Chronic, severe eczema can mar a childhood. The skin disorder starts with red, itchy, inflamed skin that often becomes crusty and raw from scratching. The eczema disturbs kids' sleep, alters their appearance and affects their concentration in school. The itching is so bad kids may break the skin from scratching and get chronic skin infections that are difficult to treat, especially from methicillin-resistant Staphylococcus aureus (MRSA).
Researchers from the Northwestern University Feinberg School of Medicine have discovered powerful relief in the form of diluted beach baths. It's a cheap, simple and safe treatment that drastically improves the rash as well as reduces flare-ups of eczema, which affects 17 percent of school-age children.
The study found giving pediatric patients with moderate or severe eczema (atopic dermatitis) diluted bleach baths decreased signs of infection and improved the severity and extent of the eczema on their bodies. That translates into less scratching, fewer infections and a higher quality of life for these children.
The typical treatment of oral and topical antibiotics increases the risk of bacterial resistance, something doctors try to avoid, especially in children. Bleach kills the bacteria but doesn't have the same risk of creating bacterial resistance.
Patients on the bleach baths had a reduction in eczema severity that was five times greater than those treated with placebos over one to three months, said Amy S. Paller, M.D., the Walter J. Hamlin Professor and chair of dermatology, and professor of pediatrics, at the Feinberg School. Paller also is an attending physician at Children's Memorial Hospital.
The study will be published in the journal Pediatrics April 27.
"We've long struggled with staphylococcal infections in patients with eczema," Paller said. She noted more than two-thirds of eczema patients have evidence of staphylococcus on their skin, the bacteria that most commonly causes infection and worsens the eczema. "This study shows that simple household bleach, which we think decreases the staphylococcus on the skin, can help these children."
In the study, Paller and researchers treated 31 pediatric patients (6 months to 17 years old) who had eczema and a bacterial staph infection for 14 days with oral antibiotics. Half of the patients received bleach in their bath water (half a cup per full standard tub), while the other half received a look-alike placebo. Patients were also instructed to put a topical antibiotic ointment or placebo control into their nose (where the staphylococcus can also grow) for five sequential days of each month. All were instructed to bathe in the bleach twice a week, and soak for five to 10 minutes for three months.
Paller said bathing in the diluted bleach bath water was surprisingly odor-free because of the small amount of bleach added. "In our clinics, no one had the just-out-of-the-swimming pool smell," she said.
The research team saw such rapid improvement in the kids taking the real bleach baths that they terminated the study early because they wanted the children getting the placebo to get the same relief.
"The eczema kept getting better and better with the bleach baths and these baths prevented it from flaring again, which is an ongoing problem for these kids," Paller said. "We presume the bleach has antibacterial properties and decreased the number of bacteria on the skin, which is one of the drivers of flares."
Northwestern researchers launched the study to confirm their hunch about the potential of bleach baths, "since bleach has been used by hospitals in the past few years as a disinfectant to decrease MRSA," Paller said.
One interesting finding in the study was the eczema on the body, arms and legs improved dramatically with the bleach baths, but the face, which was not submerged in the bath, did not improve, further evidence of the positive effect of the bath.
As a result of the study, Paller suggests that kids who have eczema on their face close their eyes and mouths and dunk under the water to help improve the lesions. In her practice, patients have found that even daily bleach baths are well tolerated. The bleach baths may also be useful for individuals with frequent staphylococcus infection, whether related to eczema or not, and in adults with eczema and recurrent infections.
To help treat a rising number of severe cases of eczema, Northwestern's Feinberg School has recently opened an Eczema Care & Education Center (www.eczemacarecenter.com).
The new center offers patients one-on-one instruction for treating eczema, while a support group helps patients and their families cope with the emotional aspects of the disease.
"This is a disorder that can drive people crazy," said Peter Lio, M.D., director of the Eczema Care & Education Center and an assistant professor of dermatology and of pediatrics at the Feinberg School. "Eczema beats people down."
Lio said he just worked with an 11-year-old girl who had missed a half-year of school because of her severe eczema. "As we were working with her and demonstrating how to treat her skin, she started weeping," he said. "Between the tears, she said 'I'm crying because I know I'm going to get better.' "
Scientists believe eczema may be triggered by urban pollutants and toxins and/or allergies, and certainly shows a genetic tendency. "We don't have all the answers and are still learning about this disease," Lio said.
By Northwestern University