Topical hypochlorous acid is an underutilized tool in the management of atopic dermatitis (AD), Joseph F. Fowler, MD, said at MedscapeLive’s annual Las Vegas Dermatology Seminar, held virtually this year.

“I definitely like hypochlorous acid products to reduce microbial load and improve itching,” said Dr. Fowler, a dermatologist at the University of Louisville (Ky.). “It’s certainly a useful adjunct – not your primary treatment – in managing atopic dermatitis, especially when infected.”

Topical stabilized hypochlorous acid for use on the skin is commercially available over the counter in gel and liquid spray forms. It’s not bleach, which is sodium hypochlorite. In fact, for use on the skin, hypochlorous acid is better than bleach, since it doesn’t stain dark clothes, it’s nonirritating, and it doesn’t smell like bleach.

“We’re not entirely sure why it has an anti-itch effect, but that might partly be due to its inhibition of mast cell degranulation. It stops the mast cell from releasing its itch-o-genic properties into the skin. It also inhibits phospholipase A2, resulting in reduction of leukotrienes and prostaglandins, which may also account for the anti-itch effect,” Dr. Fowler said.

Hypochlorous acid has a powerful antimicrobial effect. It is highly effective at rapidly killing a broad range of bacteria, viruses, and fungi, including Staphylococcus aureus, a pathogen of particular relevance in AD. After the Environmental Protection Agency added hypochlorous acid to its list of disinfectants known to be effective against coronavirus, commercial interest in the use of hypochlorous acid in higher concentrations as a disinfectant in office buildings, hospitals, and for other large-scale applications has ballooned. The product, made via a process involving electrolyzation of water, is inexpensive. It’s also nontoxic: It’s not perceived by the immune system as foreign, since hypochlorous acid is produced during the human innate immune response.

Dr. Fowler reported serving as a consultant to and on the speakers bureau for SmartPractice, and receiving research funding from Asana, Edesa Biotech, J&J, and Novartis.

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