Sodium hypochlorite body wash in the management of Staphylococcus aureus–colonized moderate‐to‐severe atopic dermatitis in infants, children, and adolescents

• Published in: Pediatric dermatology Vol. 36; no. 4; pp. 442 - 447
• Main Authors: Majewski, Sara, Bhattacharya, Tanya, Asztalos, Manuela, Bohaty, Benjamin, Durham, Katherine C., West, Dennis P., Hebert, Adelaide A., Paller, Amy S.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.07.2019; John Wiley and Sons Inc
• Subjects: Administration, Cutaneous; Adolescent; Adolescents; Age Factors; Atopic dermatitis; Baths; bleach; body wash; Child; Child, Preschool; Children; Cohort Studies; Colonization; Corticosteroids; Dermatitis; Dermatitis, Atopic - drug therapy; Dermatitis, Atopic - microbiology; Disinfectants - pharmacology; Eczema; Female; Follow-Up Studies; Humans; Infant; Infants; Male; Original; Patient Safety; Patient satisfaction; Prospective Studies; Pruritus; Questionnaires; Risk Assessment; Severity of Illness Index; Sex Factors; Skin; Sodium; Sodium hypochlorite; Sodium Hypochlorite - pharmacology; Staphylococcal Skin Infections - diagnosis; Staphylococcal Skin Infections - drug therapy; Staphylococcus aureus; Teenagers; Time Factors; Treatment Outcome; atopic dermatitis; sodium hypochlorite; body wash; bleach
• DOI: 10.1111/pde.13842
• ISSN: 0736-8046; 1525-1470

Objectives A cleansing body wash containing diluted sodium hypochlorite (0.006% NaOCl) was evaluated for management of moderate‐to‐severe Staphylococcus aureus–colonized, atopic dermatitis in children. Methods A 6‐week, prospective, open‐label study was conducted with 50 evaluable participants (ages 6 months to 17 years) who had moderate‐to‐severe atopic dermatitis with S aureus skin colonization documented by culture. Participants were instructed to continue using their current medications while using the study product, 0.006% NaOCl body wash, once daily to affected areas for 6 weeks. Primary outcome measures were Investigator's Global Assessment, Eczema Area and Severity Index, and Body Surface Area scores. Secondary outcome measures were the Visual Analog Scale for pruritus, Family Dermatology Life Quality Index, and Patient Satisfaction Questionnaire for Problem Areas. A subject daily diary and a six‐item subject questionnaire that provided information on preferences for bleach bath vs body wash were secondary outcome measures. Results Daily use of the 0.006% NaOCl body wash led to improvement for all outcome measures comparing baseline to 2‐week and to 6‐week evaluations. Of the 50 skin S aureus‐positive subjects, 32/50 (64%) were still positive at 2 weeks. A 36.5% decrease in subject's daily record of topical corticosteroid application at end of study compared to baseline was found. Participant surveys indicated preferences for the body wash over bleach baths. Conclusions Sodium hypochlorite (NaOCl) body wash improved all outcome measures for moderate‐to‐severe S aureus–colonized AD in infants, children, and adolescents. The limited reduction in S aureus further suggests that sodium hypochlorite has ameliorative effects other than antimicrobial actions.