Eczema News: Using Bleach Baths To Manage Flares

Hot water and bubble baths may sound relaxing to many, but for those with atopic dermatitis, this can have the opposite effect, causing dry, scaly, red patches to develop on the skin. Affecting nearly 28 million Americans, atopic dermatitis - also known as eczema - is frequently described as the “itch that rashes.”

Since the condition makes it harder for the skin to keep out harmful germs, viruses and other germs, people with eczema often have sensitive skin prone to inflammation and infections. Although there is no cure for eczema, dermatologists from the American Academy of Dermatology say those with moderate to severe eczema can improve their symptoms and reduce their risk of skin infections using bleach bath therapy.

“Bleach is antibacterial, and studies have shown that a diluted bleach bath may reduce eczema symptoms by reducing germs and inflammation on the skin,” says board-certified dermatologist Ross Radusky, MD, FAAD. “However, it’s important to follow your dermatologist’s recommendations carefully in order for this treatment to be safe and effective.”

A bleach bath may be helpful a few times a week. However, it shouldn’t be used daily as this can be too drying to the skin. 

To prepare a bleach bath:

1. Use regular strength (six percent) bleach. Make sure it is plain bleach, and do not use splash-less or concentrated bleach, or bleach that has fragrance.
2. Measure the amount of bleach before adding it to your bath water. Adding too much bleach can irritate your skin. However, adding too little may not be helpful. Use a half cup of bleach for a full bathtub of water, a quarter cup of bleach for a half-full tub of water, and one teaspoon of bleach per gallon of water for a baby or toddler bathtub.  
3. Pour the bleach into the running bath water while the tub is filling.Wait until your bath is fully drawn before entering the bathtub. Make sure you use lukewarm bathwater, since hot water can dry out the skin, causing your eczema to flare. Do not submerge your head in the water; only soak from the neck down.
4. Never apply bleach directly to your eczema.
5. Ask your dermatologist how long to soak in the tub. Most dermatologists recommend a five-to10-minute soak. Afterwards, turn on the shower and gently rinse your skin with lukewarm water - no soap - before exiting the bathtub.
6. Gently pat your skin dry after the bath. Use white towels if you are concerned about bleach stains.
7. If your eczema requires medication, apply it immediately after the bath.Then apply your moisturizer.

“Keep in mind that bleach baths are one component of an overall treatment plan that includes medicine and a good skin care routine,” Radusky added. “To improve your eczema and prevent flare-ups, talk to a board-certified dermatologist to create a treatment plan that’s tailored to your needs.” These tips are demonstrated in Eczema: Bleach Bath Therapy, a video posted to the AAD website and YouTube channel.

Atopic Dermatitis And Adults

Although eczema is commonly diagnosed in infancy and early childhood, it also can affect adults sometimes more profoundly than younger patients. “Adult eczema patients may have dealt with their symptoms for their entire lives, which can be draining, or they may experience symptoms for the first time as adults, which can be a difficult adjustment,” says board-certified dermatologist Jonathan I. Silverberg, MD, Ph.D., MPH, FAAD, an assistant professor at Northwestern University Feinberg School of Medicine and director of the Northwestern Medicine Multidisciplinary Eczema Center in Chicago. “Either way, this condition can take a real toll on them.”

According to current estimates, this disease affects about half as many adults as it does children, but prevalence among adults may be increasing, reflecting a recent increase in overall eczema prevalence. Although some may mistakenly view the condition as a childhood disease and not a serious health problem for older patients, eczema can have a significant impact on adults’ quality of life.

“People who aren’t familiar with the disease might say, ‘It’s just eczema,’” Silverberg says. “But for many patients, it’s not ‘just eczema.’ It can be debilitating.”

Atopic dermatitis can make everyday tasks and routine physical activities difficult, affect work attendance and performance, disrupt sleep, and contribute to mental health issues like anxiety and depression. Additionally, patients with eczema in visible locations may struggle in social situations, particularly if they face stigma from other people who incorrectly believe the disease is contagious or associated with poor hygiene.

“Fortunately for atopic dermatitis patients, treatment can help alleviate the negative effects of this disease and improve their physical and mental well-being,” he says.

In addition to identifying and managing the factors that trigger flares and exacerbate the condition, atopic dermatitis treatment regimens may include moisturizers, topical steroids or calcineurin inhibitors, phototherapy, or systemic medications.

