sodium-hypochlorite and Staphylococcal-Skin-Infections

Atopic dermatitis (AD), also known as atopic eczema, is a syndrome characterized by a chronic eczematous dermatitis, with associated pruritus, characteristic age-specific morphology and distribution of lesions and recurrent nature. Secondary infections in patients with AD are very common and difficult to treat. S. aureus colonizes almost all eczematous lesions in atopic patients and releases several super-antigens and exotoxins (i.e., toxic shock syndrome toxin-1, enterotoxins A-D, etc.), which sustain inflammatory reactions and promote tachyphylaxis. The topical antibiotics most commonly prescribed for mild/moderate secondary infections are gentamicin, fusidic acid and mupirocine. This article reviews existing therapeutic options and provides guidance for the management of secondary skin infection among patients with AD.

Topics: Adrenal Cortex Hormones; Adult; Anti-Bacterial Agents; Antigens, Bacterial; Child; Dermatitis, Atopic; Disease Susceptibility; Disinfectants; Drug Resistance, Microbial; Drug Therapy, Combination; Fusidic Acid; Humans; Skin; Skin Diseases, Bacterial; Sodium Hypochlorite; Staphylococcal Skin Infections; Staphylococcus aureus; Superantigens; Superinfection

Atopic eczema is one of the most common skin disorders in young children and also affects adults. Staphylococcus aureus infection is the most frequent complication of atopic eczema and is involved in the worsening of the disease. Antibiotic therapy against S. aureus has been an important component of treatment for atopic eczema but there are concerns about antibiotic overuse and increasing bacterial resistance. This has led some clinicians to recommend the use of homemade remedies such as bleach baths as an adjunctive treatment for patients with infected atopic eczema, despite the fact that there have been few published studies in this area. Balancing safety concerns with efficacious treatment is of particular importance in the paediatric population. This review discusses the historical use of bleach in medicine as well as its recent use for atopic eczema. Further, the chemistry and safety of bleach as well as alternative therapies are examined.

Topics: Anti-Infective Agents, Local; Baths; Dermatitis, Atopic; Humans; Sodium Hypochlorite; Staphylococcal Skin Infections; Staphylococcus aureus

Staphylococcus aureus is frequently found in patients with atopic dermatitis (AD) and contributes to disease exacerbation. The objective of this study was to evaluate the efficacy and safety of bleach baths as an adjunctive treatment in AD patients. Patients between 2 and 30 years old with moderate to severe AD were enrolled in a prospective, randomized, placebo-controlled study. Patients soaked in diluted bleach or distilled water baths for 10 min, twice a week for 2 months. Efficacy assessments included the Eczema Area and Severity Index (EASI) scores and S. aureus density was determined using quantitative bacterial cultures. Patients in the treatment group showed significant reductions in EASI scores. A 41.9% reduction in S. aureus density from baseline was seen at 1 month further reducing to 53.3% at 2 months. Equal numbers of patients in both groups experienced mild side-effects. This study demonstrates that diluted bleach baths clinically improved AD in as little as 1 month. No patient withdrew from the treatment arm because of intolerance to the baths.

Topics: Adolescent; Baths; Child; Child, Preschool; Dermatitis, Atopic; Disinfectants; Double-Blind Method; Female; Humans; Malaysia; Male; Prospective Studies; Sodium Hypochlorite; Staphylococcal Skin Infections; Treatment Outcome; Young Adult

