Bleach baths may improve clinician-reported severity in patients with moderate to severe atopic dermatitis (AD), according to study findings published in the Annals of Allergy, Asthma & Immunology.

Investigators systematically reviewed randomized controlled trials (RCTs) that reported on the efficacy and safety of bleach baths for treatment of AD. All outcomes were analyzed on an intention-to-treat basis, and the Grading of Recommendations, Assessment, Development and Evaluation was used to assess the certainty of the evidence.

A total of 12 reports (10 RCTs, 4 unpublished, and 6 published) were included, with 307 patients with AD (median patients, 28; interquartile [IQR] range, 14-41; median of mean age, 7.2 years [IQR 4.7-12.0]; 50.5% women). The estimated AD severity across all studies according to the Eczema Area and Severity Index was a mean of means of 27.57 (median SD across trials, 10.74).


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Among the 8 studies that assessed clinician-reported severity (n = 257), bleach baths “probably” improved AD severity compared with no bleach baths (ratio of means 0.78; 95% credible interval [CrI], 0.59-0.99; moderate certainty), according to the researchers. The pooled probability for AD severity to improve by 50% from baseline was 32% in the dilute bleach bathing group vs 22% in the control group (risk ratio [RR] 1.45; 95% CrI, 1.00-2.14), among the included study populations.

Bleach also may reduce the likelihood of a positive Staphylococcus aureus skin culture (RR 0.89 [95% CI, 0.73, 1.09]; risk difference, –0.09 [–0.21, 0.03], low certainty), the investigators noted.

Bleach-based interventions appeared to cause few or no adverse events (RR 0.98; 95% CI, 0.60, 1.61) in the 7 studies (n = 234) that reported adverse events. Most of the events were mild and included dry skin and irritation.

The investigators noted that the studies were highly heterogeneous with small populations, and many of the trials focused on surrogate microbiological outcomes instead of patient-relevant outcomes.

“This review, synthesizing the totality of evidence to date and with no more trials registered, provides moderate-quality evidence bleach baths 2 to 3 times per week probably improves AD severity by a modest amount and possibly promotes little to no adverse events,” stated the investigators. “These findings support patients, clinicians, researchers, and policy makers in striving for optimal outcomes for patients with AD.”

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures

Reference

Bakaa L, Pernica JM, Couban RJ, et al. Bleach baths for atopic dermatitis: a systematic review and meta-analysis. Ann Allergy Asthma Immunol. Published online March 30, 2022. doi:10.1016/j.anai.2022.03.024