Bleach baths may benefit patients with mild to severe atopic dermatitis

Bleach bathing is frequently recommended to treat atopic dermatitis (AD), but its efficacy and safety are uncertain. A study systematically synthesises randomized controlled trials (RCTs) addressing bleach baths for AD. They searched MEDLINE, EMBASE, CENTRAL, and GREAT from inception to December 29, 2021, for RCTs assigning AD patients to bleach versus 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. They obtained unpublished data, harmonized individual patient data, and did frequent and Bayesian random-effects meta-analyses.

Results:

• 10 RCTs 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).
• They 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.

Thus, bleach baths probably improve clinician-reported severity by a relative 22% in patients with moderate-to-severe AD. 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.

Reference:

Bleach baths for atopic dermatitis: A systematic review and meta-analysis including unpublished data, Bayesian interpretation, and GRADE by Layla Bakaa et al. published in the Annals of Allergy, Asthma & Immunology

DOI:https://doi.org/10.1016/j.anai.2022.03.024

Keywords:

Bleach, baths, atopic dermatitis, systematic review, meta-analysis, data, Bayesian, interpretation, and GRADE, Layla Bakaa, Jeffrey M. Pernica, Rachel J. Couban, Kelly Jo Tackett, Craig N. Burkhart, Liz Leins, PgDipACN(Paed), Joanne Smart, Maria Teresa Garcia-Romero, Itzel Guadalupe Elizalde-Jiménez, Michael Herd, Dip Paed, Rachel Netahe Asiniwasi, Annals of Allergy, Asthma & Immunology