Sodium hypochlorite baths in atopic dermatitis and their influence on the skin microbiome
Abstract
Introduction: Atopic dermatitis (AD) is a disease of multifactorial ethology. However, the bacterial microflora of the skin, especially Staphylococcus aureus, plays an important role in its the pathogenesis. Continuously, new therapies are sought which will block factors exacerbating the disease and significantly support the AD treatment. The aim of the study was to determine the effect of sodium hypochlorite baths on the eradication of St. aureus from the skin and to assess their effect on AD severity.
Material and methods: The study was conducted among 54 patients suffering from AD. A half of the patients were randomly assigned to the group treated with sodium hypochlorite baths (study group) in addition to the standard therapy of AD, the remaining patients were treated with conventional treatment (control group). The severity of the disease and the intensity of the itch were assessed in each patient at the time of enrollment into the study and 6 weeks later. A skin smear was taken for microbiological examination with pathogen identification and semi-quantitative evaluation of the isolated bacteria strains.
Results: Patients using baths in diluted sodium hypochlorite showed a greater improvement of AD severity compared to those using conventional treatment only (relative EASI improvement: 42.0% ± 32.9% vs. –33.1% ± 88.6%, p < 0.01; relative SCORAD improvement: 33.5 ± 25.9% vs. –6.7 ± 36.8%, p < 0.001). Additionally, a greater reduction of itch was observed in the study group compared to the control group (ΔNRS: 1.8 ± 2.2 vs. 0.7 ± 2.2, p = 0.04) as well as significant improvement of quality of life was noted (study group: mean DLQI before treatment: 12.7 ± 6.7 points, mean DLQI after treatment: 7.3 ± 5.4, p < 0.001; control group: mean DLQI before treatment: 10.8 ± 7.5 points, mean DLQI after treatment: 8.7 ± 5.6, p < 0.82). However, the relationship between the applied therapy and the eradication of St. aureus has not been confirmed.
Conclusions: Bathing in diluted sodium hypochlorite allowed to reduce the intensity of AD and to improve the quality of life, while ensuring good tolerability and safety of the therapy. However, no significant effect of the therapy was observed on the reduction of the number of St. aureus colonies on the skin.
Keywords: sodium hypochloriteatopic dermatitisbacterial microflora
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