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.

Detergents in Everything

When I said detergents are in everything these days, I guess I didn’t know the half of it.

The Whole Foods web site lists “ingredients that are commonly found as inactive ingredients, or excipients, in dietary supplements.”  Sodium lauryl sulfate is listed as an “emulsifier; also used to aid in the making of tablets.”  It’s also listed as GRAS (generally recognized as safe, though a lot of dermatology patients would beg to differ).  Does this mean supplements, especially tablets, are a potentially hidden source of detergents?

What about over-the-counter and prescription medications?  I just found SLS listed in the “inert ingredients” of Doryx, an important delayed-release formulation of doxycycline.  Here I’m guessing the SLS is necessary for the time release.  If so, the benefits might outweigh the consequences.  Tetracyclines aren’t generally given to children anyway.

But if the posters to this Wisegeek.com article are correct, SLS is in such common medications as aspirin, ibuprofen, and Zyrtec, which are given to children.   Poster #5 found SLS in one generic formulation of Zyrtec but not another.  It probably pays to ask the pharmacist for a detailed manufacturer’s insert to identify inert ingredients of prescribed medications.  Taking the medication prescribed by one’s doctor is the more important consideration, but often there is a choice of formulations, and different pharmacies often have very different options.

Check out this EPA document:   “Sodium lauryl sulfate is used as a flea and tick repellant in one registered pesticide product — a flea and tick shampoo for cats and dogs.  Sodium lauryl sulfate also is a widely used component of many non-pesticidal consumer products currently marketed in the United States, including shampoos and fruit juices.”

Fruit juices?! I had assumed the eczema from some processed juices had been from washing the fruit in food-grade detergents.  Now I wonder about SLS as an additive!

The document above is from 1993, so the assessment may have changed since then (though I doubt it).

It continues:

“Sodium lauryl sulfate is a detergent-like substance that employs a non-toxic mode of action in controlling fleas and ticks on household pets. The potential for dermal and/or inhalation exposure exists to people applying the registered pet shampoo product. However, this exposure is not considered significant and does not create a health risk concern. Published reports suggest that sodium lauryl sulfate has low acute mammalian toxicity and no known chronic effects. EPA has no reports of adverse effects resulting from its use. Both exposure and health risks to people using the product are expected to be low.

“EPA also believes that since the pesticide is used only on pets, negligible exposure to the environment and to nontarget organisms will result. The Agency concludes that the registered product and use of sodium lauryl sulfate should not result in unreasonable adverse effects to human health or the environment.“

Yet one more source of detergent for Solveeczema users to watch out for — reading the labels of flea collars, too.  However, since the collars are used externally, I wonder if they even have to list the “inert” ingredients?  If pet owners had problems, would it seem like an allergy to the pet?

On that score, here’s an interesting paper from a veterinary journal:  Influence of inert ingredients in pesticide formulations on dermal absorption of carbaryl by RE Baynes and JE Riviere (PMID 9492931), Feb 1998.

“The SLS also enhanced [the carbamate insecticide] absorption, especially at low solvent concentrations.”  and in conclusion , “Inert ingredients can modulate percutaneous absorption of toxicologically important pesticides…”

And lastly, a paper from Environmental Health Perspectives from 2006 (PMID 17185266):   “By statute or regulation in the United States and elsewhere, pesticide ingredients are divided into two categories: active and inert (sometimes referred to as other ingredients, adjuvants, or coformulants). Despite their name, inert ingredients may be biologically or chemically active and are labeled inert only because of their function in the formulated product. Most of the tests required to register a pesticide are performed with the active ingredient alone, not the full pesticide formulation. Inert ingredients are generally not identified on product labels and are often claimed to be confidential business information.”  (emphases mine)

Update on Sunscreens

With summer approaching, it’s time to take another look at sunscreens.

The products list on Solveeczema.org is notably short on sunscreens.  We had good luck with Mustela’s Moderate Sun Protection Stick (SPF 20), but a company spokesperson told me last week that the product has been long discontinued and they have no remaining stock.

That’s a shame, since it was not only a great sunscreen — it didn’t seem to wear off even after hours in the sun and water, and it seemed to have better protection than the advertised SPF 20 — it was also the only Mustela product on the Environmental Working Group’s 17 most safe and effective sunscreen products.  (Scroll down the page to see the list and a link to a more comprehensive list of products and the EWG’s evaluation of them.  You can also search for products to see their ranking and list of ingredients via a box on the right of the page.)

I used the EWG’s list to try out a few of the sunscreens, and found them to be fine for my son.  We liked Badger Unscented SPF 30 Sunscreen, Loving Naturals SPF 30+, and Keys-Soap Solar RX SPF 30+ the best.

