Bleach baths are recommended by the American Academy of Dermatology (AAD). They are an effective form of treatment for eczema in both children and adults. When I was at the National Institutes of Health, I was one of the first dermatologists to begin advocating the use of bleach baths as a way of controlling symptoms and reducing flare ups. If you are considering implementing these soaks as part of your eczema skin care regimen, read on to learn how to do it safely.
There are different measurements and considerations that need to be addressed before preparing a bleach bath. How big is the bath tub? Are you filling the tub halfway or completely full? In addition, it is important that you take the necessary precautions when selecting and handling the bleach. Never use bleach that contains fragrances. I have noticed some brands have several different scents, such as lemon, or mountain fresh. These will only exacerbate the condition, as fragrances are skin allergens that have been linked to worsening eczema flare ups.
The proper bleach bath protocol will include:
- Never pouring bleach directly on the skin
- Always wearing disposable, latex free gloves when dispensing bleach
- Precise measurements with measuring cup or measuring spoon
- Doctor discussion and instruction
- Never allow your child to prepare the bath themselves
How much bleach should you add to bleach bath?
- For a 1/4 full “normal sized” tub, add 1/8 cup of bleach.
- For a 1/2 full tub, add 1/4 cup of bleach.
- For a 3/4 full tub, add 3/8 cup of bleach.
These measurements will help the hypochlorite to be about .005% which is similar to what you will find in a swimming pool. Add the bleach while the water is running and wait until the bath is done before you or your child get in the tub. Recent studies have shown this treatment to be an effective part of controlling eczema in children. If your child closes their eyes, it won’t hurt them to fully submerse themselves into the bleach bath. These baths can be up to 20 minutes long.
Bleach baths are thought to help eczema for two reasons; firstly, they are antibacterial and are good and decreasing the number of Staph. aureus organisms on the skin of eczema sufferers. Secondly, the low level oxidation from the bleach turns on some anti-inflammatory pathways in the skin that help to calm the inflammation. Despite this benefits, bleach has one big problem; it is VERY alkaline and your skin is supposed to be acidic. When the skin pH becomes alkaline, skin barrier lipids production comes to a standstill and the skin barrier repairing functions of the skin become disabled. So, with a bleach bath, there is a trade off of decreasing Staph. colonization and a low level anti-inflammatory effect for a high pH and diminished skin barrier repair.
Based on this information, I think there is a better way to go; vinegar.
Vinegar Baths: Better Than Bleach Baths
There are few publications looking at the benefits of vinegar baths in eczema, yet my patients have been doing them for some time now and are getting results that are just as good or better than what they were getting with a bleach bath. The important part is the add the correct amount of vinegar to your bath and this depends on the pH of your tap water.
Here in Utah, the pH of our tap water is around 8! Your skin barrier should have a pH between 4.6 and 5.6. When you add 1/8 cup of bleach to a 1/2 full tub, the pH goes up to about 8.9!
When you add vinegar to our tap water, it takes between 3-4 cups to bring the pH of a half-full tub down to the 4.5 range. I usually tell my patients to add four cups because it is actually beneficial to “hyper-acidify” the skin barrier a LITTLE BIT. If you want to get good results, I would recommend that you buy a pH meter (usually less than $20 on Amazon) and check the pH until your bath water is between 4.2 and 4.4. And that is one of my secrets to getting your eczema to behave.
Do not rinse the vinegar water from your skin when you get out of the tub. Simply blot the skin dry and then apply your TrueLipids Eczema Experts 1% Hydrocortisone cream followed by TrueLipids Relieve & Protect Ointment 2 to 4 times/day until the skin is cleared. Once the skin is cleared, then apply the TrueLipids Ceramide+ Cream followed by the Ointment twice a day to keep your skin happy.
Even though I was one of the first dermatologists to begin advocating the use of bleach baths, I am now one of the first to advocate the use of vinegar baths over bleach baths.
One important note: antibiotics are seldom necessary when treating eczema. In fact, I have only prescribed them once in my entire career to an atopic eczema patient who was covered in frank infection. For the vast majority of cases, the skin barrier needs to be optimized and the pH needs to be balanced. I believe that if you fix the skin pH, you then fix the microbiome of the skin. And there is another big secret.