Dilute bleach baths used for treatment of atopic dermatitis are not antimicrobial in vitro

Sawada, Yu; Tong, Yun; Barangi, Mariam; Hata, Tissa; Williams, Michael R.; Nakatsuji, Teruaki; Gallo, Richard L.

doi:10.1016/j.jaci.2019.01.009

Cited by 44 publications

(29 citation statements)

References 9 publications

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“…Most recently, NaOCl 0.005% was found to have no inhibitory effect on the Agr quorum‐sensing system of S aureus (which regulates expression of toxins) . The latter study also found no inhibitory effect on two strains of the commensal bacterium, S epidermidis, suggesting the possibility for the use of both dilute NaOCl and commensal bacterial as topical therapy in the future.…”

Section: Discussionmentioning

confidence: 90%

“…In addition, concentrations of 0.01%‐0.16% were required to eradicate S aureus biofilms in vitro and a concentration of 0.04% was required to reduce bacteria from AD skin in an ex vivo model . Most recently, NaOCl 0.005% was found to have no inhibitory effect on the Agr quorum‐sensing system of S aureus (which regulates expression of toxins) . The latter study also found no inhibitory effect on two strains of the commensal bacterium, S epidermidis, suggesting the possibility for the use of both dilute NaOCl and commensal bacterial as topical therapy in the future.…”

Section: Discussionmentioning

confidence: 97%

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Sodium hypochlorite body wash in the management of Staphylococcus aureus–colonized moderate‐to‐severe atopic dermatitis in infants, children, and adolescents

Majewski

Bhattacharya

Asztalos

et al. 2019

Pediatric Dermatology

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Objectives A cleansing body wash containing diluted sodium hypochlorite (0.006% NaOCl) was evaluated for management of moderate‐to‐severe Staphylococcus aureus–colonized, atopic dermatitis in children. Methods A 6‐week, prospective, open‐label study was conducted with 50 evaluable participants (ages 6 months to 17 years) who had moderate‐to‐severe atopic dermatitis with S aureus skin colonization documented by culture. Participants were instructed to continue using their current medications while using the study product, 0.006% NaOCl body wash, once daily to affected areas for 6 weeks. Primary outcome measures were Investigator's Global Assessment, Eczema Area and Severity Index, and Body Surface Area scores. Secondary outcome measures were the Visual Analog Scale for pruritus, Family Dermatology Life Quality Index, and Patient Satisfaction Questionnaire for Problem Areas. A subject daily diary and a six‐item subject questionnaire that provided information on preferences for bleach bath vs body wash were secondary outcome measures. Results Daily use of the 0.006% NaOCl body wash led to improvement for all outcome measures comparing baseline to 2‐week and to 6‐week evaluations. Of the 50 skin S aureus‐positive subjects, 32/50 (64%) were still positive at 2 weeks. A 36.5% decrease in subject's daily record of topical corticosteroid application at end of study compared to baseline was found. Participant surveys indicated preferences for the body wash over bleach baths. Conclusions Sodium hypochlorite (NaOCl) body wash improved all outcome measures for moderate‐to‐severe S aureus–colonized AD in infants, children, and adolescents. The limited reduction in S aureus further suggests that sodium hypochlorite has ameliorative effects other than antimicrobial actions.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 97%

Sodium hypochlorite body wash in the management of Staphylococcus aureus–colonized moderate‐to‐severe atopic dermatitis in infants, children, and adolescents

Majewski

Bhattacharya

Asztalos

et al. 2019

Pediatric Dermatology

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“…This is of great importance considering that many common skin care products have a rather basic pH 4 . Compared to water baths, dilute bleach baths do not consistently reduce AD severity and S aureus load in vivo and are not antimicrobial in vitro 45,46 . In the “Guidelines of care for the management of AD” from 2015, rather acidic skin care is advised, more recent publications confirm the benefit of acidification of the skin for improved barrier function in murine models 47–52 .…”

Section: Discussionmentioning

confidence: 99%

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

Hülpüsch

Tremmel

Hammel

et al. 2020

Allergy

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Background Atopic eczema (atopic dermatitis, AD) is characterized by disrupted skin barrier associated with elevated skin pH and skin microbiome dysbiosis, due to high Staphylococcus aureus loads, especially during flares. Since S aureus shows optimal growth at neutral pH, we investigated the longitudinal interplay between these factors and AD severity in a pilot study. Method Emollient (with either basic pH 8.5 or pH 5.5) was applied double‐blinded twice daily to 6 AD patients and 6 healthy (HE) controls for 8 weeks. Weekly, skin swabs for microbiome analysis (deep sequencing) were taken, AD severity was assessed, and skin physiology (pH, hydration, transepidermal water loss) was measured. Results Physiological, microbiome, and clinical results were not robustly related to the pH of applied emollient. In contrast to longitudinally stable microbiome in HE, S aureus frequency significantly increased in AD over 8 weeks. High S aureus abundance was associated with skin pH 5.7‐6.2. High baseline S aureus frequency predicted both increase in S aureus and in AD severity (EASI and local SCORAD) after 8 weeks. Conclusion Skin pH is tightly regulated by intrinsic factors and limits the abundance of S aureus. High baseline S aureus abundance in turn predicts an increase in AD severity over the study period. This underlines the importance and potential of sustained intervention regarding the skin pH and urges for larger studies linking skin pH and skin S aureus abundance to understand driving factors of disease progression.

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“… 27 Dilute bleach at 0.005% was not suppressive of S aureus growth or toxin production. 51 Acetic acid (apple cider vinegar) has been used as an antimicrobial bathing additive for AD, 52 , although its efficacy in S aureus clearance in AD has not been established. 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.…”

Section: Prevention Of Infections In Admentioning

confidence: 99%

The infectious complications of atopic dermatitis

Wang

Boguniewicz

et al. 2021

Annals of Allergy, Asthma & Immunology

114

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Objective Atopic dermatitis (AD) is a chronic inflammatory skin disease that is complicated by an increased risk for skin and systemic infections. Preventive therapy for AD is based on skin barrier improvement and anti-inflammatory treatments, whereas overt skin and systemic infections require antibiotics or antiviral treatments. This review updates the pathophysiology, diagnosis, management, controversy of antibiotic use, and potential treatments of infectious complications of AD. Data Sources Published literature obtained through PubMed database searches and clinical pictures. Study Selections Studies relevant to the mechanisms, diagnosis, management, and potential therapy of infectious complications of AD. Results Skin barrier defects, type 2 inflammation, Staphylococcus aureus colonization, and cutaneous dysbiosis are the major predisposing factors for the increased infections in AD. Although overt infections require antibiotics, the use of antibiotics in AD exacerbation remains controversial. Conclusion Infectious complications are a comorbidity of AD. Although not common, systemic bacterial infections and eczema herpeticum can be life-threatening. Preventive therapy of infections in AD emphasizes skin barrier improvement and anti-inflammatory therapy. The use of antibiotics in AD exacerbation requires further studies.

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Dilute bleach baths used for treatment of atopic dermatitis are not antimicrobial in vitro

Cited by 44 publications

References 9 publications

Sodium hypochlorite body wash in the management of Staphylococcus aureus–colonized moderate‐to‐severe atopic dermatitis in infants, children, and adolescents

Sodium hypochlorite body wash in the management of Staphylococcus aureus–colonized moderate‐to‐severe atopic dermatitis in infants, children, and adolescents

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

The infectious complications of atopic dermatitis

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