Facing Eczema at Four Months Old
Jaylin Anderson, from Mason City, Iowa, shares her experience of trying to get her daughter’s eczema diagnosed and treated when she was an infant.
Published On: Mar 3, 2025
Last Updated On: Mar 14, 2025
“Bathe in bleach? Are you sure?” This is many people’s first thought when a doctor tells them to take a bleach bath to treat their eczema. It sounds a little out there to bathe in water and a specific amount of household bleach to make your skin feel better. Despite sounding strange, this treatment method has been recommended by dermatologists since at least the early 2000s and has been a helpful tool for many patients with atopic dermatitis (AD), the most common type of eczema.
While bleach baths are a recommended treatment option, the mechanisms underlying how they actually work to help eczema are still a bit unclear. Here, we take a look at what researchers do and don’t know about bleach baths for eczema, and how the science has evolved over the years.
Bleach baths are a non-prescription treatment option for AD. They were introduced by clinicians around 20 years ago as a supplemental treatment when far fewer treatments existed to keep AD symptoms under control.1
You should follow your doctor’s instructions for taking bleach baths including the amount of bleach and water to use, how often you should do them and how long to stay in the bath. Typically, for adults, a bleach bath includes filling a standard bathtub (about 80-gallon capacity) with water plus ½ cup (125 mL) of plain, fragrance-free household bleach. For a child, fill a bathtub halfway with water and add ¼ cup (62.5 mL) of bleach. The National Eczema Association recommends you soak for 10 minutes before getting out of the bath and patting dry.
Scientific literature has shown that bleach baths are effective at reducing itch and even disease severity in many patients with AD — we just don’t know exactly how they work.2-4 Researchers originally thought that bleach baths were antiseptic, that is that they killed some kinds of bacteria like Staphylococcus aureus (Staph aureus) that contribute to AD.5
When people first started using bleach baths, which were primarily recommended by pediatric dermatologists at the time, the scientific community did not have the technical capabilities that we have today to study all the different types of bacteria growing on the skin. Since early evidence showed that bleach baths seemed to improve AD symptoms and reduce secondary bacterial infections, assumptions were made that bleach baths killed bacteria.5
To back up this idea, a study published in 2009 included 31 AD patients with secondary bacterial infections. All of these patients were treated with an antibiotic for 14 days and then some were given nasal treatment with mupirocin ointment plus bleach baths for 3 months, while others were given nasal treatment with petroleum jelly and water baths for the same duration.5 The patients treated with nasal mupirocin and bleach baths showed decreased AD severity on the body parts that were submerged in the bleach baths compared to those who were given petroleum jelly nasally and bathed in only water.5 This seemed to add credence to the idea that bleach baths themselves were antiseptic.
However, about a decade later, Dr. Richard Gallo, a microbiology and bacteria expert in the department of dermatology at the University of California San Diego, showed definitively that the concentration of bleach being used in bleach baths did not kill laboratory strains of Staph aureus, a bacteria that live on the skin and can contribute to the severity of AD symptoms.6
A subsequent clinical study also showed that bleach baths somehow can enhance the skin barrier and reduce itch but not by normalizing the altered bacterial colonies that are known to impact AD.4 This was surprising to the scientific community. Dr. Vivian Shi, professor of dermatology at Washington University said, “Recognizing that bleach baths work through different mechanisms than we originally thought has been intriguing and has led to further research into their exact role in AD management — for example, their potential anti-inflammatory effects.” However, there are still relatively few studies on the mechanisms underlying how bleach baths work.
Based on the latest research, bleach baths don’t seem to work by killing bacteria on the skin. Instead, it seems like bleach baths help reduce AD itch by improving inflammation symptoms and the skin barrier. One study conducted at Stanford University showed that diluted bleach was able to reduce the activity of an important driver of skin inflammation, called NFkB, in both cells grown in the laboratory and mice.7 Another study looked at how the concentration of bleach found in bleach baths might slow down the activity of active proteins, called proteases, that are responsible for turnover of the outer barrier components of the skin, which may allow for a better barrier structure.8 These experiments were only conducted in cells grown in the lab and would need to be followed up with studies in mice and human skin to confirm the findings. Nonetheless, this is one example of a potential mechanism underlying how bleach baths may improve the skin barrier.
Bleach baths have always been thought of as a non-prescription supplemental treatment to help improve symptoms rather than as a primary form of treatment. The American Academy of Dermatology, American Academy of Allergy, Asthma, and Immunology, as well as current European guidelines recommend that patients with moderate to severe AD symptoms consider using bleach baths, especially if prone to secondary infections, even though the baths themselves don’t kill bacteria. A physician may recommend higher concentrations of bleach depending on the symptoms, so it is very important to talk to your doctor about exactly how to use bleach baths before initiating them.9,10
“Throughout my career I have seen bleach baths work, especially when children and adults take them in the evening, to reduce itch and help them sleep,” said Dr. Lisa Beck, professor of dermatology at University of Rochester Medical Center. “Using a washcloth will help get the bleach onto all the affected parts of the body,” she said. “The bleach bath only works on areas that receive the bleach. Patients should also be sure to moisturize after the bleach bath and before going to bed.” Dr. Beck warned, although bleach can alter the color of clothing, towels and carpets.
