1 cup per bath as tolerated.
A Spray Bottle for Diluted Bleach Application
A spray bottle can be used instead of the bleach bath. Add one (1) milliliter of bleach to 1.5-liter bottle with warm water. Transfer to a spray bottle. Spray the affected areas of skin at leave it on for 5-10 minutes. Avoid spraying the face and stay away from the eyes, nose and mouth. Follow the directions above.
Apple cider vinegar in bath water
You can use apple cider vinegar in bath water instead of bleach for AD. It may have antifungal activity as well compared to bleach. Apple cider vinegar may also help skin because it is acidic.
Dosing in bath for bleach or apple cider vinegar: start at 1/2 cup per entire bath, target: 1 cup per bath as tolerated.
References
Treatment of Staphylococcus aureus Colonization in Atopic Dermatitis Decreases Disease Severity. PEDIATRICS Vol. 123 No. 5 May 2009, pp. e808-e814 (doi:10.1542/peds.2008-2217).
Treatment of Staphylococcus aureus Colonization in Atopic Dermatitis Decreases Disease Severity. PEDIATRICS Vol. 123 No. 5 May 2009, pp. e808-e814 (doi:10.1542/peds.2008-2217).
Bleach Baths for Atopic Dermatitis. Journal Watch.
What is a bleach bath? Can it treat chronic eczema symptoms? MayoClinic.com.
Colonization of S. aureus in early childhood eczema (72.7%) originates from childrens' own noses, not from mothers http://goo.gl/0fptY
Extracellular vesicles derived from Staphylococcus aureus induce atopic dermatitis-like skin inflammation http://goo.gl/Evqr
Figures:
Comments from Twitter:
@rlbates My mom gave us bleach baths as kids to get rid of ticks esp the minute seed ticks. It worked. Just a small amt in the bath water.
Extracellular vesicles derived from Staphylococcus aureus induce atopic dermatitis-like skin inflammation http://goo.gl/Evqr
Figures:
Comments from Twitter:
@rlbates My mom gave us bleach baths as kids to get rid of ticks esp the minute seed ticks. It worked. Just a small amt in the bath water.
SumitB @Stolib: Say the words "bleach bath" and parents flip out
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