Bleach baths for atopic dermatitis Academic Article uri icon

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abstract

  • Background

    Bleach bathing is frequently recommended to treat atopic dermatitis (AD), but its efficacy and safety are uncertain.

    Objective

    To systematically synthesize randomized controlled trials (RCTs) addressing bleach baths for AD.

    Methods

    We searched MEDLINE, EMBASE, CENTRAL, and GREAT from inception to December 29, 2021, for RCTs assigning patients with AD to bleach vs no bleach baths. Paired reviewers independently and in duplicate screened records, extracted data, and assessed risk of bias (Cochrane version 2) and GRADE quality of evidence. We obtained unpublished data, harmonized individual patient data and did Frequentist and Bayesian random-effects meta-analyses.

    Results

    There were 10 RCTs that enrolled 307 participants (median of mean age 7.2 years, Eczema Area Severity Index baseline mean of means 27.57 [median SD, 10.74]) for a median of 6 weeks (range, 4-10). We confirmed that other trials registered globally were terminated. Bleach baths probably improve AD severity (22% vs 32% improved Eczema Area Severity Index by 50% [ratio of means 0.78, 95% credible interval 0.59-0.99]; moderate certainty) and may slightly reduce skin Staphylococcal aureus colonization (risk ratio, 0.89 [95% confidence interval, 0.73-1.09]; low certainty). Adverse events, mostly dry skin and irritation, along with itch, patient-reported disease severity, sleep quality, quality of life, and risk of AD flares were not clearly different between groups and of low to very low certainty.

    Conclusion

    In patients with moderate-to-severe AD, bleach baths probably improve clinician-reported severity by a relative 22%. One in 10 will likely improve severity by 50%. Changes in other patient-important outcomes are uncertain. These findings support optimal eczema care and the need for additional large clinical trials.

    Trial registration

    PROSPERO Identifier: CRD42021238486.

authors

  • Bakaa, Layla
  • Pernica, Jeffrey
  • Couban, Rachel
  • Tackett, Kelly Jo
  • Burkhart, Craig N
  • Leins, Liz
  • Smart, Joanne
  • Garcia-Romero, Maria Teresa
  • Elizalde-Jiménez, Itzel Guadalupe
  • Herd, Michael
  • Asiniwasis, Rachel Netahe
  • Boguniewicz, Mark
  • De Benedetto, Anna
  • Chen, Lina
  • Ellison, Kathy
  • Frazier, Winfred
  • Greenhawt, Matthew
  • Huynh, Joey
  • LeBovidge, Jennifer
  • Lind, Mary Laura
  • Lio, Peter
  • O'Brien, Monica
  • Ong, Peck Y
  • Silverberg, Jonathan I
  • Spergel, Jonathan M
  • Wang, Julie
  • Begolka, Wendy Smith
  • Schneider, Lynda
  • Chu, Derek

publication date

  • June 2022