Derm Dispatch: The Modern Utility of Sodium Hypochlorite and Hypochlorous Acid Beyond the Bleach Bath

In this episode of Derm Dispatch, host Renata Block, DMSc, MMS, PA-C, spoke with Jamie Restivo, MPAS, PA-C, President of the Pennsylvania Dermatology Physician Assistants and board-certified physician associate in Enola, Pennsylvania, to explore the evolving role of sodium hypochlorite and hypochlorous acid in the management of atopic dermatitis (AD) and related inflammatory skin conditions. Building on Restivo’s recent article, the discussion revisited the long history of these chlorine-based agents—dating back to battlefield antisepsis in World War I—while emphasizing their modern resurgence as practical, patient-friendly alternatives to traditional bleach baths.

Restivo highlighted that although bleach baths have been a longstanding adjunctive therapy in AD, their complexity and time burden often limit patient adherence. Precise dilution requirements, variability in bathtub sizes, and the need for detailed patient education can make this approach impractical, particularly for busy families or adult patients. In contrast, newer formulations, such as sodium hypochlorite body washes and hypochlorous acid sprays, offer a more convenient and standardized method of delivering similar antimicrobial and anti-inflammatory benefits.

The conversation underscored important distinctions between the 2 compounds. Sodium hypochlorite, the active ingredient in household bleach, is a strong base that requires careful dilution but can be safely incorporated into pre-formulated cleansers designed for skin use. Hypochlorous acid, a weak acid produced endogenously by neutrophils, is gentler and widely available in leave-on spray formulations. Both agents demonstrate antimicrobial activity, including reduction of Staphylococcus aureus colonization, and may help improve disease severity, pruritus, and overall quality of life in patients with AD.

Clinically, Restivo emphasized that these therapies should be positioned as adjuncts rather than first-line treatments, complementing topical, systemic, or biologic therapies. She advocates for individualized recommendations based on patient age, lifestyle, cost considerations, and disease severity. For example, bleach baths may still be appropriate in pediatric populations accustomed to bathing routines, whereas sprays and washes may better suit adults seeking convenience and improved adherence.

Restivo and Block also highlighted the growing influence of social media in driving patient interest in these products, reinforcing the need for clinician-led education to prevent misuse and confusion. Beyond AD, potential applications in conditions such as hidradenitis suppurativa, folliculitis, and prurigo nodularis were noted. Overall, they emphasized a broader shift toward simplifying adjunctive care, prioritizing efficacy, safety, and real-world usability to enhance patient outcomes.