DermHelpCentral

Bleach in Bath

Treatment of Staphylococcus aureus Colonization in Atopic Dermatitis Decreases Disease Severity

Jennifer T. Huang, MD  et. al.
PEDIATRICS Vol. 123 No. 5 May 2009, pp. e808-e814 (doi:10.1542/peds.2008-2217)

Departments of Dermatology and Pediatrics
Northwestern University, Feinberg School of Medicine, Chicago, Illinois

OBJECTIVES. The goals were to determine the prevalence of community-acquired methicillin-resistant Staphylococcus aureus colonization in patients with atopic dermatitis and to determine whether suppression of S aureus growth with sodium hypochlorite (bleach) baths and intranasal mupirocin treatment improves eczema severity.

METHODS. A randomized, investigator-blinded, placebo-controlled study was conducted with 31 patients, 6 months to 17 years of age, with moderate to severe atopic dermatitis and clinical signs of secondary bacterial infections. All patients received orally administered cephalexin for 14 days and were assigned randomly to receive intranasal mupirocin ointment treatment and sodium hypochlorite (bleach) baths (treatment arm) or intranasal petrolatum ointment treatment and plain water baths (placebo arm) for 3 months. The primary outcome measure was the Eczema Area and Severity Index score.

RESULTS. The prevalence of community-acquired methicillin-resistant S aureus in our study (7.4% of our S aureus–positive skin cultures and 4% of our S aureus–positive nasal cultures) was much lower than that in the general population with cultures at Children's Memorial Hospital (75%–85%). Patients in the group that received both the dilute bleach baths and intranasal mupirocin treatment showed significantly greater mean reductions from baseline in Eczema Area and Severity Index scores, compared with the placebo group, at the 1-month and 3-month visits. The mean Eczema Area and Severity Index scores for the head and neck did not decrease for patients in the treatment group, whereas scores for other body sites (submerged in the dilute bleach baths) decreased at 1 and 3 months, in comparison with placebo-treated patients.

CONCLUSIONS. Chronic use of dilute bleach baths with intermittent intranasal application of mupirocin ointment decreased the clinical severity of atopic dermatitis in patients with clinical signs of secondary bacterial infections. Patients with atopic dermatitis do not seem to have increased susceptibility to infection or colonization with resistant strains of S aureus.

Here is the protocol for Bleach Baths

1.  All patients received cephalexin at 50 mg/kg per day (maximum of 2 g/day), divided into 3 daily doses, for 2 weeks to treat their staphylococcal infections.
2.  Patients were instructed to add 0.5 cup of 6% bleach (final concentration: 0.005%; treatment arm)  to a full bathtub of water (40 gallons); the amount of administered bleach solution or water can be adjusted by the family on the basis of the bathtub size and estimated height of bathtub water.
3.  Patients were instructed to bathe in the dilute bleach bath for 5 to 10 minutes twice weekly. The frequency and number of baths without bleach  were not restricted.
4. Patients and their household members also were instructed to apply mupirocin ointment intranasally twice daily for 5 consecutive days of each month.
6.  The patient should maintained a stable regimen of topical antiinflammatory medication and emollient therapy.

  

Zen of Medical Blogging

Attached is a handout for a talk on medical blogging which was given on April 17, 2009 in Ottawa, Ontario.  I will try to put the PowerPoint Presentation on the SlideShare web site.

Zen of Medical Blogging:  Download Handout Blog Ottawa

Itch - Update

From the NY Times, April 7, 2009 (Health Section)

Scratching Relieves Itch by Quieting Nerve Cells

By Benedict Carey

A new study "reports that specialized cells in the spinal cord appear to be critically involved in producing the sensation of itch and the feeling of relief after the application of fingernails, at least in healthy individuals. The study appears in the current issue of the journal Nature Neuroscience.

It suggests that itch, like pain, may be a “gated” system in which signals from other nerve cells can interfere with or moderate the sensation. Scratching the skin near, but not directly on, the spot that itches often provides relief, just as rubbing an aching limb can reduce pain. Perceptions in the brain, too, probably moderate the urge to scratch: some chronic, compulsive cases of itching suggest that the brain is not properly reading the effect of outside signals at all but is instead acting on a mistaken internal representation of what is happening to the skin.

Full NY Times Article

Nature/Neduroscience Article:

Davidson S, Zhang X, Khasabov SG, Simone DA, Giesler GJ Jr. Relief of itch by scratching: state-dependent inhibition of primate spinothalamic tract neurons.

Itch is relieved by scratching, but the neural mechanisms that are responsible for this are unknown. Spinothalamic tract (STT) neurons respond to itch-producing agents and transmit pruritic information to the brain. We observed that scratching the cutaneous receptive field of primate STT neurons produced inhibition during histamine-evoked activity but not during spontaneous activity or activity evoked by a painful stimulus, suggesting that scratching inhibits the transmission of itch in the spinal cord in a state-dependent manner.

Zinc Sulfate for Resistant Warts

A recent study in a major journal has shown the efficacy of zinc supplementation for recalcitrant warts. After a 2-month course of treatment with zinc sulfate, a response rate of 78.1% (25/32 patients) was achieved. The mean serum zinc level in patients who responded to treatment increased to 199.7 ± 19.9 μg/100 mL, while in the remainder, the mean serum zinc level was 73.5 ± 9.2 μg/100 mL After 6 months of follow-up in those who received oral zinc therapy and responded to the treatment, no instance of recurrence was noticed.

The study is from Iran and needs to be repeated, however, this is a safe therapy with little risk.  An Iranian colleague told me that low serum zinc is not unusual in his country.  On the skeptical side, we remember similar optimism twenty years ago with reports of the effectiveness of oral cimetadine.  It never panned out.

Full article starts at the bottom right hand corner of first page of pdf: Download Zinc and Warts

The Zen of Medical Blogging

The following is a handout for a talk given to the Ottawa Dermatoloical Society Meeting on April 17, 2009. If you want to start a blog, you may find this helpful.  Download Zen Med Blog Ottawa

If you have questions or comments, please contact DJ Elpern

Botox - Reloxin War: Allergan vs Medicis

A new wrinkle is on the Cosmetic Dermatology horizon: Will Reloxin, expected to be approved by the F.D.A. this year, be more effective or affordable [than Botox]?

The buzz among doctors that has been spreading in the news media and on beauty-oriented Web sites like RealSelf.com is that Reloxin works more quickly and lasts longer than the roughly four months Botox does." [Dermatologist and plastic surgeon KOLs - key opinion leaders - who get high fees and perks from Big Pharma are weighing in. ) One dermatologist who did some of the clinical trials for Botox and Reloxin, recently said on NBC's "Today" show, "It's time that we have something that lasts a little bit longer" than Botox."  Not everyone agrees there is any difference between Reloxin and Botox. This is a high stakes game -- and it is worth billions to Allergan and Medicis -- not to mention the money the KOLs will get for their second homes, kids' tuitions and expense paid vacations.

This is a strange article and shows the direction dermatology is headed. See:  Heads Up, Botox