Bleach baths for atopic dermatitis

Atopic dermatitis (eczema) is a common, chronic, relapsing itchy, inflammatory skin disease. It is characterised by abnormalities in skin barrier structures, an exaggerated immune response to environmental antigens, defects in innate immunity and alteration in skin flora. This can result in increased susceptibility to bacterial, fungal and viral infections. Clinically, infected (impetiginised) eczema is erythematous, pustular, exudative, crusted and spreads rapidly. Overgrowth of Staphylococcus aureus is an important contributing factor to exacerbations of eczema, independent of true secondary infection. With this in mind, clinicians are increasingly recommending antiseptic treatments, including diluted bleach baths, for decolonisation therapy. Bleach baths are recommended by the American Academy of Dermatology and National Eczema Association as an adjunct to the treatment of severe eczema with recurrent infections4 and interest in this therapy is now increasing around the world.