Q:

10/30/2012
There seems to be an epidemic of atopic dermatitis in young children, which can be poorly responsive to treatment including evaluating for food allergy, hydration, emollients, topical corticosteroids and/or immunomodulators. When do you recommend a trial of dilute bleach baths? And what are the nuts and bolts of it. How much bleach to how much water, how much time in the tub, any necessary precautions- such as what if eyes get splashed. When do you recommend wet wraps and how best to do it? What kind of bandages should be used, etc?  As always your help is greatly appreciated.

A:

Thank you for your inquiry.

Dilute bleach baths are usually employed for patients with moderate to severe atopic dermatitis. Wet wraps, which are far more arduous to do, are usually indicated in patients with moderate to severe atopic dermatitis.

I copied for you below the formula for a dilute bleach bath which is present on the Academy’s website and has been reviewed by Dr. Thanai Pongdee, who is in charge of our website. The link to the full article is here should you wish to read further.

Diluted bleach bath recipe and instructions:
Add ¼ - ½ cup of common household bleach to a bathtub full of water. Soak your torso or just the affected part of your skin for about 10 minutes. Limit diluted bleach baths to no more than twice a week. Do not submerge your head and be very careful to avoid getting the diluted bleach into the eyes. Rinse off with fresh water and apply moisturizer.

In addition, there is an excellent video from “Dermtube.com” which will give you explicit instructions as to how to prepare and use dilute bleach baths. Finally, the same site has a video presenting, in detail, the “nuts and bolts" of how to prepare and use wet wraps.

Thank you again for your inquiry and we hope this response is helpful to you.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology