My take on dilute bleach baths and eczema

If you follow developments in eczema treatment, you’ve seen this recommendation to try bathing your child regularly in diluted bleach baths to reduce eczema severity.  I thought this article in MedPage Today summed it well.

If you understand the Solveeczema.org approach, then you probably also know my take on it.

I discuss in Solveeczema.org‘s solutions page the necessity of treating infected eczema in the problem-solving stage.  Even if the detergents are the source of the eczema, sometimes the infected skin has to be treated before the eczema will go away.

But my approach is to eliminate what I believe is the source of the eczema at the same time, so that treating the infected skin brings it back to normal and the skin can remain normal.  This study is suggesting regular bleach baths as a treatment to reduce but not eliminate eczema.

Additionally, my observation has been that when the approach in Solveeczema is properly implemented, along with potentially eliminating the eczema, the skin changes and becomes healthier and more substantial — in children whose eczema is being eliminated, as well as in other members of the household (even if they don’t have eczema).  These skin improvements typically take place over about a two-month time period after the eczema is eliminated.

A few diluted bleach baths could be a helpful “reset” button at the start.

In the study, the researchers observed a reduction of eczema as compared to placebo over time, but only on the parts of the children’s bodies submerged in the diluted bleach water, not the face and neck, and apparently not overall a hugely convincing improvement.  A review article in the British Journal of Dermatology stated, “the difference could have been explained by regression to the mean.”

A doctor who conducted the bleach bath study felt the improvements were the result of knocking out staphyloccocus on the skin, which is known to be a problem for children with eczema, though the above review article found no evidence that managing staphylococcus aureus alone had any “clinically helpful” impact on eczema.

I personally believe fungi/yeast can be a part of the abnormal microbial picture, too, since babies do not fight yeast infections on the skin especially well.  I also — obviously — believe the skin microbial imbalances are a result of the abnormal environmental influence, the increases in membrane permeability from detergents on the skin and the problems that causes.  The more conventional belief is that the eczema and microbial imbalances are the result of a defect in the skin and that perhaps the staph plays a more causative role, though again, no clinical improvements have been directly associated with controlling the staph.

Although it is certainly also mainstream to see the eczema epidemic as primarily environmental because the rapid rise cannot be reconciled with a purely genetic cause (again, see Solveeczema for reference), this observation conflicts with the skin “defect perspective.”

My concerns:

While I am glad to see a potential new tool for dealing with infected skin on a short-term basis, I have concerns about using these bleach baths as a chronic treatment.

First of all, it doesn’t eliminate the eczema and it must be done regularly.

And, I don’t think clinical recommendations can be made from such limited study of such small numbers anyway and safety has not been established.

Secondly, I would note that bleach in the water would help remove detergent residues from the skin of these children better than water alone.  How much of the improvement they noticed was the result of inadvertently regularly mitigating detergent on the skin of these children?  The researchers wouldn’t even have been aware of this issue.  (I would personally see this kind of bleach-bath treatment as a problem-solving step, not an ultimate treatment modality to pursue.)

Thirdly, children and babies have very permeable skin, and chlorine is absorbed by the skin and mucous membranes.  Real concerns about bleach and safety are not hard to find, for example, in this California Environmental Protection Agency sheet on safe sanitizing in childcare centers.  While I personally think doing this kind of bath once or twice might be a reasonable trade-off, I have real concerns about kids regularly bathing in and breathing the fumes from a bleach bath, especially if it’s not actually eliminating the eczema.

Kids with eczema are more at risk of developing asthma.  And breathing chlorine fumes (swimming in chlorinated pools) increases risk for kids of  getting brionchiolitis, asthma, and allergy.   I have inserted one link there, but type “bleach asthma” into the journal search box and you will find a long list of journal articles on this topic.

To the best of my knowledge, the researchers conducting the bleach bath study have not made clinical recommendations.  I would personally recommend against experimenting with anything with the potential safety concerns of bleach.  However, for someone currently eliminating detergents in the household who has concerns of persistently infected skin from past eczema, trying a few of these diluted bleach baths — ONLY after discussing it thoroughly with your child’s pediatrician! — might be helpful and potentially gentler than an oral medication approach.

