Bleach baths for atopic dermatitis: A systematic review and meta-analysis including unpublished data, Bayesian...

Area of Science:

• Dermatology
• Clinical Trials
• Evidence Synthesis

Background:

• Atopic dermatitis (AD) management often includes bleach baths, but their effectiveness and safety are not well-established.
• Uncertainty exists regarding the clinical utility of bleach bathing for AD.
• Need for a systematic review of randomized controlled trials (RCTs) on bleach baths for AD.

Purpose of the Study:

• To systematically synthesize evidence from RCTs comparing bleach baths to no bleach baths for treating AD.
• To evaluate the efficacy and safety of bleach baths in patients with atopic dermatitis.

Main Methods:

• Systematic search of multiple databases (MEDLINE, EMBASE, CENTRAL, GREAT) up to December 2021.
• Inclusion of 10 RCTs with 307 participants, data extraction, risk of bias assessment (Cochrane v2), and GRADE certainty evaluation.
• Harmonization of individual patient data and application of Frequentist and Bayesian random-effects meta-analyses.

Main Results:

• Bleach baths probably improve AD severity, with a 22% relative improvement in Eczema Area Severity Index (EASI) scores (moderate certainty).
• A 50% improvement in EASI was observed in approximately 1 in 10 participants.
• Skin Staphylococcus aureus colonization may be slightly reduced (low certainty), while adverse events and other patient-important outcomes showed no clear differences (low to very low certainty).

Conclusions:

• Bleach baths likely offer a modest benefit in clinician-reported severity for moderate-to-severe AD.
• The certainty of evidence for most outcomes is low to moderate, highlighting the need for more robust clinical trials.
• Findings support current eczema care guidelines and underscore the necessity for further research to clarify benefits and risks.