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Sodium hypochlorite washes

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Sodium hypochlorite washes are skin cleansers formulated with sodium hypochlorite (NaOCl) and surfactants. These cleansing liquids or gels are lathered onto wet skin and rinsed off. They are recommended for inflammatory skin conditions (eczema, atopic dermatitis and radiation dermatitis), microbial driven skin disorders (folliculitis, acne, ring worm, skin infections and staph colonization) and body odor.[1]

Sodium hypochlorite bath

Sodium hypochlorite baths became an acceptable treatment of atopic dermatitis due to a 2009 landmark study by JT Huan.[2] The use of sodium hypochlorite in the form of a bleach bath, has been reported to improve atopic dermatitis severity in children with moderate-to-severe dermatitis or eczema.[3][4]

Solutions of 0.05–0.06% NaOCl are considered safe and still maintain bactericidal activity against Staphylococcus aureus.[5][6] Bleach bath dilution can be achieved by adding approximately 1/4 cup of household bleach (6% or 8.5%) to a ½ bathtub (13 gallons) of water.[7] A person would then submerge themselves, from the neck down, or the affected area in the bath for 10 to 30 minutes. Significant reduction in eczema severity was demonstrated in 31 Staphylococcus aureus infected atopic dermatitis patients after 3 months of using dilute bleach baths twice a week, in a randomized, single-blind, placebo-controlled trial.[4][8] In another clinical trial, Wong evaluated 36 moderate-to-severe atopic dermatitis patients with clinical skin infection and reported improved disease severity with the use of twice-weekly dilute bleach baths.[3]

In addition to having bactericidal activity, sodium hypochlorite baths have been shown to have a direct effect on suppressing NF-κB signaling in the outermost layer of skin in mice, and reduced dermatitis severity in a mouse model of radiation dermatitis.[9] Findings suggest that sodium hypochlorite baths may have a direct suppressive effect on the inflammation. The same investigators demonstrated an anti-aging effect of bleach bath in mice.[9]

Some cases of severe burns have been reported for using too much bleach within the water.[10] Using too little bleach may not be effective and the American Academy of Dermatology recommends using regular strength bleach, not concentrate.[11]

Sodium hypochlorite cleansers

A sodium hypochlorite cleanser is used to cleanse and soothe skin that is prone to infection and conditions such as eczema, atopic dermatitis, folliculitis and other skin conditions.[12] The first cleansers using sodium hypochlorite for the treatment of skin conditions were developed by Dr. Azam Anwar, Founder and Chairman of TopMD Skin Care Inc. (Dallas, TX) and Clay J. Cockerell,[13] a dermatopathologist and clinical professor of dermatology and dermatopathology at the University of Texas Southwestern Medical Center.[14][15] The idea for cleansers came from bleach baths which were used to kill bacteria to prevent infections and treat infections after they occurred. Cleansers were formulated into body washes for a gentle, convenient use in the shower as opposed to having bath treatments.[12]

A 2013 study with 18 children (6 months of age and older), showed positive responses using a sodium hypochlorite-formulated body wash called CLn BodyWash to treat atopic dermatitis.[16] The study used an Investigator Global Assessment (IGA) score and measured the body surface area affected by the dermatitis.[16] Patients saw an overall IGA improvement with a mean reduction of 14.8% in affected body surface area.[16] A 2014 study led by Dr. Adelaide Herbert showed a decrease in severity scores of 23–35% within 2 weeks and 35–45% reduction in severity scores after 6 weeks using this same wash.[17]

References

  1. ^ Polin, Richard A.; Ditmar, Mark F. (2015). Pediatric Secrets. Elsevier Health Sciences. ISBN 978-0323315807. OCLC 698080046.[page needed]
  2. ^ Goddard, Allison L.; Lio, Peter A. (15 July 2015). "Alternative, Complementary, and Forgotten Remedies for Atopic Dermatitis". Evidence-Based Complementary and Alternative Medicine. 2015: 676897. PMC 4518179. PMID 26257817.
  3. ^ a b Wong, SM; Ng, TG; Baba, R (20 September 2013). "Efficacy and safety of sodium hypochlorite (bleach) baths in patients with moderate to severe atopic dermatitis in Malaysia". The Journal of Dermatology. 40 (11): 874–80. doi:10.1111/1346-8138.12265. PMID 24111816.
  4. ^ a b Huang, JT; Abrams, M; Tlougan, B; Rademaker, A; Paller, AS (12 May 2009). "Treatment of Staphylococcus aureus colonization in atopic dermatitis decreases disease severity". Pediatrics. 123 (5): e808–14. CiteSeerX 10.1.1.318.6231. doi:10.1542/peds.2008-2217. PMID 19403473.
  5. ^ McKenna, PJ; Lehr, GS; Leist, P; Welling, RE (September 1991). "Antiseptic effectiveness with fibroblast preservation". Annals of Plastic Surgery. 27 (3): 265–68. doi:10.1097/00000637-199109000-00011. PMID 1952753.
  6. ^ Coetzee, E; Whitelaw, A; Kahn, D; Rode, H (17 November 2011). "The use of topical, un-buffered sodium hypochlorite in the management of burn wound infection". Journal of the International Society for Burn Injuries. 38 (4): 529–33. doi:10.1016/j.burns.2011.10.008. PMID 22100425.
  7. ^ Gibson, Lawrence E. "Can a bleach bath treat chronic eczema?". Mayoclinic.org. Retrieved 8 November 2015.
  8. ^ Huang, JT; Rademaker, A; Paller, AS (February 2011). "Dilute bleach baths for Staphylococcus aureus colonization in atopic dermatitis to decrease disease severity". Archives of Dermatology. 147 (2): 246–47. doi:10.1001/archdermatol.2010.434. PMID 21339459.
  9. ^ a b Leung, TH; Zhang, LF; Wang, J; Ning, S; Knox, SJ; Kim, SK (15 November 2013). "Topical hypochlorite ameliorates NF-κB-mediated skin diseases in mice". The Journal of Clinical Investigation. 123 (12): 5361–70. doi:10.1172/JCI70895. PMC 3859383. PMID 24231355.
  10. ^ Meddows, David (26 August 2015). "Bleach bath burns: Mum's horrific injuries after alleged skin care advice from doctor". Retrieved 8 November 2015.
  11. ^ "Eczema: Bleach bath therapy". American Academy of Dermatology. Retrieved 8 November 2015.
  12. ^ a b "Treating Skin Conditions Like Acne & Eczema". Bloomberg. Retrieved 8 November 2015.
  13. ^ "Sodium-hypochlorite-based body wash compositions". Google Patents. Retrieved 8 November 2015.
  14. ^ "Product Questions". CLn Skin Care. Retrieved 8 November 2015.
  15. ^ "Melanoma Monday pushes skin cancer checkus". North Hills, Pennsylvania: New Record. 1 May 1995.
  16. ^ a b c Ryan, Caitriona; Shaw, Richard E.; Cockerell, Clay J.; Hand, Shari; Ghali, Fred E. (30 May 2013). "Novel Sodium Hypochlorite Cleanser Shows Clinical Response and Excellent Acceptability in the Treatment of Atopic Dermatitis". Pediatric Dermatology. 30 (3): 308–15. doi:10.1111/pde.12150. PMC 3666086. PMID 23617366.
  17. ^ Herbert, Adelaide. "Improved Clinical and Quality of Life Assessments and Decreased aureus Colonization in Pediatric Subjects with Moderate to Severe Atopic Dermatitis". UTHealth. Retrieved 8 November 2015.
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