Nidhi Sharma, Sandipan Dhar, Abhishek De, Kiran Godse, D S Krupa Shankar, Vijay Zawar, Mukesh Girdhar, Bela Shah
Abstract
Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disorder affecting 15–20% of children and 1–10% of adults. Staphylococcus aureus (S. aureus) infection is the most frequent complication of AD and is involved in the worsening of the disease. Systemic and topical antibiotics are used in the treatment for AD but there are concerns over increasing resistance. Bleach (sodium hypochlorite, NaOCl) baths are an inexpensive, widely accessible, alternative antibiotic treatment that may not worsen antibiotic resistance. Bleach baths are used as adjunctive treatment in AD patients to treat superinfections, although their mechanism of action is not well understood. Balancing safety concerns with efficacious treatment should be important especially for AD where the majority of patients are in pediatrics age groups. Studies available in PubMed databases were included in this review. Most suggested bleach bath improves clinical symptoms of AD and restores surface microbiome by eradicating bacteria, most notably S. aureus. Some studies have noted that this antimicrobial effect has reduced the need for topical corticosteroids. In addition, bleach seems to have strong anti-inflammatory and antipruritic effects. Overall, bleach baths seem to be safe on human skin, without disrupting the epidermal barrier function. The review concluded, although there are some advantages of use of bleach baths, more studies to investigate long-term efficacy and safety of bleach baths are required before fixing its role in the treatment of AD especially in the context of the Indian scenario.
Key Words: Atopic dermatitis, bleach baths, sodium hypochlorite
Nicole Natarelli, BA 1 , Yvonne Nong, MS 2,3,4 , Jessica Maloh, ND 2,3 , Raja Sivamani, MD, MS, AP 2,3,5,6 a
1 Morsani College of Medicine, University of South Florida, Tampa, Florida, 2 Pacific Skin Institute, Sacramento, CA, 3 Zen Dermatology, Sacramento,
CA, 4 Michigan State University College of Human Medicine, Flint, Michigan, 5 Department of Dermatology, University of California-Davis, Sacramento,
CA , 6 College of Medicine, California Northstate University, Elk Grove, CA
Keywords: hypochlorous acid, integrative dermatology, wound healing, scar management, infection, atopic dermatitis, pruritus
Relevance
Hypochlorous acid (HClO) is a weak acid and powerful oxidant traditionally used as an active ingredient in various sanitizers and disinfectants. HClO is produced endogenously from activated leukocytes, and it was first exogenously synthesized in 1834, later to be used medicinally as a wound disinfectant during World War I and II.
Objective
In this review, we aim to review the literature assessing the efficacy and safety of dermatologic uses of topical hypochlorous acid.
Methods
A PubMed search for articles with the following keywords was performed: “hypochlorous acid” AND “dermatology” OR “dermis” OR “dermal.” Forty-one reports were included in the efficacy and safety analysis.
Results
Hypochlorous acid exhibits antimicrobial properties and has been demonstrated to promote re-epithelialization in wound healing with low cytotoxicity to keratinocytes and fibroblasts. Recent work has highlighted its anti-inflammatory properties via modulation of the NF-kβ signaling pathway and downregulation of inflammatory cytokines; reports have discussed its application for the management of various inflammatory skin conditions including atopic dermatitis and psoriasis.
Conclusion
Dermatologic application of hypochlorous acid includes infection prevention, wound care and scar management, inflammatory modulation, treatment in atopic dermatitis and pruritus. Emerging research has discussed potential applications in acne vulgaris, seborrheic dermatitis, and tumor suppression.
This article is excerpted from the《Frontiers in Cell and Developmental Biology》by Wound World
伤口世界平台生态圈,以“关爱人间所有伤口患者”为愿景,连接、整合和拓展线上和线下的管理慢性伤口的资源,倡导远程、就近和居家管理慢性伤口,解决伤口专家的碎片化时间的价值创造、诊疗经验的裂变复制、和患者的就近、居家和低成本管理慢性伤口的问题。
2019广东省医疗行业协会伤口管理分会年会
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