Bakaa Layla, Pernica Jeffrey M, Couban Rachel J, Tackett Kelly Jo, Burkhart Craig N, Leins Liz, Smart Joanne, Garcia-Romero Maria Teresa, Elizalde-Jiménez Itzel Guadalupe, Herd Michael, Asiniwasis Rachel Netahe, Boguniewicz Mark, De Benedetto Anna, Chen Lina, Ellison Kathy, Frazier Winfred, Greenhawt Matthew, Huynh Joey, LeBovidge Jennifer, Lind Mary Laura, Lio Peter, O'Brien Monica, Ong Peck Y, Silverberg Jonathan I, Spergel Jonathan M, Wang Julie, Begolka Wendy Smith, Schneider Lynda, Chu Derek K
Evidence in Allergy Group, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Department of Pediatrics, Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada.
Ann Allergy Asthma Immunol. 2022 Jun;128(6):660-668.e9. doi: 10.1016/j.anai.2022.03.024. Epub 2022 Mar 30.
Bleach bathing is frequently recommended to treat atopic dermatitis (AD), but its efficacy and safety are uncertain.
To systematically synthesize randomized controlled trials (RCTs) addressing bleach baths for AD.
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 We obtained unpublished data, harmonized individual patient data and did Frequentist and Bayesian random-effects meta-analyses.
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.
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.
PROSPERO Identifier: CRD42021238486.
漂白浴常被推荐用于治疗特应性皮炎（AD），但其疗效和安全性尚不确定。
系统综合针对AD漂白浴的随机对照试验（RCT）。
我们检索了MEDLINE、EMBASE、CENTRAL和GREAT数据库，从建库至2021年12月29日，查找将AD患者分配至漂白浴组与非漂白浴组的RCT。两名评审员独立且重复地筛选记录、提取数据，并评估偏倚风险（Cochrane第2版）和GRADE证据质量。我们获取了未发表的数据，整合个体患者数据，并进行了频率学派和贝叶斯随机效应荟萃分析。
有10项RCT纳入了307名参与者（平均年龄中位数为7.2岁，湿疹面积严重程度指数基线均值的均值为27.57[中位数标准差，10.74]），中位治疗时间为6周（范围4 - 10周）。我们确认全球其他注册的试验已终止。漂白浴可能改善AD严重程度（湿疹面积严重程度指数改善50%的比例为22%对32%[均值比0.78，95%可信区间0.59 - 0.99]；中等确定性），并可能轻微降低皮肤金黄色葡萄球菌定植（风险比，0.89[95%置信区间，0.73 - 1.09]；低确定性）。两组之间不良事件（主要是皮肤干燥和刺激）以及瘙痒、患者报告的疾病严重程度、睡眠质量、生活质量和AD发作风险没有明显差异，确定性为低至极低。
在中重度AD患者中，漂白浴可能使临床医生报告的严重程度相对改善22%。每10人中可能有1人严重程度改善50%。其他对患者重要的结局变化尚不确定。这些发现支持优化湿疹护理以及进行更多大型临床试验的必要性。
PROSPERO标识符：CRD编号：CRD42021238486 。