Dr. Lynda Schneider, a professor of pediatrics at Harvard Medical School and the section chief for the allergy and immunology program at Boston Children’s Hospital said, “Bleach baths two to three times per week probably modestly improve AD severity likely with little to no adverse events.” She also noted that patients’ values, preferences and circumstances need to be taken into account when discussing bleach baths. For example, patients told to take bleach baths need to have a bathtub, and the bleach baths need to fit into the patient’s schedule.” Clear, written instructions from your healthcare provider are also very important to be sure the right amount of bleach is used.
A systematic review and analysis of all publications about bleach baths was conducted in 2022 to review how safe bleach baths are and how much they improve patient symptoms (efficacy).11 The research review found approximately a 22% improvement in severity of AD symptoms for patients who used bleach baths, according to their clinicians. Only about one in 10 patients saw this improvement. Some patients reported side effects like dry skin, but this was not frequently reported. Since 22% is a relatively small improvement and not that many patients reported seeing improvement, the guideline panel recommended bleach baths mostly for patients with moderate to severe disease and not widespread use.11 More large scale clinical trials about bleach baths would be needed than currently exist to generate additional insights.
Healthcare providers may also be recommending bleach baths a little less these days due to all the new treatments for AD. “I am already recommending bleach baths less,” Dr. Beck said. “However, some patients and caregivers don’t want to use the newer systemic prescriptions, and some of them are still really expensive, so there are still cases where bleach baths are a good choice in addition to other treatments. Bleach baths are never a stand-alone treatment, but they can still be good tools to keep AD symptoms under control.”
Dr. Shi agreed and added, “While newer therapies have revolutionized the treatment of moderate to severe AD, I believe that bleach baths will continue to serve as an accessible, cost-effective adjunct therapy. For many patients, bleach baths can offer an affordable way to manage flare-ups and reduce itch.”
References:
1. Barnes TM, Greive KA. Use of bleach baths for the treatment of infected atopic eczema. Australas J Dermatol. 2013;54(4):251-258.
2. Chopra R, Vakharia PP, Sacotte R, Silverberg JI. Efficacy of bleach baths in reducing severity of atopic dermatitis: A systematic review and meta-analysis. Ann Allergy Asthma Immunol. 2017;119(5):435-440.
3. Conway AE, Kartha N, Maddukuri C, Shaker MS. Pearls for practice from the 2023 allergy immunology joint task force on practice parameters GRADE and institute of medicine based atopic dermatitis guidelines. Curr Opin Pediatr. 2024.
4. Stolarczyk A, Perez-Nazario N, Knowlden SA, et al. Bleach baths enhance skin barrier, reduce itch but do not normalize skin dysbiosis in atopic dermatitis. Arch Dermatol Res. 2023;315(10):2883-2892.
5. Huang JT, Abrams M, Tlougan B, Rademaker A, Paller AS. Treatment of Staphylococcus aureus colonization in atopic dermatitis decreases disease severity. Pediatrics. 2009;123(5):e808-814.
6. Sawada Y, Tong Y, Barangi M, et al. Dilute bleach baths used for treatment of atopic dermatitis are not antimicrobial in vitro. J Allergy Clin Immunol. 2019;143(5):1946-1948.
7. Leung TH, Zhang LF, Wang J, Ning S, Knox SJ, Kim SK. Topical hypochlorite ameliorates NF-kappaB-mediated skin diseases in mice. J Clin Invest. 2013;123(12):5361-5370.
8. Huang SM, Chen YY, Chen YC, Wu CS, Lan CE. 0.005 % hypochlorite reduces serine protease in cultured human keratinocytes: Evidences supporting bleach bath improves atopic dermatitis. J Dermatol Sci. 2022;107(3):169-172.
9. Pagliaro M, Pecoraro L, Stefani C, Pieropan S, Piacentini G, Pietrobelli A. Bathing in Atopic Dermatitis in Pediatric Age: Why, How and When. Pediatr Rep. 2024;16(1):57-68.
10. Panel AAJADG, Chu DK, Schneider L, et al. Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE- and Institute of Medicine-based recommendations. Ann Allergy Asthma Immunol. 2024;132(3):274-312.
11. Bakaa L, Pernica JM, Couban RJ, et al. Bleach baths for atopic dermatitis: A systematic review and meta-analysis including unpublished data, Bayesian interpretation, and GRADE. Ann Allergy Asthma Immunol. 2022;128(6):660-668 e669.
Jaylin Anderson, from Mason City, Iowa, shares her experience of trying to get her daughter’s eczema diagnosed and treated when she was an infant.
Colloidal oatmeal baths can be a good natural remedy for reducing itch caused by eczema. Learn about how to make colloidal oatmeal at home and the science about how it reduces itch.
Researchers at the National Eczema Association publish a new letter Journal of Investigative Dermatology evaluating the prevalence of different forms of eczema.
Dulce Marilyn Morán shares how she overcame fear of judgment over her skin and built a greater sense of self-confidence.
Evidence-based articles, expert-sourced lifestyle tips and stories from your community.