• This review reported the current understanding of the mechanism of action of bleach in modulating atopic dermatitis (AD). Bleach baths are reported to improve clinical symptoms of AD and restore surface microbiome by eradicating bacteria, most notably Staphylococcus aureus, as well as reducing biofilm, thus reducing the need for topical corticosteroids and antibiotics. Bleach may lead to significant reduction in pruritus and also has anti-inflammatory effects.
• As some studies included in this review were conducted with concomitant AD treatment modalities, studies to investigate the long-term use of bleach alone are needed. The emergence of new bleach-containing products may help improve the practicality of bleach use. These products thus deserve further investigation on their efficacy and safety.

  – InYoung Kim, MD, PhD

Abstract
Individuals with atopic dermatitis (AD) have used bleach baths to treat superinfections, although their mechanism of action is not well understood. The ClinicalTrials.gov, National Eczema Association, and PubMed databases were searched for studies that investigate the role bleach plays in modulating AD. Fifteen studies were included in this review. Bleach bath improves clinical symptoms of AD and restores surface microbiome by eradicating bacteria, most notably Staphylococcus aureus. Many studies have noted that this antimicrobial effect has reduced the need for topical corticosteroids or topical antibiotics. In addition, bleach seems to have strong anti-inflammatory and antipruritogenic effects. Lastly, bleach baths seem to be safe on human skin, without disrupting epidermal barrier function. Although the effects of bleach are promising, studies that investigate the long-term use of bleach alone, without concomitant AD treatment modalities, are needed. The emergence of new bleach-containing products warrants future investigations to examine their effects on cutaneous microbiome, epidermal barrier function, and immunity.

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Abstract