TY - JOUR
T1 - Bleach baths for atopic dermatitis
T2 - A systematic review and meta-analysis including unpublished data, Bayesian interpretation, and GRADE
AU - Bakaa, Layla
AU - Pernica, Jeffrey M.
AU - Couban, Rachel J.
AU - Tackett, Kelly Jo
AU - Burkhart, Craig N.
AU - Leins, Liz
AU - Smart, Joanne
AU - Garcia-Romero, Maria Teresa
AU - Elizalde-Jiménez, Itzel Guadalupe
AU - Herd, Michael
AU - Asiniwasis, Rachel Netahe
AU - Boguniewicz, Mark
AU - De Benedetto, Anna
AU - Chen, Lina
AU - Ellison, Kathy
AU - Frazier, Winfred
AU - Greenhawt, Matthew
AU - Huynh, Joey
AU - LeBovidge, Jennifer
AU - Lind, Mary Laura
AU - Lio, Peter
AU - O'Brien, Monica
AU - Ong, Peck Y.
AU - Silverberg, Jonathan I.
AU - Spergel, Jonathan M.
AU - Wang, Julie
AU - Begolka, Wendy Smith
AU - Schneider, Lynda
AU - Chu, Derek K.
N1 - Publisher Copyright:
© 2022 American College of Allergy, Asthma & Immunology
PY - 2022/6
Y1 - 2022/6
N2 - Background: Bleach bathing is frequently recommended to treat atopic dermatitis (AD), but its efficacy and safety are uncertain. Objective: To systematically synthesize randomized controlled trials (RCTs) addressing bleach baths for AD. Methods: We searched MEDLINE, EMBASE, CENTRAL, and GREAT from inception to December 29, 2021, for RCTs assigning patients with AD to bleach vs no bleach baths. Paired reviewers independently and in duplicate screened records, extracted data, and assessed risk of bias (Cochrane version 2) and GRADE quality of evidence. We obtained unpublished data, harmonized individual patient data and did Frequentist and Bayesian random-effects meta-analyses. Results: There were 10 RCTs that enrolled 307 participants (median of mean age 7.2 years, Eczema Area Severity Index baseline mean of means 27.57 [median SD, 10.74]) for a median of 6 weeks (range, 4-10). We confirmed that other trials registered globally were terminated. Bleach baths probably improve AD severity (22% vs 32% improved Eczema Area Severity Index by 50% [ratio of means 0.78, 95% credible interval 0.59-0.99]; moderate certainty) and may slightly reduce skin Staphylococcal aureus colonization (risk ratio, 0.89 [95% confidence interval, 0.73-1.09]; low certainty). Adverse events, mostly dry skin and irritation, along with itch, patient-reported disease severity, sleep quality, quality of life, and risk of AD flares were not clearly different between groups and of low to very low certainty. Conclusion: In patients with moderate-to-severe AD, bleach baths probably improve clinician-reported severity by a relative 22%. One in 10 will likely improve severity by 50%. Changes in other patient-important outcomes are uncertain. These findings support optimal eczema care and the need for additional large clinical trials. Trial Registration: PROSPERO Identifier: CRD42021238486.
AB - Background: Bleach bathing is frequently recommended to treat atopic dermatitis (AD), but its efficacy and safety are uncertain. Objective: To systematically synthesize randomized controlled trials (RCTs) addressing bleach baths for AD. Methods: We searched MEDLINE, EMBASE, CENTRAL, and GREAT from inception to December 29, 2021, for RCTs assigning patients with AD to bleach vs no bleach baths. Paired reviewers independently and in duplicate screened records, extracted data, and assessed risk of bias (Cochrane version 2) and GRADE quality of evidence. We obtained unpublished data, harmonized individual patient data and did Frequentist and Bayesian random-effects meta-analyses. Results: There were 10 RCTs that enrolled 307 participants (median of mean age 7.2 years, Eczema Area Severity Index baseline mean of means 27.57 [median SD, 10.74]) for a median of 6 weeks (range, 4-10). We confirmed that other trials registered globally were terminated. Bleach baths probably improve AD severity (22% vs 32% improved Eczema Area Severity Index by 50% [ratio of means 0.78, 95% credible interval 0.59-0.99]; moderate certainty) and may slightly reduce skin Staphylococcal aureus colonization (risk ratio, 0.89 [95% confidence interval, 0.73-1.09]; low certainty). Adverse events, mostly dry skin and irritation, along with itch, patient-reported disease severity, sleep quality, quality of life, and risk of AD flares were not clearly different between groups and of low to very low certainty. Conclusion: In patients with moderate-to-severe AD, bleach baths probably improve clinician-reported severity by a relative 22%. One in 10 will likely improve severity by 50%. Changes in other patient-important outcomes are uncertain. These findings support optimal eczema care and the need for additional large clinical trials. Trial Registration: PROSPERO Identifier: CRD42021238486.
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U2 - 10.1016/j.anai.2022.03.024
DO - 10.1016/j.anai.2022.03.024
M3 - Article
C2 - 35367346
AN - SCOPUS:85130588627
SN - 1081-1206
VL - 128
SP - 660-668.e9
JO - Annals of Allergy, Asthma and Immunology
JF - Annals of Allergy, Asthma and Immunology
IS - 6
ER -