Scientists in the US found that giving children with chronic, severe eczema regular baths of diluted bleach reduced the clinical severity of the
condition in cases with secondary bacterial infection.
The study was the work of Dr Amy S Paller, the Walter J. Hamlin Professor and chair of dermatology, and professor of pediatrics, at the Northwestern University Feinberg School of Medicine, in Chicago, Illinois.
Paller, who is also an attending physician at Chicago Children's Memorial Hospital, where the research was done , told the press that compared to children treated with placebos, children on the bleach baths experienced a five times reduction in eczema severity over one to three months.
About 17 per cent of children are affected by eczema, and chronic, severe eczema can ruin a childhood. At first the skin is red, inflamed and itchy, but as children scratch, the condition progresses until the skin is raw and crusty, and often becomes infected with bacteria that are difficult to treat, especially MRSA (methicillin-resistant Staphylococcus aureus). The result is misery, disturbed sleep, and oftentimes poor concentration which affects school performance.
Oral and skin-applied antibiotics are the most common ways to treat the condition, but doctors don't like using them, especially in children, because they raises the chance that the bacteria will develop resistance.
"We've long struggled with staphylococcal infections in patients with eczema."
She said that more than two-thirds of eczema patients show signs of staphylococcus on their skin, the bacteria that most commonly causes infection and makes the eczema worse.
"This study shows that simple household bleach, which we think decreases the staphylococcus on the skin, can help these children," she explained.
For the randomized, investigator-blinded, placebo-controlled study, Paller and colleagues set out to discover how common it was for patients with atopic dermatitis (chronic eczema) to also be infected with community-acquired MRSA and whether suppressing its spread with bleach (sodium hypochlorite) baths and intranasal mupirocin (an antibiotic marketed under brand names Bactroban and Centany) would reduce the severity of the eczema.
They recruited 31 patients aged from 6 months to 17 years, all of whom had moderate to severe atopic dermatitis and were showing clinical signs of bacterial infection. All the patients took cephalexin (a first line antibiotic for skin conditions, marketed as Keflex and Sporidex) for 14 days before being randomly assigned to either the treatment or the placebo group.
For three months, the treatment group participants had baths in diluted sodium hypochlorite (bleach) and received intranasal mupirocin ointment treatment, while the placebo group participants had intranasal petrolatum ointment treatment and plain water baths. All participants were instructed to soak in their baths for up to 10 minutes twice a week for three months.
The main measure for the results was the Eczema Area and Severity Index score.
The results showed that:
- The prevalence of community-acquired MRSA in this study (7.4 per cent of the S aureus positive skin cultures and 4 per cent of the S aureus positive nasal cultures tested positive for MRSA) was much lower than that of the general population as determined from cultures held at Children's Memorial Hospital (75 to 85 per cent).
- Patients in the treatment group showed significantly greater mean reductions from baseline (before and after scores) in Eczema Area and Severity Index scores than the placebo group, both at the 1 and 3 month assessment.
- However, scores for the head and neck (they were not submerged during bleach baths) did not go down in the treatment group compared to the placebo group.
- Only the other body sites showed significant reductions in severity scores for the treatment group compared to the placebo group at the 1 and 3 month assessment.
"Chronic use of dilute bleach baths with intermittent intranasal application of mupirocin ointment decreased the clinical severity of atopic dermatitis [chronic eczema] in patients with clinical signs of secondary bacterial infections."
"Patients with atopic dermatitis do not seem to have increased susceptibility to infection or colonization with resistant strains of S aureus," they added.
In a separate statement, Paller said that the baths were surprisingly odor free, presumably because the bleach was so dilute (they used about half a cup of bleach per full standard tub).
"In our clinics, no one had the just-out-of-the-swimming pool smell," she said.
The researchers stopped the study early because the improvement in the treatment group was so dramatic they wanted the placebo group to have the option of getting the same relief. Paller said that the eczema "kept getting better and better with the bleach baths and these baths prevented it from flaring again, which is an ongoing problem for these kids."
"We presume the bleach has antibacterial properties and decreased the number of bacteria on the skin, which is one of the drivers of flares," she explained.
Bleach has been used succesfully by hospitals to reduce MRSA, said Paller, which is why they thought it might work for eczema.
The difference in results depending on whether the head and neck or other parts of the body were assessed is seen as further evidence that the bleach bath was effective, since the children did not put their heads under the water when they bathed.
Paller suggests that kids who have eczema and use this method close their eyes and mouth and dunk under the water to help improve the lesions on their face, head and neck. She said that in her practice they have found even daily baths with diluted bleach are well tolerated.
She said bleach baths might also help people with frequent staphylococcus infection, with or without eczema or not, and adults with eczema and recurrent infections.
Scientists say there are still more questions than answers when it comes to eczema, but suggest it is probably caused by a genetic predisposition that is triggered by environmental factors such as urban pollutants and toxins and/or allergies.
"Treatment of Staphylococcus aureus Colonization in Atopic Dermatitis Decreases Disease Severity."
Jennifer T. Huang, Melissa Abrams, Brook Tlougan, Alfred Rademaker, and Amy S. Paller.
Pediatrics, May 2009; 123: e808 - e814.
Additional sources: Northwestern University.
Written by: Catharine Paddock, PhD