Are Bleach Baths an Effective Adjunctive Treatment to Reduce the Severity of Atopic Dermatitis?
Date of Award
Selective Evidence-Based Medicine Review
Master of Science in Health Sciences - Physician Assistant
Physician Assistant Studies
OBJECTIVE: The objective of this selective EBM review is to determine whether or not bleach baths are an effective adjunctive treatment for reducing clinical severity of atopic dermatitis.
STUDY DESIGN: Review of three randomized controlled trials published after 2008, all written in English. The articles all compared a treatment arm, bleach baths, vs a placebo, water baths, as add on treatment to a stable regimen of anti-inflammatory medications and emollients.
DATA SOURCE: The three randomized controlled trials were found via PubMed, Cochrane Library, Alt Health Watch, AMED, and CINAHL PLUS. They were selected based on their relevance to the objective and as well as having patient-oriented outcomes.
OUTCOMES MEASURED: In this review, two methods for measuring severity were used. SCORing Atopic Dermatitis Index (SCORAD) and the Eczema Area and Severity Index (EASI). Patients were scored using this index before the study was conducted and re-scored after the treatments, using change from baseline to compare the outcomes.
RESULTS: The three studies selected in this review showed inconsistent data on the effectiveness of bleach baths reducing the clinical severity of atopic dermatitis. Wong, Ng, Baba, et al. (J Dermatol. 2013;40(11):874-880. doi: 10.1111/1346-8138.12265 [doi]) demonstrated a significant difference in EASI scores from baseline in treatment arm at 1 and 2 months, p< 0.001, and when the treatment arm was compared to the placebo arm, p=0.02. Hung, Abrams, Tlougan, et al.(Pediatrics. 2009;123(5):808. doi: 10.1542/peds.2008-2217 [doi]) found a significant decrease in baseline for the treatment arm compared to placebo arm at both 1 month, (p=.03) and 3 months, (p=.0005). Hon, Tsang, Lee, et al.(J Dermatolog Treat. 2016;27(2):156- 162. doi: 10.3109/09546634.2015.1067669 [doi]) showed no significant decrease in clinical severity in atopic dermatitis after using bleach baths, and showed a bigger reduction from baseline in the placebo arm than in the treatment arm p=.032.
CONCLUSION: The three randomized controlled trials studied in this review found inconsistent evidence that bleach baths could help reduce the severity of atopic dermatitis.
Klug, Allison S., "Are Bleach Baths an Effective Adjunctive Treatment to Reduce the Severity of Atopic Dermatitis?" (2020). PCOM Physician Assistant Studies Student Scholarship. 514.