Bleach Bath Treatment of Adults With Atopic Dermatitis
Condition: Atopic Dermatitis
MeSH terms: Dermatitis, Atopic; Dermatitis; Eczema
Study type: Interventional

Summary: 
      This is pilot, mechanistic study to address whether bleach baths given to adult subjects with
      atopic dermatitis or eczema, who are colonized with the bacteria Staphylococcus aureus, will
      significantly alter their skin microbiome and in so doing improve their skin barrier,
      diminish expression of inflammatory proteins in the skin and improve itch. To answer these
      questions the investigators will perform a 3-month, pilot, investigator-initiated,
      single-center, open-label clinical study. This study will allow us to test the following
      hypothesis: 1) that bleach baths will normalize skin barrier function, 2) that bleach baths
      will diminish the local inflammatory response in the skin, and 3) that bleach baths will
      improve validated measures of itch (also called pruritus).
    

Detailed description: 
      Atopic Dermatitis subjects have different proportions of bacterial communities on their skin
      surface. Often, their skin is colonized with the pathogenic bacteria called Staphylococcus
      aureus. Studies have demonstrated a remarkable clinical improvement in Atopic Dermatitis
      subjects who take bleach baths two times per week for three months. The assumption was that
      this worked by reducing the S. aureus on the skin surface but by standard culture techniques
      there was no change in S. aureus colonization. Therefore, the mechanism by which these bleach
      baths improved the disease remains entirely unknown. This study will assess the effects
      bleach baths have on bacteria that can and cannot be cultured using new molecular biologic
      tools that have shown us that the skin is home to thousands of different microbial species.
      This bacterial ecosystem is called the microbiome. The investigators will also determine
      whether bleach baths affect skin barrier integrity and the cutaneous expression of
      lymphocyte-derived cytokines that are thought to cause the skin inflammation in subjects with
      Atopic Dermatitis. The investigators will also assess to what degree these baths improve
      disease severity and the symptoms of itch using validated scoring systems. This work will
      likely uncover new ideas about the pathogenesis of Atopic Dermatitis and may be the first
      step to developing new pro-microbial and antimicrobial therapeutics.

      This study is designed to test the following hypotheses:

        1. The chronic use of bleach baths will normalize skin barrier function in adult Atopic
           Dermatitis subjects as measured by physiological measures of barrier in vivo, and as
           assessed by ex vivo studies (measuring transepithelial electrical resistance (TEER) and
           permeability of the epidermis from skin biopsies). The investigators will evaluate
           whether any of the functional changes correlate with changes in expression of relevant
           tight and intercellular junction molecules at the messenger ribonucleic acid (mRNA)
           level.

        2. Bleach baths will improve validated measures of pruritus (itch).

        3. Bleach baths will diminish the local T-helper 2 (Th2) immune response measured from skin
           biopsy samples.
    

Intervention name(s): bleach bath (sodium hypochlorite)
Intervention type(s): Drug
Intervention description(s): Subjects will take diluted bleach bath (0.005% Sodium Hypochlorite) for 5-10 minutes twice a week for 12 weeks.
Other intervention name(s): Sodium hypochlorite
Intervention MeSH terms: Sodium Hypochlorite; Eusol
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: atopic dermatitis; eczema; bleach bath; itch; skin barrier; staphylococcus aureus