Bleach baths are a controversial therapy for patient with atopic eczema, also known as atopic dermatitis (AD). In recent years, there has been an increase in the use of bleach baths to decrease the severity of the eczema. However, a recent review showed that while bleach baths did seem to decrease the severity of atopic eczema, it was no more effective than water baths alone. There has been a lot of research into the effect of bleach baths on Staphylococcus bacteria and it seems like the concentration of bleach used in bleach baths may not be high enough to kill bacteria. There may be other anti-inflammatory properties that have yet to be discovered.

With all of the conflicting data out there, the best summation is probably what was stated in the latest Canadian consensus statement on pediatric atopic eczema: “bleach baths have not been consistently shown to improve outcomes in AD and may be used at the discretion of the treating health care provider.”

Reference:
Lansang P et al, Approach to the Assessment and Management of Pediatric Patients With Atopic Dermatitis: A Consensus Document. Section IV: Consensus Statements on the Assessment and Management of Pediatric Atopic Dermatitis. J Cutan Med Surg.2019;23(5):32S-39S.

Pulsed dye laser (PDL) is a very effective treatment for redness of the face due to enlarged blood vessels. It has proven to be very safe and effective. However, there is some discomfort from the laser pulses and while most patients have no difficulty tolerating treatment without any anesthetic, some patients do find it difficult to tolerate. Topical anesthetic can be used to decrease the discomfort of laser treatments but there has always been the question of whether the vasoconstrictive properties (i.e. constriction of blood vessels) of the anesthetic might have an adverse effect on outcome if you are trying to get rid of blood vessels.

A recent study by Chunharas et al in April of 2020 (Lasers Surg Med. 2020 Apr;52(4):307-314) demonstrates that topical anesthesia with lidocaine and tetracaine do not interfere with the efficacy of pulsed dye lasers. This is great news for those who want to receive treatments with pulsed dye lasers.