25 Sep Apple Cider Vinegar Soaks Did Not Improve Skin Barrier in Atopic Dermatitis – Eczema

MedicalResearch.com Interview with:

Dr. Flowers

Hal Flowers MD
Assistant Professor of Dermatology
University of Virginia
Dr. Flowers specializes in autoimmune connective tissue disease (rheumatologic dermatology), phototherapy and blistering skin diseases 

MedicalResearch.com: What is the background for this study?

Response: Unfortunately, there really is not much literature at all addressing the treatment of atopic dermatitis with apple cider vinegar (ACV), even though we know that this is something our patients are doing. ACV is appealing as a “natural therapy” for treatment of skin disease. Since it’s an acid, it can theoretically correct the loss of acidity that occurs in the skin of our eczema patients. Plus, we know that high enough concentrations will kill certain bacteria that promote eczema, particularly Staphylococcus aureus. There are plenty of blogs and anecdotes as well as physicians who recommend this treatment, but as of yet, we don’t know the best concentration, safety or the benefit of ACV. 

MedicalResearch.com: What are the main findings?

Response: In our study, we compared dilute apple cider vinegar soaks vs plain water soaks in patients with eczema and without eczema. Compared to baseline, the skin of eczema patients became more acidic (a good thing!) but this did not last after 2 weeks of treatment. In addition, there was no change after the 2 weeks of soaks in the “skin barrier function” which we measured as the amount of water lost from the skin (“transepidermal water loss”). We did however see several skin reactions to apple cider, most commonly mild skin discomfort. Sixteen of our 22 patients actually reported some degree of discomfort. One eczema patient did have to stop the study due to severe rash.

MedicalResearch.com: What should readers take away from your report? What recommendations do you have for future research as a result of this work?

Response: I think this study shows several things that are important to consider for physicians recommending apple cider vinegar and for patients considering using it.

First, we know why ACV should work in eczema but we really don’t have evidence or data to prove that it does those things. In our study, we showed that any changes that occurred in the skin in eczema patients were not long lasting, even after several weeks of daily soaks in dilute apple cider vinegar. Future studies will be needed to show the true effect of ACV in eczema. Second, we often consider natural treatments as harmless, but our study showed that this may not necessarily be the case.

This highlights the importance of patients reaching out to their dermatologist or provider before undertaking home remedies for their skin, to ensure they are doing them in the safest (and most evidence-based) manner.

MedicalResearch.com: What are the limitations of the study?

Response: There are several limitations to our study and both physicians and laypeople should interpret these results with caution.

First, this was a small study of less than a dozen patients in each group. The average age was in the 20s, so it’s unclear if these results would apply to children or to older adults/elderly people. Additionally, we only tested specific parameters (pH and transepidermal water loss) at a particular body site. We did not specifically look at the effect on eczema itself (does it improve or not) or the effect on bacterial on the skin. We tested a fairly strong concentration of apple cider vinegar (1 part ACV to 10 parts water dilution in our study) relative to what is being recommended by most physicians (1 part ACV to 80 parts water, or 3-4 cups ACV to ½ bathtub of water). This may have increased the risk of side effects in our study but in spite of the higher concentration, we showed no permanent or lasting effect on skin acidity or on skin barrier in atopic dermatitis patients.

No disclosures. The study was funded by the University of Virginia, and is just one of many efforts the Departments of Dermatology, Allergy/Immunology and the health system in general are undertaking to investigate safe and effective treatments for our patients. 

Citation: 

Luu, LA, Flowers, RH, Kellams, AL, et al. Apple cider vinegar soaks [0.5%] as a treatment for atopic dermatitis do not improve skin barrier integrity. Pediatr Dermatol. 2019; 36: 634– 639. https://doi.org/10.1111/pde.13888

ABOUT PEDIATRIC DERMATOLOGY:

The official publication for the Society for Pediatric Dermatology (SPD), Pediatric Dermatology is a peer-reviewed bimonthly journal that captures leading research in the field of children’s skin, hair and nail disorders to promote skin health across the United States and aid the development of new treatments for pediatric patients.

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Last Updated on September 25, 2019 by Marie Benz MD FAAD