Bleach baths enhance skin barrier, reduce itch but do not normalize skin dysbiosis in atopic dermatitis

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• In this non-randomized trial, 15 patients with atopic dermatitis (AD) colonized with Staphylococcus aureus and 5 non-atopic healthy controls were instructed to take two bleach baths per week for 12 weeks in total. After 12 weeks, patients with AD reported experiencing a significant reduction in the EASI score, a reduction in itch, and an improvement in sleep quality. Although patients with AD experienced a reduction in transepidermal water loss values, these values were unchanged in healthy controls. Most patients with AD remained S aureus–culture positive after 12 weeks of bleach baths.
• Although bleach baths improve disease severity and itch in patients with AD, they have little impact on the quantity of S aureuson the skin surface.

–  Katherine M. Stiff, MD

Abstract 

Studies have demonstrated that bleach baths improve atopic dermatitis (AD) severity; however, the effects on itch, skin barrier, and cutaneous microbial composition are less clear. We examined whether bleach baths reduce itch, normalize skin barrier function, reduce S. aureus absolute abundance, and increase microbial diversity in adults with AD who were colonized with S. aureus on their non-lesional skin. This was an open label, non-randomized, controlled trial performed at a single academic center. Fifteen AD and five non-atopic healthy controls (NA) were instructed to take two bleach baths (0.005% NaClO; 5-10 min duration) per week for a total of 12 weeks as add-on therapy. Adults 18 to 65 years (inclusive) with mild to severe AD were recruited with EASI score > 6.0, S. aureus culture positivity, access to a bathtub, and ability and willingness to maintain current topical or systemic treatments. They were evaluated at baseline (before bleach baths), 6 weeks, and 12 weeks after the intervention of twice-weekly bleach baths. Efficacy measurements included EASI as well as 5-D Pruritus and ItchyQoL™. Transepidermal water loss (TEWL) and stratum corneum (SC) integrity assay were performed to assess the skin barrier. Skin dysbiosis was measured by S. aureus cultivation, S. aureus abundance (qPCR of thermonuclease gene), and V1-V3 16S rRNA gene sequencing on non-lesional and lesional AD skin. After 12 weeks of bleach baths, 8/15 (53.3%) AD subjects achieved an EASI50 and a significant reduction in itch as measured by 5-D pruritus and Itchy QoL. Eighty-seven percent reported improvements in sleep quality. At study entry, AD subjects had higher non-lesional TEWL values than NA subjects, and only AD subjects experienced a reduction with bleach baths (p = 0.006). Similarly, SC integrity improved as early as 6 weeks after bleach baths in AD subjects. Notably, bleach baths had no significant effect on S. aureus culture-positivity, qPCR absolute abundance, or microbial diversity. The addition of twice-weekly bleach baths improves investigator-assessed AD severity, patient-reported pruritus and sleep as well as physiological measures of skin barrier function in adult AD subjects while having no effect on qualitative and quantitative measures of cutaneous S. aureus. Trial Registration: ClinicalTrials.gov Identifier: NCT01996150, Date of registration: November 27th, 2013.

Archives of Dermatological Research

Bleach baths enhance skin barrier, reduce itch but do not normalize skin dysbiosis in atopic dermatitis

Arch Dermatol Res 2023 Sep 27;[EPub Ahead of Print], A Stolarczyk, N Perez-Nazario, SA Knowlden, E Chinchilli, A Grier, A Paller, SR Gill, A De Benedetto, T Yoshida, LA Beck 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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