Sodium Hypochlorite (Bleach) Is Not Recommended for Psoriasis Treatment
Sodium hypochlorite (bleach baths) has no established role in psoriasis management and is not mentioned in current psoriasis treatment guidelines. The American Academy of Dermatology's comprehensive 2021 guidelines for psoriasis topical therapy do not include sodium hypochlorite as a treatment option 1.
Why Bleach Baths Are Not Used for Psoriasis
Lack of Evidence and Guideline Support
- The most recent AAD/NPF joint guidelines (2021) for psoriasis management make no mention of sodium hypochlorite as a therapeutic option 1.
- Earlier AAD guidelines (2011) similarly do not include bleach baths in their comprehensive review of topical treatments for psoriasis 1.
- Bleach baths are specifically recommended only for atopic dermatitis with secondary bacterial infection and MRSA decolonization—not for psoriasis 2, 3.
Different Disease Pathophysiology
- Psoriasis is fundamentally different from atopic dermatitis: while atopic dermatitis benefits from bleach baths due to bacterial colonization with Staphylococcus aureus, psoriasis is primarily an IL-17-driven inflammatory condition without the same bacterial colonization pattern 4.
- Recent research shows that psoriasis involves sodium accumulation in the skin (not sodium deficiency), with higher skin sodium content correlating with disease severity 4.
- The pathogenic mechanism involves sodium-driven T helper 17 cell expansion, making sodium-containing treatments theoretically counterproductive 4.
What Actually Works for Psoriasis
Evidence-Based First-Line Topical Therapy
- Combination calcipotriene/betamethasone dipropionate applied once daily for 4-12 weeks is the recommended first-line approach for mild to moderate psoriasis 5.
- Mid- to high-potency topical corticosteroids combined with vitamin D analogues provide superior efficacy compared to either agent alone 5.
- Emollients should be applied in conjunction with active treatments to reduce itching and scaling 5.
Alternative Topical Options
- Coal tar preparations (0.5-1% in petroleum jelly, increasing to 10% as tolerated) 5.
- Anthralin starting at 0.1% concentration 5.
- Tazarotene 0.05-0.1% gel or cream combined with corticosteroids 5.
Critical Safety Consideration
If a patient mistakenly uses bleach baths for psoriasis, the primary risk is skin irritation from inadequate dilution 2. While properly diluted bleach baths are safe for skin when used appropriately for atopic dermatitis, they offer no therapeutic benefit for psoriasis and represent wasted time when evidence-based treatments should be initiated 2, 3.
Common Pitfall to Avoid
Do not confuse atopic dermatitis protocols with psoriasis management. Patients and providers may incorrectly assume that because bleach baths help inflammatory skin conditions like eczema, they would also benefit psoriasis—this is not supported by any evidence or guidelines 1, 2, 3.