Within the last year, the U.S. Food and Drug Administration approved two new treatment options for atopic dermatitis - an anti-inflammatory topical medication for mild to moderate disease and an injectable systemic drug for moderate to severe disease. There are additional treatments in the development pipeline.

“This is an exciting time that offers a lot of hope and promise for people with eczema, both children and adults,” Silverberg continued. “If you’re struggling with this disease, there are treatment options out there for you, and a board-certified dermatologist can help you find the eczema management plan that works best for you and improve your quality of life.” 

Treating Severe Eczema With Allergy Shots

If you’ve suffered with severe eczema for a long time and have tried what you think is every available option for relief, you may want to consider allergy shots. A medically-challenging case presented at the American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting found that allergy shots provided significant benefits to the eczema symptoms suffered by a 48-year-old man.

“The man had suffered with severe eczema since childhood,” says allergist Anil Nanda, MD, ACAAI member and lead author of the paper. “He had tried many previous therapies for years including mild and high-strength topical corticosteroid cream, as well as other topical anti-inflammatory creams and topical moisturizer creams.

“Biologic therapy has been available to treat eczema for about a year and-a-half but was not yet a treatment option at the time we saw this man,” Nanda continued. “We thought allergy shots might be beneficial because he also had multiple allergies.

We conducted skin testing and found the man was allergic to dust mites, weeds, trees, grasses, mold, cats and dogs,” added allergist Anita Wasan, MD, ACAAI member and co-author of the paper. “Because his allergies could all be treated with allergy shots, we thought treating his allergies might also benefit his eczema.

After one year, he reported significant benefit to his symptoms, which was great news. And once he reached a maintenance dose of allergy shots, he no longer needed high-dose steroid therapy for his eczema.”

New and existing treatments for eczema can reduce the severity of symptoms like itching and excessively dry skin. Eczema is a chronic condition, and symptoms can come and go.  An allergist can help you find relief from this chronic disease. Allergists are specialists in allergic diseases like eczema and are trained to help you take control of your symptoms, so you can live the life you want.

Link Between Eczema And Cardiovascular Disease 

For the roughly seven percent of adults who live with atopic dermatitis, a common form of eczema, a recent study reports a little good news: Despite recent findings to the contrary, the skin condition is likely not associated with an increase in cardiovascular risk factors or diseases.

"In our study, people who reported having atopic dermatitis were not at any increased risk for high blood pressure, Type 2 diabetes, heart attacks or strokes," said lead author Dr. Aaron Drucker, an assistant professor of dermatology at the Warren Alpert Medical School of Brown University and a physician with the Lifespan Physicians Group. The findings appear in the British Journal of Dermatology.

Drucker and a team of co-authors made the findings by analyzing the records of 259,119 adults aged 30 to 74 in the Canadian Partnership for Tomorrow Project. Drucker led the data analysis with the hypothesis, suggested by two recent studies, that people with atopic dermatitis (AD) would be significantly more likely to have various cardiovascular problems.

A diagnosis of AD was associated with somewhat reduced risk of stroke, hypertension, diabetes and heart attack. Drucker emphasized, however, that he does not believe that AD is protective. Given the mixed evidence accumulated by researchers, the best conclusion is that AD is likely not positively associated with cardiovascular disease.

"It's important to make this clear so it doesn't get misinterpreted: Even though we found lower rates of these outcomes with atopic dermatitis, we are not interpreting that as atopic dermatitis decreasing the risk," he said.

The findings are based on a statistical analysis that accounted for confounders including age, gender, ethnic background, body-mass index, smoking, alcohol consumption, sleep, physical activity and asthma. The suspicion that AD might be associated with cardiovascular disease has likely arisen from the better-substantiated association researchers have found between the skin condition psoriasis and cardiovascular disease.

But while the two inflammatory skin ailments share some clinical similarities, they work differently at the molecular level, which might explain why only one may be associated with cardiovascular disease.

"In response to the increased risk of cardiovascular disease discovered for psoriasis, clinicians and psoriasis patients have been encouraged to more actively screen for and manage cardiovascular disease," Drucker said. "It appears that similar measures may not be warranted for atopic dermatitis."

Drucker acknowledged that the study could not answer the question of whether AD severity might correlate with cardiovascular disease. He said he is pursuing that question in new research, though there is a paucity of datasets that include both severity information and cardiovascular disease diagnoses.

Learn more about eczema and dermatitis at verywellhealth.

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