Author: Kevin Zheng, Medical Student, University of Auckland, New Zealand; Chief Editor: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand, August 2015.
Bleach baths are recommended in patients with frequent skin infections to reduce skin colonisation by pathogenicbacteria, particularly Staphylococcus aureus. Bleach baths have been reported to reduce the severity of atopic dermatitis and to reduce the need for topical steroids and antibiotics.
Skin infections
Staphylococcal infections of the skin and soft tissue are common, especially in children, and can be severe. Despite treatment, more than 20% of patients with skin and soft tissue infections have a recurrence within three months. Primary staphylococcal skin infections include:
Chlorhexidine solution as a bath or shower antiseptic cleanser
General hygiene and wound care.
What is a bleach bath?
Bleach baths are dilutions of household bleach with water in a bath. The concentration of chlorine is similar to that of a swimming pool. It has antimicrobial action.
The active compound in commercial household bleaches is sodium hypochlorite (NaOCl).
Bleach contains 3–6% available chlorine (Cl2), approximately 0.5–1.5% sodium hydroxide (NaOH) as a stabiliser, small quantities of surfactants, and perfume.
At pH 11–13, it is an alkaline aqueous solution with major oxidising properties.
Sodium hypochlorite 0.0006% is also available as a convenient wash suitable to use in a shower.
Why use a bleach bath?
In conjunction with other methods of decolonisation, bleach baths reduce rates of recurrent primary and secondary skin and soft tissue infections.
Bleach baths have a broad spectrum of action against:
No microbial resistance has been reported to sodium hypochlorite. The effect of bleach baths on decolonising the patient's skin is only temporary, so must be repeated regularly.
Bleach baths also seem to reduce inflammation and itching in eczema.
How to use a bleach bath
Mix 2 ml of 2.2% household bleach for every 1 litre of water to make a 0.005% solution. Brands vary strength, so check the label. If the concentration is higher, use less bleach, and if the concentration is lower, use more bleach.
Bath type
Usual capacity
Millilitres (mL) of 2.2% bleach required
Baby bath
15 litres of water
30 ml (approx. two tablespoons)
Full-sized bath
80 litres of water (for 10 cm deep)
160 ml (approx. half a cup)
Soak trunk and limbs in the bath for 10–15 minutes. Do not submerge head.
Rinse off with warm tap water and pat dry with a towel. Avoid sharing towels.
Apply topical steroid and moisturisers if prescribed.
Bleach baths are recommended at least twice a week.
These symptoms are often due to added perfumes or detergents in the bleach. If troublesome, try another brand. Do not apply the bleach directly to the skin.
Toxicity or poisoning is rare but potentially very serious. It is usually due to ingestion of undiluted solution. Keep bleach in its original container with a child-proof top and make sure young children are not able to open it.
Ingestion of small volumes may lead to:
Irritation of the oropharynx,
Burning sensation in the mouth and throat
Thirst
Nausea
Vomiting
Haematemesis (vomiting blood).
Ingestion of large amounts or more concentrated solutions can lead to:
Corrosion of the mucous membranes
Chest and abdominal pain
Watery diarrhoea
Melaena (blood in faeces)
Ulceration or perforation of the oesophagus or stomach
Haemorrhage and shock.
References
Barnes TM, Greive KA. Use of bleach baths for the treatment of infected atopic eczema. Australas J Dermatol. 2013;54(4):251-8. doi:10.1111/ajd.12015 PubMed
Fritz SA, Camins BC, Eisenstein KA, et al. Effectiveness of measures to eradicate Staphylococcus aureus carriage in patients with community-associated skin and soft-tissue infections: a randomized trial. Infect Control Hosp Epidemiol. 2011;32(9):872-80. doi:10.1086/661285 PubMed Central
Maarouf M, Shi VY. Bleach for atopic dermatitis. Dermatitis. 2018;29(3):120-6. doi:10.1097/DER.0000000000000358PubMed
Smith CH, Goldman RD. Staphylococcus aureus decolonization for recurrent skin and soft tissue infections in children. Can Fam Physician. 2012;58(12):1350-2. Journal