Bleach Baths and Nasal Antibiotics

Staphylococcus aureus is a bacterium that lives in relatively small numbers on normal skin without a problem. On eczematous skin, however, it is a different story. In atopic dermatitis the skin and inside of the nose tends to be colonised by large numbers of S. aureus which play a part in aggravating the condition and causing secondary bacterial infection.

A recent study performed in Chicago* has investigated the effect of reducing the number of S.aureus in patients with infected atopic dermatitis. The investigators recruited 31 patients with infected atopic dermatitis aged between 6 months and 17 years. All patients were given a two week course of an oral antibiotic (cephalexin) and were randomly split into two groups. One group was assigned an ‘active’ regimen of antibacterial treatment, and the other a placebo regimen, both for three months. The active group were given an antibiotic ointment (mupirocin) to be applied to the inside of the nose twice daily on five consecutive days each month, and instructed to soak in a dilute sodium hypochlorite (bleach) bath for five to 10 minutes twice a week. The placebo group were given the same instructions but using a dummy nasal ointment and fake solution for the bath. Neither patient nor investigator knew who was receiving active or placebo treatment.

Over the three months the improvement in the skin condition was measured using a standard system known as the Eczema Area and Severity Index (EASI). The results showed that there was a significant improvement in the skin of the active group compared to the placebo group after one and three months. Interestingly this improvement was only seen from the neck down, ie the area of the body which was immersed in the bath.

This was only a small study and the authors cautiously concluded that the use of nasal ointment and bleach baths to control S aureus may help in the management of infection-prone atopic dermatitis. They stressed that additional studies are needed to confirm these findings. Also there are real safety problems with the use of bleach baths. They are not something to try at home without strict medical advice and supervision. [The dilution used in this study was 0.005%].

*Reference: Huang, Abrams, Tlougan Pediatrics 2009;123:e808-814

Article Written By Dr Rupert Mason And Adapted From An Original Article released by Pediatrics, Official Journal of the American Academy of Pediatrics

 

Page created: 22 May 2009