When treating children for chronic eczema, pediatricians may want to look in the laundry room, according to a new study published this week in the journal Pediatrics. The study reports that adding a small amount of household bleach to a child's bathwater can dramatically reduce the itching, rashes and discomfort caused by eczema.
The treatment sounds harsh, but the findings confirm what many pediatric dermatologists have seen anecdotally for years. The theory is that the antimicrobial properties of bleach help relieve symptoms of eczema not by acting directly on that skin condition, but by improving children's skin infections of staph bacteria a common co-occurrence that exacerbates the irritating symptoms of eczema.
In the new study, researchers followed 31 children between the ages of 6 months and 17 years, who had both conditions: atopic dermatitis, the most common form of childhood eczema, which affects 17% of the school-aged population, as well as a co-infection of Staphylococcus aureus. Although antibiotics are typically used successfully to combat such staph infections, the emergence of drug-resistant MRSA (or methicillin-resistant Staphylococcus aureus) has physicians increasingly wary of overusing the medicines.
"The bottom line is that the more antibiotics we use, the higher the risk for something becoming resistant to them," says Dr. Amy Paller, a study author, specialist in pediatric dermatology and chair of the dermatology department at Northwestern University's Feinberg School of Medicine. "The beauty of something like dilute bleach is that one doesn't get resistance to it."
Each study participant was given an identically labeled bleach bottle, but only half of the bottles actually contained bleach. (Although patients, or at least their parents, could easily distinguish whether they were in the bleach group or the placebo group by smelling the contents of their bottle, they were instructed not to tell the researchers which group they were in.) Those who received real bleach were instructed to draw a bath twice a week with a heavily diluted bleach solution a half-cup of bleach per 40 gallons of water and immerse their limbs and torsos, leaving the neck and head above water, for five to 10 minutes each time. They were told to pat dry afterward and apply a heavy slathering of moisturizer. The placebo group was not given restrictions about the frequency of baths. Both groups of patients were also treated with oral antibiotics and the nasal ointment muciprocin to control staph infections, which often exist in the nostrils.
After three months, the group using bleach baths reported improvement of symptoms in the areas of the body that had been submerged, with 67% of those using bleach baths benefiting, compared with just 15% of those who bathed in normal water. "This is so simple, and it's really working." Paller says.
Dr. Nanette Silverberg, director of pediatric and adolescent dermatology at Beth Israel Medical Center in New York, has been using bleach baths with her patients for years. (She first learned of the treatment during her fellowship in pediatric dermatology studying under Paller.) She says parents and patients are usually dumbfounded when she first suggests the remedy. "They call in relatives from the waiting room to witness the insanity," Silverberg laughs. "Many patients look at me like I've lost my marbles."
But in her practice, when combined with other treatments, the baths have been a valuable and successful technique, Silverberg says. "The bleach baths do work," she says. "I'm a big believer in using them."
If bleach baths work, then perhaps children with chronic eczema and persistent staph infections could be treated with fewer courses of antibiotics. Continuous antibiotic treatment is not a viable option, especially given the emergence of MRSA, say Silverberg and Paller. "We have been looking for agents that are antibacterial but would not have the problems that we see with antibiotics, where you can and will develop resistance over time," Silverberg says. "With the bleach bath, you reduce the chances of getting grossly infected and needing to go on the antibiotics, and it has benefits in the general community you're not walking around with staph [lesions]."
Paller and Silverberg underscore that bleach baths should be used as one component of a larger treatment strategy for chronic eczema, always in consultation with a doctor, and that bleach should never be applied directly to the skin. For patients with severe skin damage such as cracking, baths of any kind including dilute bleach may initially be too painful, and should be introduced later in treatment only after the skin has begun to improve.
When used correctly, Paller says the baths are extremely safe for patients with eczema. What's more, she adds light-heartedly, "It keeps the tub clean too."