Bleach Baths for Moderate-to-Severe Atopic Dermatitis with Staph Colonization
Never apply undiluted household bleach (Clorox) directly to your skin—this will cause severe chemical burns and irritation. 1 Instead, use properly diluted bleach baths as an adjunctive treatment alongside your topical corticosteroids and emollients.
Proper Bleach Bath Protocol
The American Academy of Dermatology recommends dilute bleach baths specifically for patients like you with moderate-to-severe atopic dermatitis and clinical signs of secondary bacterial infection (crusting, weeping, or pustules). 1, 2
Exact Preparation Instructions
- Add 1/4 cup of regular household bleach (6% sodium hypochlorite) to a standard bathtub filled 1/4 full (approximately 13 gallons of water). 1, 2
- Alternative measurement: 1 teaspoon of bleach per gallon of bathwater. 3, 2
- This creates a 0.005% sodium hypochlorite solution—the same concentration as a swimming pool. 2
Treatment Schedule
- Soak for 15 minutes per session. 1, 2
- Perform bleach baths twice weekly for up to 3 months. 3, 1, 2
- Pat skin dry (do not rub) and immediately apply your emollient to lock in moisture. 1
Critical Safety Warnings
- Never mix bleach with any other cleaning products, especially ammonia—this creates toxic chlorine gas. 1
- Ensure good bathroom ventilation during the bath. 1
- Avoid getting bleach water in your eyes. 2
- Inadequate dilution causes severe skin irritation—measure carefully and follow written instructions exactly. 3, 2
Combination Therapy for Maximum Benefit
Bleach baths work best when combined with intranasal mupirocin ointment, which targets the nasal reservoir of Staphylococcus aureus that can continuously re-seed your skin. 2, 4
- Apply mupirocin ointment inside both nostrils twice daily for 5 consecutive days each month during your 3-month bleach bath course. 2, 4
- This combination approach produced significantly greater reductions in eczema severity scores at 1 month and 3 months compared to placebo in the landmark pediatric trial. 4
Continue Your Core Eczema Treatments
Do not stop your topical corticosteroids—bleach baths are adjunctive therapy, not a replacement. 5, 2
- Continue applying your topical corticosteroid no more than twice daily to affected areas. 5
- Use the lowest potency that controls your symptoms. 5
- Maintain liberal emollient use even when skin appears clear—this is the cornerstone of maintenance therapy. 5
Expected Outcomes and Evidence Strength
- A 2022 systematic review and meta-analysis found that bleach baths probably improve clinician-reported AD severity by a relative 22%, with moderate certainty of evidence. 6
- Approximately 1 in 10 patients will achieve a 50% improvement in disease severity. 6
- Bleach baths may slightly reduce skin S. aureus colonization (low certainty evidence). 6
- Interestingly, the original 2009 pediatric trial showed that body sites submerged in bleach baths improved significantly, but the head and neck (not submerged) did not improve—suggesting a direct antimicrobial effect rather than systemic benefit. 4
Important Caveats
- One 2016 crossover trial found that water baths alone were as effective as bleach baths for reducing AD severity over 4 weeks, though bleach baths did reduce topical corticosteroid and antibiotic use. 7
- The evidence for bleach baths is moderate quality at best, with small sample sizes and short treatment durations in most trials. 6
- Adverse events—mostly dry skin, irritation, and itch—occur in both bleach and water bath groups, though the difference is uncertain. 6
When to Seek Further Care
- If you develop grouped vesicles, punched-out erosions, or sudden deterioration with fever, suspect eczema herpeticum—this is a medical emergency requiring immediate oral or IV acyclovir. 5
- If your eczema does not improve after 4 weeks of appropriate topical therapy plus bleach baths, you need referral for systemic therapy (phototherapy, immunosuppressants, or biologics like dupilumab). 5