I’d like to make a parenthetical note here that if the results of this study are reproducible, it contradicts the interpretation of other bath studies ostensibly supporting the hygiene hypothesis.  Previous studies found that infants who were excessively bathed had more eczema, and the conclusion in some quarters has been that these kids were “too clean” and “sterile” skin can lead to allergies.

I personally did not find that interpretation logical, as I have said on Solveeczema.org, the skin of these children would be so breached from all that bathing, they would have more microbial problems, not fewer.  This bleach bath study directly refutes that interpretation, as the bleach (which would have sterilized the skin) seemed to at least moderately improve the eczema over time.

 

 

The role of surfactant in asthma

I’ve gotten much feedback over the years that the changes described in Solveeczema.org do more than help eliminate eczema for certain people, they help reduce or eliminate asthma, even in atopic family members who do not have eczema.  I’m not going to do too much analysis here, I’m going to let this article speak for itself:  The role of surfactant in asthma .  I haven’t yet looked for more recent research, but I feel like I’ve hit a gold mine.

We humans make surfactant essential for the proper function of our airway lining.  What happens when stronger, artificial surfactants are introduced with other inhaled substances, such as dust?

Listen to this:  “…sputum samples from patients with asthma have a low surface activity.”

And, “Interestingly, a washing procedure [of the airways ] with saline … restored surfactant function.”

I’m not drawing conclusions, but this is very, very interesting.

Persistence of Detergent Residues

I think this research paper by Horiuchi Utako from Gunma University in Japan speaks for itself — the translation of the abstract isn’t perfect, but the meaning is perfectly clear:

1)  A lot of detergent remains in clothing even after excessive rinsing.

2)  A significant amount of those residues can migrate onto other surfaces that come into contact with the clothing, including skin.

The abstract is short and is well worth reading.  The interesting conclusion to Solveeczema users:  “wash the diapers for the babies with hypersensitivity using soaps in stead of synthetic detergents.”

The paper appears to have been published in 1983.

Update on mattresses: Avoiding dust

Here’s an interesting development.  In a previous post, I wrote about our experience choosing a mattress that wouldn’t be an allergy source for this specific detergent problem.   In trying to find something that wouldn’t shed detergent-laden dust or introduce potential allergens such as latex, we chose an organic cotton mattress with a food-grade polyethylene dust-mite barrier from Naturepedic, on a solid maple platform bed from Pacific Rim.

With some months of experience behind us now, I have to add a wonderful observation.  Not only have we had no problems with detergent dust, we have had no problems with dust of any kind!  In my experience, the space under mattresses is a breeding ground for large dust bunnies.  Under this mattress, there have been no dust bunnies to speak of, and almost no dust at all.

I don’t know if the dust-mite barrier is entirely the reason, or if it is a combination of the barrier and the higher-than usual space under the bed (good air circulation) — but the rest of the room has remained quite low-dust as well, with no dust bunnies around the bed, either.

In contrast, the traditional mattress in the other room begets as many dust bunnies as ever, as I have come to expect is normal under a bed.

Quite apart from the allergy issue, it’s wonderful not to get those piles of dust under the mattress.  I never realized shedding from the mattress could be such a source — especially since we vacuum our traditional mattress every time we change the bedding.

Picture Eczema

(I’m still stretched and stressed by medical paperwork and still not able to spend much time with the site.  So, here is a post from my draft archive…)

They say a picture is worth a thousand words.  I receive many wonderful words of thanks, but relatively few pictures.  Or I should say, I receive a lot of offers to send pictures – only to hear later almost as many epiphanies of how eczema changed parents’ lives without their realizing it.  It happened to me, too, in the same way.

A friend – whose baby’s eczema is entirely related to detergent exposure – recently gave me a “before” photo of her son with terrible baby eczema.  I have some beautiful “after” photos that I took myself.  I am wondering whether to post them on my blog – the “before” photos are so fuzzy.  And my friend says they were only taken after they had already started removing detergents and the eczema was 90% better. Typical story.  

In the past, when people wrote to tell me their stories of dramatic transformations, I often asked if they were willing to share photos.  People were very generous, offering to go through their photos to find good “before” and “after” comparisons.

