Is there such a term as a bleach bath?

Bleach Baths in Medical Practice

Yes, bleach bath is a legitimate medical term referring to the addition of diluted sodium hypochlorite (household bleach) to bathwater as a therapeutic intervention for certain skin conditions. This treatment approach is recognized in clinical practice guidelines for conditions such as atopic dermatitis and recurrent skin infections.

Clinical Applications of Bleach Baths

For Atopic Dermatitis

• Bleach baths are recommended as an adjunctive treatment for patients with moderate to severe atopic dermatitis, particularly those with clinical signs of secondary bacterial infection 1
• The addition of sodium hypochlorite (bleach) to bathwater may be useful for reducing disease severity in atopic dermatitis patients 1
• A recent meta-analysis showed that bleach baths probably improve atopic dermatitis severity by a relative 22% compared to regular baths 2

For Recurrent Skin Infections

• Bleach baths are recommended as part of decolonization strategies for patients with recurrent methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections 1
• They are particularly indicated when a patient develops recurrent skin infections despite optimizing wound care and hygiene measures 1
• In vitro studies have shown that sodium hypochlorite at appropriate concentrations can kill community-acquired MRSA after 5 minutes of exposure 1

Preparation and Administration

Standard Dilution Recommendations

• For atopic dermatitis: The typical concentration is 1 teaspoon of bleach per gallon of bathwater 1, 3
• For MRSA decolonization: The recommended concentration is either:
  • 1 teaspoon per gallon of bathwater 1, or
  • 1/4 cup of bleach per 1/4 tub (approximately 13 gallons) of water 1

Duration and Frequency

• For MRSA decolonization: Bleach baths are typically given for 15 minutes twice weekly for up to 3 months 1
• For atopic dermatitis: Similar protocols are followed, though optimal duration of therapy is still being investigated 1, 2

Mechanism of Action

• Antimicrobial effect: Bleach baths reduce bacterial carriage, particularly Staphylococcus aureus, which commonly colonizes the skin of atopic dermatitis patients 4, 3
• Anti-inflammatory and antipruritic effects: Beyond antimicrobial properties, bleach appears to have anti-inflammatory effects that may contribute to symptom improvement 5
• Restoration of skin microbiome: Treatment may help normalize the cutaneous microbiota on lesional skin 6

Safety Considerations

• Potential for skin irritation: Clear instructions should be provided to patients as inadequate dilution can cause skin irritation 1
• The benefits and risks of irritants in bleach baths should be weighed prior to application 1
• Generally well-tolerated: When properly diluted, bleach baths appear to be safe on human skin without disrupting epidermal barrier function 3, 5
• Not recommended for infants under 2 months of age due to potential skin sensitivity 1

Evidence Quality and Limitations

• While evidence supports the use of bleach baths, some studies suggest they may not be more effective than water baths alone for atopic dermatitis 1
• Most studies have been conducted in pediatric populations with moderate-to-severe atopic dermatitis 2
• Long-term efficacy and safety data for extended use of bleach baths are still needed 3, 5

Bleach baths represent a relatively inexpensive, accessible treatment option that may reduce the need for topical corticosteroids or antibiotics in certain patients 3, 5.