Gerald Fogg and Beth Longo
107 S. Main St.
Philippi, WV  26416
gmfogg@aol.com

Our son, Gavin, is a 14-year old boy with recessive dystrophic epidermolysis bullosa, often referred to as "RDEB" or just "EB".  This article is intended for those who have EB and their caregivers.  For those readers who are not familiar with this disease, EB is a genetic disorder caused by the absence of anchoring fibrils between certain layers of the skin.  Gavin's skin is constantly tearing or blistering and he always has many open wounds that need to be patched and bandaged daily.  Some of them are small and heal quickly.  Others are large, chronically infected wounds that heal very slowly, if at all.

For years, we've heard about treating skin infections by adding Clorox or vinegar to bathwater and we often tried these home remedies without much success.  However, we recently learned how to combine small amounts of vinegar and bleach to create an effective weapon against skin infection.  We used it to successfully eliminate a widespread, aggressive pseudomonas infection that we had been fighting for months.  It took just four days.  We are writing to share this discovery with others.

The secret ingredient in this process is hypochlorous acid (HOCL) which forms when the sodium hypochlorite in bleach is added to water having a pH of 6.5 or less.  Hypochlorous acid has rapid biocidal activity against all human pathogenic bacteria, fungi and viruses but no health or safety risks.  This "secret" will come as no surprise to swimming pool or hot tub owners.  The chlorine solution they pour into the water breaks down into several chemicals including hypochlorous acid which kills bacteria and microorganisms in seconds.  But it was news to us, and if you are struggling with a skin infection, we hope it will be good news to you.  If you want to try it, here's what to do.

Procedure

1. Take a long, soaking bath and remove all dressings, patches, creams, dead skin, exudate, dirt, etc.  Gavin soaks over an hour in Aveeno Daily Moisturizing Bath with Natural Colloidal Oatmeal which is designed to clean the skin without soap.  Whatever you use, the object is to get your entire body as clean as you can.  Then drain the tub and rinse it out so that no soap scum or other debris remains behind.
   

2. Refill the tub with clean, warm water, get in and relax.

3. Test the pH of the water with test strips used for swimming pools.  pH measures the acidity or alkalinity of a solution on a scale from 0 to 14.  Making sure that your bathwater is the right pH is critical to the success of this procedure.
   
   We use "hth Test Strips" made by Arch Chemicals, Inc. that we buy at Walmart.  One box contains 50 strips and each strip tests for chlorine, pH and total alkalinity.  Follow the directions on the box and determine the pH of you bathwater by dunking the strip in the bathwater and comparing the color on the strip with a color chart on the box.  The pH of our bathwater is usually 7.2 or greater.
   

4. If the pH of your bathwater is 6.5 or more, lower it to something less than 6.5.  Begin with 1/3 cup of vinegar, stir the bathwater, and test the pH.  If the pH is still too high, lower it by adding more vinegar in 1/3 cup increments until the pH indicator on the test strip turns yellow.  The pH color scale on our box doesn't go lower than 6.4 but the indicator on the strip turns a brighter yellow as the pH goes lower and the water becomes more acid.  The rule of thumb is - make sure the pH is less than 6.4 but not so low that the increased acidity becomes painful.  In our case, we use 2/3 cup of vinegar to obtain the right pH.
   

5. Now -- and only now -- are you ready to kill germs by the millions by adding Clorox or any household bleach.  The sodium hypochlorite in the bleach reacts with water to form hypochlorous acid -- a powerful disinfectant that kills bacteria within seconds without harming your skin.  But remember: this acid only forms in significant amounts if the pH is equal to or lower than 6.5.  Otherwise you will get hypochlorite ions which also kill germs but much less effectively.
   

6. Begin by adding two teaspoons of bleach, then stir the water and test.  Look at the Free Chlorine indicator on the strip.  It should be getting darker.  The Free Chlorine indicator measures the concentration of hypochlorous acid, provided that the pH of the water is 6.5 or less.  Now add another two teaspoons and test, and then another two, taking care between each addition to make sure the solution in the water is not becoming too painful.  We try to get the Free Chlorine to match the darkest colored square on the color chart, which is about 10 ppm (parts per million) and keep it there during the bath.  We use about 9 teaspoons of Clorox which we add in increments over 30 minutes.  Gavin soaks for about 50 minutes from beginning to end.