In my own case, looking for those photos was an eye opening experience.  Until I needed photos for the newsletter articles, I hadn’t realized how much our picture taking habits had changed:  after the eczema became severe, we took far fewer pictures.  We took photos from a distance, or of a “good” side when the eczema waned.  We don’t have any photos showing the eczema at its worst, not one. 

That story played out over and over again when parents contacted me and offered to look for photos.  Like me, these parents did not realize how their picture taking had been affected by trying to work around the eczema.  So many times parents got back to me – often with sheepish apologies – only to report in wonder that in fact they didn’t have any good “before” close ups of the eczema at its worst.

So, if people have photos and offer them, that’s great and it helps for other parents to see them.  There are a few on the “Letters” page of Solveeczema.org, and a few more in my files that I’ll get around to posting someday.  But I almost never ask for them anymore.

If you are just starting the process described on the Solveeczema website, it’s a good idea to take a few photos of the eczema at its worst.  If detergents are the problem, when the eczema is cleared up, old photos help explain the choices you continue to make to protect your child.  

As much as parents may forget altering way they take photographs of their child with eczema, they also seem to frequently forget how bad things were once everything is cleared up.  There is nothing like old photos to remind yourself of what you did for your child, and just how much better things are when the eczema is cleared up.  This comparison, too, seems a perennial, wonderful surprise – like a cosmic pat on the back.

 

A Success to Share from Florida

I have been hearing from more and more people whose doctors gave them an article about solveeczema.org or a link to the web site.  I heard this from a mom in Florida recently:

I want to start by saying Thank You!!!  You have helped my family sooo much.  I have two children with allergies and eczema.  I have been through so many doctors, and all they kept saying was use more lotion, use more drugs.  One doctor told me, “You’re in a search for a cause and effect that does not exist … use more lotion!!!”

I was desperate … on top of caring for my son’s disability I was dealing with the scratching and bleeding and cries through the night.  I always thought the detergent, which was [commonly recommended scent- and dye-free detergent],  was causing a problem… however the doctors said no.

Finally I switched to our current allergist who gave me your printout.  I removed the detergent and used soap flakes for washing clothes and also used Ben’s Bar from Ipswich Bay Soap Company.  After two weeks my kids’ skin cleared up completely.  They still get some spots from time to time on their feet and hands, but we can deal with that.  My daughter had been covered from head to toe.  Also my son has a breathing problem which needed a nebulizer from time to time.  Barely ever do we use it now (except if he has a cold).

Thanks soooo much again.  Before reading your article, going to the park with my daughter was such a nightmare.  She would be itching and scratching so hard blood would show.  I thought how unfair it was for a child to not be able to enjoy life.  My kids are doing soooo well.  Their skin looks beautiful and they are very happy!!!!  Thank you.

Kattie

Not an allergic reaction to detergents

Eczema from detergents – per solveeczema.org – is caused by how detergents affect skin membrane permeability and function and is not a true IgE-mediated allergy to detergents. In fact, very few people (if any) have a true allergy to detergents, most detergent allergies are actually allergies to product enzymes and additives. Sodium lauryl sulfate, known to be highly problematic for people with eczema, is a detergent analog of a surfactant our bodies make and use to regulate membrane permeability, among other things. I’m not sure we even could be allergic to it in the true sense; again, the eczema comes about from how it affects the skin membrane.

Thus you could not test for detergent reactivity with traditional allergy blood tests. Initially I sometimes used the word “allergy” in regards to this reaction, with some justification, but it’s not a true allergic reaction to the detergents themselves.

Pets get eczema, too

Early on in my search for soaps, I asked a local saddlery about products. I must have had the term “saddle soap” in the back of my mind – I figured I’d find soap products for washing horses that would likely be fine for humans, too.

I was surprised to find that all of the products available for washing horses were detergent-based, most using sodium lauryl sulfate. I did a little hunting on the web, only to find that horses are having eczema problems in recent years, especially certain breeds. Family pets get eczema, too – You don’t even necessarily have to wash them to expose them to detergents, they get significant exposure just from detergents in modern household dust.

And it sure seems to me from everything I have read that the underlying causes (plural) as outlined on my site are the same as in humans. Makes sense.

I hear myself say this over and over, but … Although my site is geared to parents of babies with severe eczema – people who need to see rapid and dramatic results for infants who have the most permeable skin – if you read and understand the underlying issues, it’s possible to make sense of and solve eczema in pets.

