Rachel N. Asiniwasis April 07, 2022
Ann Allergy Asthma Immunol. 2022 Mar 30:S1081-1206(22)00286-1. Online ahead of print. BACKGROUND: Bleach bathing is frequently recommended to treat atopic dermatitis (AD), but its efficacy and safety is uncertain.OBJECTIVE: Systematically synthesize randomized controlled trials (RCTs) addressing bleach baths for AD. METHODS: We searched MEDLINE, EMBASE, CENTRAL, GREAT from inception to December 29, 2021, for RCTs assigning patients with AD to bleach versus no bleach baths. Paired reviewers independently and in duplicate screened records, extracted data, and assessed risk of bias (Cochrane version 2) and GRADE quality of evidence. We harmonized individual patient data and did Frequentist and Bayesian random effects meta-analyses. PROSPERO registration CRD4202123848. RESULTS: 10 RCTs enrolled 307 participants (median of mean age 7.2 years, EASI baseline mean of means 27.57 [median SD 10.74]) for a median of 6 weeks[range 4-10]. We confirmed other trials registered globally were terminated. Bleach baths probably improve AD severity (22% vs 32% improved EASI by 50% [ratio of means 0.78, 95% credible interval 0.59-0.99]; moderate certainty) and may slightly reduce skin Staphylococcal aureus colonization (RR 0.89[95%CI 0.73-1.09]; low certainty). Adverse events, mostly dry skin and irritation, along with itch, patient-reported disease severity, sleep quality, quality of life, and risk of AD flares were not clearly different between groups and of low to very low certainty. CONCLUSION: In patients with moderate to severe AD, bleach baths probably improve clinician reported severity by a relative 22%. One in 10 will likely improve severity by 50%. Changes in other patient-important outcomes are uncertain. These findings support optimal eczema care and the need for additional large clinical trials. PMID:35367346 | DOI:10.1016/j.anai.2022.03.024
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