Bleach bath

Bleach baths are recommended in patients with frequent skin infections to reduce skin colonization by pathogenic bacteria, particularly Staphylococcus aureus. Bleach baths have also been reported to reduce the severity of atopic dermatitis (eczema) and to reduce the need for topical steroids and antibiotics. Bleach baths also seem to reduce inflammation and itching in eczema. The current clinical guidelines for management of eczema or atopic dermatitis now recommend bleach baths. This requires simply the addition of regular household bleach to twice-weekly baths.

Bleach is the generic name for any chemical product which is used industrially and domestically to clean, and to remove stains. Bleach often refers, specifically, to a dilute solution of sodium hypochlorite (NaOCl or NaClO), also called “liquid bleach”, a household chemical widely used (since the 18th century) as a disinfectant or a bleaching agent. The compound in solution is unstable and easily decomposes, liberating chlorine, which is the active principle of such products. Indeed, sodium hypochlorite is the oldest and still most important chlorine-based bleach.

Bleach baths are dilutions of household bleach with water in a bath. The concentration of chlorine is similar to that of a swimming pool. It has antimicrobial action.

• The active compound in commercial household bleaches is sodium hypochlorite (NaOCl).
• Bleach contains 3–6% available chlorine (Cl2), approximately 0.5–1.5% sodium hydroxide (NaOH) as a stabilizer, small quantities of surfactants, and perfume.
• At pH 11–13, it is an alkaline aqueous solution with major oxidizing properties.
• Sodium hypochlorite 0.0006% is also available as a convenient wash suitable to use in a shower.

Bleach bath for your skin

Mix 2 ml of 2.2% household bleach for every 1 liter of water to make a 0.005% solution. Brands vary strength, so check the label. If the concentration is higher, use less bleach, and if the concentration is lower, use more bleach.

• Soak trunk and limbs in the bath for 10–15 minutes. Do not submerge head.
• Rinse off with warm tap water and pat dry with a towel. Avoid sharing towels.
• Apply topical steroid and moisturizers if prescribed.
• Bleach baths are recommended at least twice a week.
• Keep bleach out of reach from children.

Bleach bath side effects

Exposure to bleach baths can lead to:

• Dry skin
• Rash/dermatitis/skin irritation
• Asthma exacerbation
• Nasal irritation.

These symptoms are often due to added perfumes or detergents in the bleach. If troublesome, try another brand. Do not apply the bleach directly to the skin.

Toxicity or poisoning is rare but potentially very serious. It is usually due to ingestion of undiluted solution. Keep bleach in its original container with a child-proof top and make sure young children are not able to open it.

Ingestion of small volumes of bleach bath water may lead to:

• Irritation of the oropharynx,
• Burning sensation in the mouth and throat
• Thirst
• Nausea
• Vomiting
• Vomiting blood (hematemesis).

Ingestion of large amounts or more concentrated solutions can lead to:

• Corrosion of the mucous membranes
• Chest and abdominal pain
• Watery diarrhea
• Melena (blood in feces)
• Ulceration or perforation of the esophagus or stomach
• Hemorrhage and shock.

Bleach bath for staph infection

Staphylococcal infections of the skin and soft tissue are common, especially in children, and can be severe. Despite treatment, more than 20% of patients with skin and soft tissue infections have a recurrence within three months. Primary staphylococcal skin infections include:

• Impetigo
• Boils
• Folliculitis.

Secondary staphylococcal infections include:

• Infected eczema
• Infected wounds, including surgical wounds and trauma.

Predisposing factors for skin and soft tissue infections include:

• Bacterial colonization of the patient’s skin with Staphylococcus aureus
• The colonization of a family member’s skin
• Colonization with methicillin-resistant Staphylococcus aureus (MRSA)
• Dermatitis, particularly atopic eczema, discoid eczema and venous stasis eczema.

Attempts to reduce Staphylococcus aureus (S. aureus) by decolonization of the skin include combinations of:

• Bleach baths or shower washes ¹⁾
• Mupirocin nasal ointment
• Oral antibiotics (eg, flucloxacillin, rifampicin, doxycycline)
• Chlorhexidine solution as a bath or shower antiseptic cleanser
• General hygiene and wound care.

Bleach bath benefits

In conjunction with other methods of decolonization, bleach baths reduce rates of recurrent primary and secondary skin and soft tissue infections.

Bleach baths have a broad spectrum of action against:

• Bacteria (Gram-positive and Gram-negative)
• Fungi and spores
• Viruses.

No microbial resistance has been reported to sodium hypochlorite. The effect of bleach baths on decolonizing the patient’s skin is only temporary, so must be repeated regularly.

Bleach baths also seem to reduce inflammation and itching in eczema ²⁾.

Bleach bath for eczema

Clinical trials have actually proven that bleach baths to be very effective. In one of the first formal studies ³⁾, conducted at Northwestern University’s Feinberg School of Medicine, 31 children between the ages of 6 months and 17 years suffering from moderate to severe eczema were treated. Additionally, the children had signs that indicated they had some form of bacterial infection that aggravated their condition.

Half of the patients bathed in a tub of water diluted with household bleach twice a week, and the other half took baths without bleach twice a week. The bleach baths used one-half cup of 6% bleach in an average-size bathtub that was full of water (40 gallons). The final concentration of bleach to water was 0.005%. All patients also took an oral antibiotic (cephalexin) and had mupirocin ointment applied in their noses. Additionally, all patients were instructed to use anti-inflammatories and emollients as they normally would.

After 3 months of treatment, the children who took the bleach baths had a dramatic reduction in the severity of their eczema, 5 times greater than those who took the placebo baths. No patients withdrew from the study because of intolerance to the baths; however, one patient who received the bleach baths reported skin irritation and itching. That patient dropped out of the study and then developed a multidrug-resistant Staphylococcus aureus skin infection (commonly known as a staph infection) that resulted in hospitalization and IV antibiotics. After discharge from the hospital, the patient started bleach baths again and had no adverse effects.

Part of the reason the bleach bath therapy may be so effective is that 9 out of 10 people with eczema have Staphylococcus aureus on their skin, including some with methicillin-resistant Staphylococcus aureus (MRSA). Only about 2 out of 10 people in the general population do. Frequent scratching by eczema sufferers breaks the skin, which increases the likelihood of Staphylococcus aureus causing an infection. The diluted bleach helps to kill the microbes that cause these infections.

What is so extraordinary about this treatment is that it is not an expensive topical cream or new drug. For a few cents’ worth of household bleach, patients showed remarkable results comparable to more sophisticated and expensive medical treatment. For those with very sensitive skin, it is advisable to rinse off in the shower after a bleach bath.

While this may not be good news for pharmaceutical companies, it certainly is for eczema sufferers. Doctors now routinely recommend bleach baths to their patients with moderate to severe eczema in addition to regular gentle skin care and appropriate medication as needed. However, as with all treatments, people respond differently, so be sure to consult with your dermatologist before trying this therapy.