Amy Paller, MD
Amy Paller, MD, chair, department of dermatology, professor of dermatology, professor of pediatrics, Northwestern University Feinberg School of Medicine, Chicago.
It turns out that a decades-old wound treatment — diluted bleach — offers significant relief from the discomfort of eczema. Amy Paller, MD, chair of dermatology at Northwestern University’s Feinberg School of Medicine, told me that she recalls learning to use a bleach solution on wounds during her medical residency. She had also found it beneficial for eczema, which led to her study, recently published in Pediatrics. “We needed to look at it scientifically and get the word out so it can be used more reliably,” Dr. Paller explained.
The research involved children who had eczema combined with a staphylococcus infection (as do most eczema patients). Staph is everywhere on our skin, and many factors can cause it to overgrow — for instance, scratching enables staph to enter broken skin. People who don’t have eczema are able to naturally produce proteins in their skin that fight infection, but the inflammation of eczema inhibits production of these proteins… setting up a cycle in which the bacterial overgrowth from unchecked staph leads to eczema’s inflammation, and the factors causing inflammation suppress the skin’s own defense. While antibiotics are effective at both clearing the infection and suppressing the inflammation, the symptoms and often the infection return when they are stopped.
The study of 31 patients (ages six months to 17 years) with moderate to severe eczema and bacterial infection was randomized and placebo-controlled. All patients received an oral antibiotic for two weeks and then were given either medication (a bottle of bleach and a topical antibiotic to put in the nose) or placebo (the same bottle but filled with water, and a topical ointment without the antibiotic). They were instructed to add one-half cup of the solution to a full bathtub of lukewarm water (it works out to about two teaspoons/gallon of water) and soak for five to 10 minutes daily for three months. They were also instructed to apply the ointment inside their nostrils twice daily for five days a month.
Using a standard scale for grading eczema, the bleach bath patients showed a “very significant” improvement over the placebo group at three months. Most telling, said Dr. Paller, was that the areas that didn’t get submerged (patients’ heads and necks) in the bleach bath group showed no significant improvement, whereas submerged areas showed ‘highly significant’ improvement.” It appears that the bleach bath gets credit.
Dr. Paller told me that based on her experience, this strategy also may benefit adults. She noted that patients with eczema and associated crusting that is localized to their hands can soak them in the dilute bleach solution for 10 minutes daily, then follow that with use of moisturizing cream to seal in moisture, as is routinely used for patients with eczema after the bath.
I asked Dr. Paller whether there are any risks to taking bleach baths. She said she hasn’t seen or heard about any yet, even with daily use. But, since the main problem with eczema is inflammation, she cautioned that bleach baths should not replace topical anti-inflammatory medication and other treatments as prescribed by a patient’s physician.