Apple cider vinegar soaks [0.5%] as a treatment for atopic dermatitis do not improve skin barrier integrity

Abstract

Background/Objectives Atopic dermatitis (AD) is a common chronic inflammatory skin condition associated with high transepidermal water loss, high skin pH, and Staphylococcus aureus skin colonization. The treatment of AD with bath additives remains highly debated. Recent evidence suggests that dilute apple cider vinegar (ACV) may improve skin barrier integrity in AD, but its safety and efficacy are not well studied. This pilot split‐arm study analyzed the effect of dilute apple cider vinegar soaks on skin barrier integrity in patients with atopic dermatitis as measured by skin transepidermal water loss and skin pH. Methods A total of 22 subjects (11 AD and 11 healthy controls) were enrolled. Subjects soaked both of their forearms for 14 days, with one arm in dilute ACV (0.5% acetic acid) and the other in water 10 minutes daily. Transepidermal water loss and pH were measured pre‐ and post‐treatment. Results In both groups, transepidermal water loss increased and pH decreased at 0 minutes post‐ACV treatment, but these effects were not sustained at 60 minutes. In total, 72.7% (16/22) of subjects reported mild side effects from ACV with improvement after discontinuing the soaks. Conclusions Dilute ACV soaks have no significant effect on skin barrier integrity but caused skin irritation in a majority of subjects. Study limitations include analysis of a single brand, dilution, and application of ACV. Future studies are needed to explore whether lower concentrations of ACV soaks or other applications such as a leave‐on acidic ointment could improve skin barrier integrity in a safe, nonirritating way.

Skin pH–dependent Staphylococcus aureus abundance as predictor for increasing atopic dermatitis severity

“…As previously described, skin pH cannot be easily altered sustainably by the study emollients although a short‐term change was observed (Figure ) 9,44 . However, especially in AD, a temporary difference in skin pH was observed, hinting toward a reduced buffer capacity in AD.…”

The infectious complications of atopic dermatitis

“…Another study reported that 0.5% acetic acid daily bath for 14 days did not improve skin barrier function or acidity in patients with AD, as compared with plain water baths. 53 In contrast, skin irritation was reported in some patients treated with dilute acetic acid. Chlorhexidine bath has been used in the decolonization of MRSA in the general population, but it has not been studied adequately in AD.…”

Contemporary pursuits of vinegar from scullery to dermatology

“…43 Patients with atopic dermatitis showed a significantly lessened skin tolerance for acetic acid and higher incidence of irritant reactions. 28,43 Chemical burns: partial or complete thickness burns have been reported on application of glacial acetic acid or undiluted acetic acid. 5 Vaginal burns, bleeding and blistering if accidently high concentration is applied.…”