Eczema (atopic dermatitis) is a chronic skin condition that compromises the skin barrier, leading to redness, inflammation, and intense itching. Bleach baths are a doctor-recommended, adjunctive treatment for moderate to severe eczema, particularly when flares are frequent or resistant to standard care. The treatment involves bathing in water mixed with a highly diluted concentration of household bleach (sodium hypochlorite). This method creates a solution similar in chlorine level to a public swimming pool, making it a safe and accessible option when used correctly.
The Therapeutic Action of Diluted Bleach
The primary reason dermatologists recommend bleach baths is to address the high colonization of bacteria, particularly Staphylococcus aureus, often found on the skin of people with eczema. This bacterial overgrowth is thought to trigger the immune system, worsening inflammation and symptoms. The initial theory was that the diluted sodium hypochlorite acted as an antiseptic, effectively reducing the number of harmful surface bacteria.
The reduction in bacterial load can decrease the risk of secondary skin infections, which often complicate eczema management. However, recent research suggests the mechanism of action may be more complex than simple antimicrobial killing. Studies indicate the standard clinical dilution may not be high enough to kill bacteria like S. aureus but still improves patient symptoms.
Current understanding suggests that the diluted bleach may also exert a direct anti-inflammatory effect on the skin. This action helps reduce the chronic redness and itching that characterize eczema, even without a direct bactericidal effect. By calming the immune response and potentially improving skin barrier function, bleach baths reduce disease severity and may lessen the reliance on topical steroid application.
Performing the Bleach Bath: A Step-by-Step Guide
The process begins by selecting the correct product: regular, unscented household bleach containing approximately 5% to 8.25% sodium hypochlorite. Avoid concentrated or splash-less formulas, as their concentration levels complicate the necessary dilution. Fill a standard 40-gallon bathtub with lukewarm water to prevent irritation and excessive drying.
For this amount of water, add no more than a half cup of bleach to achieve the correct therapeutic concentration. If using a half-full tub, reduce the bleach amount to a quarter cup. The bleach must be thoroughly mixed into the bathwater before stepping in to ensure an even and safe dilution.
The soaking time should be limited to five to ten minutes, which is sufficient for the solution to have its therapeutic effect. During the soak, avoid submerging the head and keep the water out of the eyes. Afterward, the body must be completely rinsed off with fresh, lukewarm tap water to remove all traces of the sodium hypochlorite solution.
The final step is the “soak and seal” method. The skin should be gently patted mostly dry with a clean, soft towel. While the skin is still slightly damp, immediately apply a generous amount of moisturizer or any prescribed topical medication. This locks in moisture, protects the skin barrier, and counteracts potential drying effects from the bath.
Essential Safety Measures and Precautions
The most important safety measure is ensuring the bleach is always highly diluted and never applied directly to the skin. Using too much bleach can cause significant skin irritation, burning, and dryness, potentially worsening eczema. Use a precise measuring cup, as simply pouring from the bottle risks over-concentrating the solution.
Individuals with open cuts, deep cracks, or weeping lesions should proceed with caution, as the bleach solution can cause stinging or burning. If severe irritation, pain, or stinging occurs, stop the bath immediately and rinse the skin thoroughly with clear water. People with a known chlorine allergy or allergic asthma may be sensitive to the fumes and should avoid the treatment entirely.
The bathroom must be well-ventilated during the bath to prevent the inhalation of chlorine fumes, which can irritate the respiratory system. Bleach should be stored securely, out of the reach of children, to prevent accidental ingestion or contact. Always check the sodium hypochlorite concentration on the bottle, as products vary, and the correct dilution ratio must be maintained.
When to Incorporate Bleach Baths into Treatment
Bleach baths are considered an adjunctive therapy, meaning they are a supportive treatment used alongside other eczema management strategies like topical medications and consistent moisturizing. They are not a standalone cure and work best when incorporated into a physician-guided regimen. The treatment is typically recommended for individuals with moderate to severe eczema, especially when signs of bacterial colonization or frequent secondary infections are present.
The frequency of the baths should be determined by a healthcare provider, but they are generally performed two to three times per week. This schedule is usually sufficient to manage the bacterial load and reduce inflammation without causing excessive dryness. Before starting bleach baths, especially for infants or children, consultation with a dermatologist or pediatrician is necessary. Medical oversight ensures the correct dilution is used and confirms the treatment is appropriate for the individual.