Amy Paller, MD, a dermatologist, talks about things you may already have at home that can treat a skin infection or make a bath more comfortable.
Should I add anything to the bath of a child who has eczema?
Putting additives into the bath can be very helpful. We [dermatologists] don’t use a lot of bath oils. They minimally will help with moisturizing the skin, and they can make the bathtub slippery.
However, we do like to add agents that are antibacterial, particularly in those children with moderate to severe eczema who have a risk of recurrent infections.
Staph aureus is a bacterium that colonizes — or is almost always found on the surface of the skin and often too inside of the nose — in individuals who have eczema.
Studies have shown that if we add a little bit of bleach to the bath water, we can improve the eczema. We know that children and adults with eczema have staph aureus, a particular bacterium, on their skin when one just cultures an area that’s affected and oftentimes even areas that don’t show lesions of eczema.
And, we also know that staph aureus is not just sitting there waiting to overgrow and turn into an infection, but also drives the inflammation of eczema and the itching related to it. So we think that the bleach bath is working by decreasing the numbers of bacteria on the skin. Therefore, [we think the bleach baths] not only decrease the risk of infection, but most importantly as shown in trials, actually improve the eczema.
This [making a bleach bath] is so easy. It’s just a matter of putting a little bit of bleach into the bath water. [Add] a 1/2 of a cup [of bleach] if you have a full tub [of water] and a 1/4 cup [of bleach] if you have a half tub of bath water. And, we always say a scant teaspoon per gallon [of water] if we’re talking about a young child who might be in a tubbie.
It’s so important that the bleach water really get on hands and feet, which are areas that currently can show crusting and evidence of overgrowth of bacteria.
We also know from studies that the bleach water should also be applied, perhaps with a little washcloth, to the head and neck — areas that may not be submerged in the bath water — but can benefit from the exposure and decreased numbers of bacteria on the skin.
Interestingly there’s been recent evidence that the dilute bleach bath may do something more than just decrease bacteria. It may actually more directly suppress some of the inflammation. And we look forward to more studies to test that.
Sometimes the bleach baths can be uncomfortable, particularly for those children who have an infection — areas of skin that are open and sore. So in those cases, particularly if I see evidence of infection upfront, I might treat with a course of antibiotics and wait several days before starting the bleach baths.
But what should be stressed is that the bleach bath is not a quick turnaround fix.
It’s part of a maintenance regimen. It needs to be used on an ongoing basis, perhaps 2 times a week or 3 times a week. But in more severely affected children who do get recurrent infections and have evidence of crusting every so often, you really can do this daily with even better control.
People [may use] a different type of additive and that is dilute vinegar baths. I have found this to also be helpful for patients.
Finally, sometimes when children are uncomfortable in the bathtub, adding a big handful of baking soda can be soothing. This in itself doesn’t particularly have the antibacterial properties of a bleach bath, but can be soothing. I’ve heard of Epsom salts being used as well.
These are all very easy, inexpensive ways to make the bath into a tool for helping the eczema.
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How to bathe a child who has eczema