Despite a paucity of evidence, decolonization measures are prescribed for outpatients with recurrent Staphylococcus aureus skin and soft-tissue infection (SSTI).. Compare the effectiveness of 4 regimens for eradicating S. aureus carriage.. Open-label, randomized controlled trial. Colonization status and recurrent SSTI were ascertained at 1 and 4 months.. Barnes-Jewish and St. Louis Children's Hospitals, St. Louis, Missouri, 2007-2009.. Three hundred patients with community-onset SSTI and S. aureus colonization in the nares, axilla, or inguinal folds.. Participants were randomized to receive no therapeutic intervention (control subjects) or one of three 5-day regimens: 2% mupirocin ointment applied to the nares twice daily, intranasal mupirocin plus daily 4% chlorhexidine body washes, or intranasal mupirocin plus daily dilute bleach water baths.. Among 244 participants with 1-month colonization data, modified intention-to-treat analysis revealed S. aureus eradication in 38% of participants in the education only (control) group, 56% of those in the mupirocin group (P = .03 vs controls), 55% of those in the mupirocin and chlorhexidine group (P = .05), and 63% off those in the mupirocin and bleach group (P = .006). Of 229 participants with 4-month colonization data, eradication rates were 48% in the control group, 56% in the mupirocin only group (P = .40 vs controls), 54% in the mupirocin and chlorhexidine group (P = .51), and 71% in the mupirocin and bleach group (P = .02). At 1 and 4 months, recurrent SSTIs were reported by 20% and 36% of participants, respectively.. An inexpensive regimen of dilute bleach baths, intranasal mupirocin, and hygiene education effectively eradicated S. aureus over a 4-month period. High rates of recurrent SSTI suggest that factors other than endogenous colonization are important determinants of infection. Trial registration. ClinicalTrials.gov identifier: NCT00513799.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Anti-Infective Agents, Local; Baths; Carrier State; Child; Child, Preschool; Chlorhexidine; Combined Modality Therapy; Community-Acquired Infections; Female; Humans; Infant; Male; Mupirocin; Nose; Patient Compliance; Patient Education as Topic; Sodium Hypochlorite; Soft Tissue Infections; Staphylococcal Skin Infections; Staphylococcus aureus; Treatment Outcome; Young Adult

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.. 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.. 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.. 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.

Topics: Administration, Cutaneous; Adolescent; Age Factors; Baths; Child; Child, Preschool; Cohort Studies; Dermatitis, Atopic; Disinfectants; Female; Follow-Up Studies; Humans; Infant; Male; Patient Safety; Prospective Studies; Risk Assessment; Severity of Illness Index; Sex Factors; Sodium Hypochlorite; Staphylococcal Skin Infections; Time Factors; Treatment Outcome

Atopic dermatitis (AD) is characterized by an increased susceptibility to skin infections. Staphylococcus aureus is reported to dominate in AD lesions and reports have revealed the presence of staphylococcal biofilms. These infections contribute to aggravation of the eczema. Sodium hypochlorite is known to reduce bacterial load of skin lesions, as well as disease severity, in patients with AD, but the effect on biofilms is unknown.. To investigate the antimicrobial and antibiofilm effects of sodium hypochlorite against S. aureus isolates derived from patients with AD.. Skin biopsies derived from patients with infected AD were examined by scanning electron microscopy (SEM). Using radial diffusion assays, biofilm assays and confocal laser scanning microscopy, we assessed the effect of sodium hypochlorite on S. aureus isolates derived from lesional skin of patients with AD.. SEM revealed clusters of coccoid bacteria embedded in fibrin and extracellular substances at the skin of a patient with infected AD. At concentrations of 0·01-0·08%, sodium hypochlorite showed antibacterial effects against planktonic cells. Eradication of S. aureus biofilms in vitro was observed in concentrations ranging from 0·01% to 0·16%. Confocal laser scanning microscopy confirmed these results. Finally, when human AD skin was subjected to sodium hypochlorite in an ex vivo model, a dose of 0·04% reduced the bacteria derived from AD skin.. Sodium hypochlorite has antimicrobial and antibiofilm effects against clinical S. aureus isolates. Our findings suggest usage of a higher concentration than currently used in bleach baths of patients with skin-infected AD.

Topics: Anti-Bacterial Agents; Baths; Biofilms; Dermatitis, Atopic; Disinfectants; Humans; Microbial Sensitivity Tests; Skin; Sodium Hypochlorite; Staphylococcal Skin Infections; Staphylococcus aureus

Topics: Carrier State; Chlorhexidine; Female; Humans; Male; Mupirocin; Sodium Hypochlorite; Soft Tissue Infections; Staphylococcal Skin Infections; Staphylococcus aureus