Mustela sent me a sample of the product they make to replace their discontinued sunstick, their SPF 50 Sun Cream for Sensitive Areas.  It also proved to be fine.  (It scores a 3 on the EWG’s rating system, 0 being safest and 10 being most problematic.)

We have tried California Baby stick sunscreens, and based on the ingredients, they too should be fine per the issues on Solveeczema.  They rank well on the EWG’s list of safe and effective sunscreens.  Note:  the California Baby stick sunscreen we tried gave my son a rash, but it couldn’t be because of the active ingredients, it must be an individual allergy.  A friend whose preschooler has this detergent problem worse than my son and follows the Solveeczema guidelines quite effectively to keep his skin clear, uses the California Baby stick sunscreens without problems.

Per Solveeczema.org, barrier-type sunscreens (such as with zinc oxide and titanium dioxide) are  a better bet than those that absorb.

Luckily, per the EWG’s evaluations, the majority of sunscreens on their safest ingredients list also seem to be zinc oxide and/or titanium dioxide based.  As with other products, it’s always good to try a small patch for sensitivity first.  (All sunscreens contain other ingredients; always be aware of the potential for allergy to other ingredients, especially in the sun and water.)

Have a safe and fun summer!

Non-detergent Cleaners on Oprah

Here’s an entire page of non-detergent cleaners — all of which would work for Solveecema users — recommended on Oprah’s web site for being green and saving money.

http://www.oprah.com/world/Shift-Your-Habit-to-a-Fresh-Start-This-Spring-Elizabeth-Rogers/4

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.

No More Toxic Tub Report

Although my site is narrowly focused, this might be of some interest to solveeczema.org users:

A new report by the Campaign for Safe Cosmetics discusses toxic contaminants in children’s bath and personal care products.

“Despite marketing claims like ‘gentle’ and ‘pure,’ dozens of top-selling children’s bath products are contaminated with the cancer-causing chemicals formaldehyde and 1,4-dioxane, according to the March 2009 Campaign for Safe Cosmetics report, ‘No More Toxic Tub.‘”

Of most interest to users of solveeczema:

“The chemicals were not disclosed on product labels because they’re contaminants, not ingredients, and therefore are exempt from labeling laws.

Formaldehyde contaminates personal care products when common preservatives release formaldehyde over time in the container. Common ingredients likely to contaminate products with formaldehyde include quaternium-15, DMDM hydantoin, imidazolidinyl urea and diazolidinyl urea.

1,4-dioxane is a byproduct of a chemical processing technique called ethoxylation, in which cosmetic ingredients are processed with ethylene oxide. Manufacturers can easily remove the toxic byproduct, but are not required by law to do so. Common ingredients likely to be contaminated with 1,4-dioxane include PEG-100 stearate, sodium laureth sulfate, polyethylene and ceteareth-20.”

Read the entire report at safecosmetics.org

Talk of Pillows

Someone asks me recently if I could suggest pillows that would work, a question I have been asked before, but I really cannot answer in relation to the material on Solveeczema, at least with any degree of certainty.

We still mostly do without.

At one point, I ordered several very expensive organic pillows (cotton, wool, etc.) that were supposed to have been formulated for people with allergies.  All caused congestion (but no eczema).

I did wash all of the pillows, which turned out to be pretty difficult — especially with cotton, any agitation at all would ruin the fill.  I did a lot of machine soaking and spinning out with no agitation.  There’s no way to know if the congestion was because of the materials or a failure of the washing technique.

In desperation, I did finally pull some old boudoir-sized 100% goosedown pillows out of the closet, and toss them in the washing machine.  At least I didn’t have to worry about lumps forming from agitation.  I wasn’t sure they would survive the washing, though.  I washed several times, including a soaking with oxygen-based bleach, followed by soap and including hot water washes, followed by lots and lots of plain water washes and rinses.

The pillows came out of the front-load washer as flat as pancakes.  They looked ruined.  But I put them in the dryer by themselves, and dried until they were thoroughly dry.  They came out beautifully normal in the end, like I had never washed them.

I can’t recommend this to other people, because down is expensive (and we were probably lucky we didn’t ruin ours), and I suspect a great many people will still be allergic to something like down even after thorough washing.  But it was the only thing in our case that we were able to wash thoroughly — and in the end, surprisingly, it didn’t cause any congestion or eczema.  (Though it did become clear that if we wanted the pillows to remain so, we would have to keep them pretty clean, i.e., wash them again on a fairly regular basis.  Who knows how long they will last this way.)

Web Site Renovations

I am taking an online web design class and making long-overdue updates to Solveeczema.org.

The changes have taken a lot more time than I anticipated — among other things, making any file changes with my current web host is a nightmare — so the web site (and the content) will be something of a construction zone for the next several weeks.

After that I hope to go back and answer some long overdue emails for the site.