Before you add each increment of bleach, check the pH and keep it below 6.5 by using small amounts of vinegar.  As you soak in the bath, your own body can cause the pH to rise, so test often.  We seldom need to add any but you might depending on the pH of your water. 

Also during the bath, some of the hypochlorous acid will combine with dead skin cells and other microscopic debris from your body and become unavailable to kill germs.  You may need to add some bleach to keep the Free Chlorine from falling.  

During the bath, we use a few capfuls of "hth Water Moisturizer for Spas", which we also get at Walmart, to protect the skin from excessive drying.  It seems to help and doesn't affect the Free Chlorine values.  You may want to try it.

7. After this bath, we drain the tub and refill it for another brief soak to get the chlorine off.  We usually add some more Water Moisturizer and also 1/2 cup of vinegar so that the water stays slightly acid.  This soak lasts no more than 5 minutes.  You could shower or spray if you want but Gavin finds a soak less painful.
   

8. For days that Gavin doesn't bathe, we mix the solution in a bottle and spray it on between dressing changes.  We use 2 cups water, 1ML vinegar, and 6-8 drops of Clorox.  Use test strips to test and adjust the solution.

Results

Before we tried this procedure, Gavin was suffering from a widespread pseudomonas aeruginosa skin infection.  If you've had it, you know the green slime and distinctive odor that some call sweet but which reminds me slightly of airplane glue.  Even after a bath and re-dressing, the slime was never gone and you could smell the odor wherever he went.  Wound cultures showed heavy growth of the stuff.  We tried all sorts of remedies and were considering yet another round of intravenous antibiotics which is the standard medical treatment.

After one bath, the slime and smell were completely gone but began to reappear within a day.  As we fine tuned the procedure, we were able to suppress it totally and have seen no evidence of infection of any kind for two weeks.  Moreover, the wounds which had stubbornly refused to heal for months are beginning to shrink and produce less exudate.  Right now, Gavin bathes every other day.  On days he doesn't bathe, we spray the solution in between dressing changes.

Disclaimer and warning

I'm not a doctor or a chemist so please be careful and proceed at your own risk.  It is possible to create poisonous chlorine gas by combining vinegar and bleach if you use too much of both and make the water extremely acid.  I am told that the risk is extremely small with the dilute amounts we are using and we have had no adverse effects at all.  All the same, be careful out there.

Credits

The idea of combining bleach and vinegar to create hypochlorous acid was given to me by Joe Rafferty of Sterilox Technologies, Inc. in Radnor, PA.  Joe is a great guy who has taken an interest in Gavin and he continues to help me improve this procedure.  Joe also sent me an article about the chemistry of using chlorine as a disinfectant which I recommend that you read.  The article is listed below with other source material.

Thanks also to Andrew Muir, a chemist with Sterilox Technologies, for taking the time to listen and offer his suggestions.

Joe's company is working with doctors in the U.K. who are using hypochlorous acid to successfully treat chronic lower leg ulcers. So far as I know, no one else is using this chemical to treat skin infections although it is widely used to disinfect equipment and food products.  By the way, the doctors in the U.K. are using concentrations of up to 200 ppm.  We are getting good results at 10 ppm so it is probably safe to use more bleach if necessary.

Sources

Development of New Antiseptic (hypochlorous acid) for Preparing Wound Beds; European Tissue Repair Society, www.etrs.org

Chemistry of Chlorine Sanitizers in Food Processing
Dairy, Food and Environmental Sanitation
Vol. 22, No. 7, Pages 534-538, July 2002
www.foodprotection.org

How does chlorine work to clean swimming pools?
www.howstuffworks.com/question652.htm

Owner's Guide to Swimming Pool Water Chemistry
(I'm not sure of the website.  Just type in the above phrase on a search engine.  This site has a good Guide to Technical Terms including an understandable explanation of pH.)