My take on dilute bleach baths and eczema

If you follow developments in eczema treatment, you’ve seen this recommendation to try bathing your child regularly in diluted bleach baths to reduce eczema severity.  I thought this article in MedPage Today summed it well.

If you understand the Solveeczema.org approach, then you probably also know my take on it.

bath bubblesI discuss in Solveeczema.org‘s solutions page the necessity of treating infected eczema in the problem-solving stage.  Even if the detergents are the source of the eczema, sometimes the infected skin has to be treated before the eczema will go away.

But my approach is to eliminate what I believe is the source of the eczema at the same time, so that treating the infected skin brings it back to normal and the skin can remain normal.  This study is suggesting regular bleach baths as a treatment to reduce but not eliminate eczema.

Additionally, my observation has been that when the approach in Solveeczema is properly implemented, along with potentially eliminating the eczema, the skin changes and becomes healthier and more substantial — in children whose eczema is being eliminated, as well as in other members of the household (even if they don’t have eczema).  These skin improvements typically take place over about a two-month time period after the eczema is eliminated.

A few diluted bleach baths could be a helpful “reset” button at the start.

In the study, the researchers observed a reduction of eczema as compared to placebo over time, but only on the parts of the children’s bodies submerged in the diluted bleach water, not the face and neck, and apparently not overall a hugely convincing improvement.  A review article in the British Journal of Dermatology stated, “the difference could have been explained by regression to the mean.”

A doctor who conducted the bleach bath study felt the improvements were the result of knocking out staphyloccocus on the skin, which is known to be a problem for children with eczema, though the above review article found no evidence that managing staphylococcus aureus alone had any “clinically helpful” impact on eczema.

I personally believe fungi/yeast can be a part of the abnormal microbial picture, too, since babies do not fight yeast infections on the skin especially well.  I also — obviously — believe the skin microbial imbalances are a result of the abnormal environmental influence, the increases in membrane permeability from detergents on the skin and the problems that causes.  The more conventional belief is that the eczema and microbial imbalances are the result of a defect in the skin and that perhaps the staph plays a more causative role, though again, no clinical improvements have been directly associated with controlling the staph.

Although it is certainly also mainstream to see the eczema epidemic as primarily environmental because the rapid rise cannot be reconciled with a purely genetic cause (again, see Solveeczema for reference), this observation conflicts with the skin “defect perspective.”

My concerns:

While I am glad to see a potential new tool for dealing with infected skin on a short-term basis, I have concerns about using these bleach baths as a chronic treatment.

First of all, it doesn’t eliminate the eczema and it must be done regularly.

And, I don’t think clinical recommendations can be made from such limited study of such small numbers anyway and safety has not been established.

Secondly, I would note that bleach in the water would help remove detergent residues from the skin of these children better than water alone.  How much of the improvement they noticed was the result of inadvertently regularly mitigating detergent on the skin of these children?  The researchers wouldn’t even have been aware of this issue.  (I would personally see this kind of bleach-bath treatment as a problem-solving step, not an ultimate treatment modality to pursue.)

Thirdly, children and babies have very permeable skin, and chlorine is absorbed by the skin and mucous membranes.  Real concerns about bleach and safety are not hard to find, for example, in this California Environmental Protection Agency sheet on safe sanitizing in childcare centers.  While I personally think doing this kind of bath once or twice might be a reasonable trade-off, I have real concerns about kids regularly bathing in and breathing the fumes from a bleach bath, especially if it’s not actually eliminating the eczema.

Kids with eczema are more at risk of developing asthma.  And breathing chlorine fumes (swimming in chlorinated pools) increases risk for kids of  getting brionchiolitis, asthma, and allergy.   I have inserted one link there, but type “bleach asthma” into the journal search box and you will find a long list of journal articles on this topic.

To the best of my knowledge, the researchers conducting the bleach bath study have not made clinical recommendations.  I would personally recommend against experimenting with anything with the potential safety concerns of bleach.  However, for someone currently eliminating detergents in the household who has concerns of persistently infected skin from past eczema, trying a few of these diluted bleach baths — ONLY after discussing it thoroughly with your child’s pediatrician! — might be helpful and potentially gentler than an oral medication approach.

I’d like to make a parenthetical note here that if the results of this study are reproducible, it contradicts the interpretation of other bath studies ostensibly supporting the hygiene hypothesis.  Previous studies found that infants who were excessively bathed had more eczema, and the conclusion in some quarters has been that these kids were “too clean” and “sterile” skin can lead to allergies.

I personally did not find that interpretation logical, as I have said on Solveeczema.org, the skin of these children would be so breached from all that bathing, they would have more microbial problems, not fewer.  This bleach bath study directly refutes that interpretation, as the bleach (which would have sterilized the skin) seemed to at least moderately improve the eczema over time.

Update:  October 3, 2016

Since this is perennially one of my most popular posts, I feel I should update it with a caveat that many bleach products contain copious amounts of detergents.  While I am a fan of Chlorox brand bleach because I have found the product to be consistent and good quality (I experienced some surprising variation when I used to use whatever was at the store), most of the bleach products they make now have detergents in them.  Chlorox is quite open about sharing the ingredients in their products on a website they provide (on the bottle), so it’s possible to find the ones that don’t have detergents in them.  Their straight bleach products don’t.  Obviously, if you read SolveEczema.org and want to follow the strategies, if your child’s doctor recommends these diluted baths, I would recommend always reading ingredients and taking care to stick with products that are only bleach.  (My positive words about Chlorox brand are my own opinion not an endorsement of any brand.)

Update:  September 12, 2017

I discovered recently that only one Chlorox bleach product has a slate of ingredients that I can verify as meeting SolveEczema criteria.  Currently, the Chlorox product I can recommend as meeting SolveEczema site criteria for laundry because of the ingredients is the “Germicidal” bleach, available at Costco, Home Depot, and Loew’s.  It is concentrated and contains: Sodium hypochlorite, sodium chloride, sodium carbonate, sodium chlorate, sodium hydroxide.  I called the toll-free number on a bottle of Regular today and the agent told me they don’t recommend the Germicidal for laundry.  However, the Chlorox website says it’s fine for laundry   Q. “Can I use this [Germicidal] bleach on my clothes like Chlorox Regular Bleach?”  “A. … YES”

The agent also told me that they do not recommend the use of bleach at all for diluted beach baths, i.e., for this purpose.  (I wish this was described more accurately not as “diluted bleach baths” but as a small amount of bleach heavily diluted by water, because many products are concentrated now.  If your physicians prescribes diluted bleach baths, please be very careful to make sure their instructions are correct given the way different brands are now concentrating their products, and how hazardous bleach and its fumes can be.)  As I wrote above, I have many reservations and concerns about using bleach in this way with children, especially since I believe eczema is otherwise eminently solvable.  But there are all kinds of circumstances, such as MRSA infections, where one’s physician may may have good reasons and there may not be other, as effective, alternatives.  I believe families should make decisions best for them in consultation with their physicians.  (I do not know off-hand how much more concentrated the recommended dilute baths would be than in swimming pools, but I can’t imagine it would be much.  Please let me know if that is wrong.)

Again, these are my opinions and not intended as an endorsement of any brand.  Just be aware that many, if not most, bleach products out there contain detergents other other ingredients, and that many brands are not as easy to identify the other ingredients in the products as Chlorox.

 

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