I don’t know if eczema in pets makes them less cute and cuddly and more likely to be abandoned or worse (especially since detergent-caused eczema would be present early on), or if current trends of offering more advanced medical care to pets would make caring for a pet with eczema more common. The information I can find about eczema in family pets is very sketchy, so I fear the former may be an issue. I’d love to know more about the problem from anyone who works with animals.

Please contact me through the web site, via the feedback links on the home page.

http://www.solveeczema.org

Autumn Eczema

We stayed recently with friends whose soon-to-be toddler has detergent-reactive eczema as bad or worse than our son did at that age. Going detergent-free in their home took more work than we did in our case, and what we did was enough! Fortunately, as their baby enters toddlerhood, their baby’s skin will become naturally less permeable and so can tolerate more detergent exposure without breakouts. But, I warned, at their baby’s age, they have one more difficult autumn, then it should be smooth sailing from there.

I encourage people with this problem to maintain the changes over time – even when susceptibility to breakouts decreases as children get older and their skin becomes naturally less permeable – to keep that reduced antigen load and hopefully reduce asthma and other allergy risk. Their skin should also stay more substantial and less dry that way. But when that threshold to breaking out increases, it is no longer is necessary to sweat the small stuff. As toddlers enter early childhood, they may even seem to “outgrow” the eczema. Unfortunately, sometimes, then “autumn eczema” hits.

As everyone with eczema knows, weather and humidity modulate eczema severity.

Summertime humidity can be such a help to those who are in the problem-solving stages, or who have a baby whose exposures are very difficult to control. Unfortunately, when autumn rolls around, and the heat comes on indoors – drying the air – people with detergent-reactive eczema become more susceptible to breakouts from lower levels of detergent.

I have in the past told friends to write a note about this in their calendars and not to panic if they see new breakouts at this time – they just have to be a little more vigilant to bring detergent exposure down to a lower level for awhile. (Usually they forget and panic anyway, but soon sort it out with just a little more vigilance.)

As I point out on my site, absent detergents that increase skin permeability, even dry air will not result in eczema in susceptible individuals. If you’ve gotten lax like we always did over the summer, now might be a good time to increase vigilance about exposures to prevent those autumn breakouts. (Or, wait until the heat comes on and just remember not to panic…)

Recommendation for Dove Withdrawn Until Further Notice

Until further notice, I must withdraw my recommendation for Dove bar products. (I have never recommended the liquid products.)

For general use, and especially for “the washing test” on the solveeczema.org web site, I no longer recommend using Dove or any bar products with the same surfactant formula as Dove’s current unscented Sensitive Skin product, the formula of which was changed as of January 2007. See previous posts on this blog for more information.

Initially, there were several products with the same surfactant formula as the OLD unscented Dove formula with sodium cocoyl isethionate (give or take a few fragrances and colors), but they, too, seem to be changing over to the new surfactant formula with sodium lauroyl isethionate.

Here’s the problem:

I can recommend that people use any soap product, because soaps are a very narrowly defined surfactant. Thus, I can say that all soaps, provided they are relatively non-drying (and there are MANY non-drying soaps) should be fine for people with detergent-reactive eczema (also provided there are no individual ingredient allergies).

Without getting into a detailed discussion about Dove, empirically, unscented Dove, a combination of mild detergents, soaps, and fatty acids, was also fine. It was more than fine, actually, it worked especially beautifully to remove existing detergents on the skin that are a problem for people with detergent-reactive eczema.

Unfortunately, I have no such empirical information about the new formula. In fact, the majority of visits to my blog these days appear to be from people trying to figure out what happened to the old unscented Dove formula. I have received several reports of problems, though I cannot draw conclusions until I know much, much more.

The old unscented Dove product had lots and lots of empirical support, not just from those who successfully used my site, but from dermatologists’ experiences over many years. I have no idea why Dove’s maker would want to monkey with this successful product line.

Until further notice, instead of unscented Dove for the “washing test” on the solveeczema.org web site, use Cal Ben’s liquid dish glow from a foaming dispenser. (Do not use it straight as it is quite concentrated.) Rinse especially well. As always, spot test it first to determine personal sensitivity to the ingredients.