The Battle Against Microbial Pathogens: Basic Science, Technological Advances and Educational Programs (A. Méndez-Vilas, Ed.)
Sodium Hypochlorite (NaClO): Ruffini Method for the Treatment of Topic Infectious Diseases of the Skin, Mucous Membranes and Systemic Diseases Ruffini Gilberto1 and Terzo Eloisa2 1 2
DM, Surgeon Specialist in Hematology DVM, MRCVS Surgeon Specialist in Clinical Sciences & Clinical Pathology of Small and Large Animals
1. Ruffini Method The Ruffini Method is a dermatological treatment for topical use skin of Sodium Hypochlorite (NaClO) between 6% and 12% [1,2]. This therapeutic methodology was born in 1991 when Dr. Gilberto Ruffini, a surgeon and hematologist, during the carrying out of a clinical work for an aphthae, dealing with Sodium Hypochlorite 5% (already in use in the dental field but limited to specific use) [3-9], he noticed a net and fast improvement certainly unexpected at that time. From there he began to study deeply the molecule for a vast number of clinical cases discovering and obtaining impressive results on many difficult diseases and then came on 24 July 1996 to submit application for the patent filing that he obtained the following year. MI96A patent No. 001,557. Since 1997, the year in which Dr. Ruffini obtained the official patent with the copyright and protection of intellectual authorship and a good control over the otherwise possible economic speculation by pharmaceutical companies, Dr. Ruffini has contacted and informed the so-called "competent medical bodies" in the hope that it could be started successfully the official procedure for national and international recognition of such great treatment. Since 2008 we started to update constantly the official site www.metodoruffini.it recognizing reporting many successful treatments and clear communications [2].
2. Sodium Hypochlorite Pure, sodium hypochlorite is a salt pentahydrate (NaClO · 5 H2O) which melts at about 18 ° C and is particularly unstable[5, 7]. Both by frictioning and by heating to temperatures exceeding 35 ° C it can decompose violently. Precisely for this reason it is never marketed in a pure state. Instead, it is used in aqueous solution, at a concentration generally not exceeding 25%. Chemically it is obtained by a strong alkali, sodium hydroxide (caustic soda) almost neutralized by a weak acid, which imparts to the final solution an alkaline pH; a solution of 160 g of sodium hypochlorite in a liter of water has a pH of about 12 [5,7]. Industrially, is obtained by bubbling the chlorine gas in the sodium hydroxide, according to the following reaction (Fig.1): Cl2 + 2NaOH NaClO + NaCl + H2O
Fig. 1 Sodium hypochlorite, NaClO chemical formula.
Being a chemical base, sodium hypochlorite is sometimes confused with the same lye, common name of sodium hydroxide (caustic soda), which differently is much more corrosive. The solutions of hypochlorite up to 5.6% are sold for home use under the names of bleach[10, 11]. More concentrated solutions (12-15%) are widely used by laundries industries and worldwide disinfection of swimming pool’s water. For this and other purposes it is also used a white powder: the sodium dichloroisocyanurate, liberating compound hypochlorite in water to which is added. It has cyclic molecule, where six atoms form a hexagon. Three of
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them are nitrogen, and two of these three are bonded to chlorine atoms. The chlorine-nitrogen bond is broken by water (by hydrolysis); with its molecules, the water, known formula of H2O, attacks a hydrogen atom (H) and nitrogen an OH group to chlorine, giving HOCl, which forms hypochlorous acid. The latter is in equilibrium with its negative ion, precisely hypochlorite, depending on the pH: if the environment is basic (pH greater than 7), prevails this ion[3, 7]. The bactericidal properties of the salts containing the latter (sodium Hypochlorite, calcium hypochlorite, etc.) were clarified in 1881 by the famous German microbiologist Robert Koch and by the French Louis Pasteur , but its use was sporadic and began over sixty years in advance to disinfect and deodorize hospitals and toilets[12, 13]. Many spread had the so-called chloride of lime, industrial mixture of chloride and calcium hypochlorite. Albert Calmette showed that those hypochlorites destroyed the tuberculosis bacterium, well noted to be resistant to alcohol instead[14-16]. In fact, rather than the hypochlorite ion, it is much more effective the hypochlorous acid, which, as just said, is in equilibrium with it. Such acid penetrates through the cell walls of microorganisms and interferes with some important enzymes. However, if prevail in the products suitable for use as disinfectants, such as would be in acidic solutions (pH below 7), they will simply retain little: in fact we have seen that, if an acid is mixed with the bleach, it releases chlorine. For historical completeness, it must be said also that the same chlorine as such was used as a disinfectant in the first half of the nineteenth century: [16, 17] Friedlieb Ferdinand Runge, German chemist, experimented with success during a cholera epidemic (1831). Much time has passed since, and is absolutely worth to state that the hypochlorite is essential for disinfection, as well as of aqueducts and pools, also of wounds and burns, bottles and teats and such many other disinfectant indications have been used worldwide. Its powerful action to fight viruses and bacteria make its use recommended highly by international health authorities to combat AIDS, hepatitis, polio and cholera.[12, 18-20]
3. Hypochlorous acid Hypochlorous acid is an inorganic weak acid with chemical formula HClO. [21] It can be produced by reacting water and dichlorine monoxide according to the following reaction: H2O + Cl2O 2HClO Hypochlorous acid has a strong oxidizing ability (its standard potential of reduction is of 1.61 Volt) given [22]that in its molecule is present a chlorine atom in oxidation number +1 (which tends to decrease buying 2 electrons until reaching the octet rule of chloride ion in oxidation number -1). Its salts derived take the name of hypochlorites. The latter, for the same reason as HClO, enjoy oxidizing capacity (however significantly smaller) but have distinctly basic properties (Brønsted bases) because they are salts derived from a weak acid which therefore tend to add protons to return the corresponding acid ( Fig.2). H2O + ClO- HClO + OH-
Fig. 2 Hypochlorous acid, HcLO chemical formula.
4. Sodium Hypochlorite (NaClO): How it works. Sodium Hypochlorite (NaClO) is a molecule that is known historically been the subject of numerous studies and many applications around the world[3, 6, 10, 12, 20, 21, 23, 24]; We will focus only on its health aspect (since the product is generally used for thousands of uses) and here we report our contribution in human and veterinary medical field[3, 9, 20, 21, 25-30]. With this chapter we are willing to describe with simplicity the 99 diseases treatable or curable in only a few applications. We would like to make a clarification: In Ruffini method are excluded those skin diseases of genetic and autoimmune origin, allergic manifestations and neurological ones (such as diabetic neuropathy or ischemic events). The use of Ruffini Method is just strictly dedicated to topical dermatological diseases or disorders of various etiology,
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including viral, microbial, fungal, protozoal and parasitic diseases; Also included are acid-base reactions (for example, from formic acid).[1, 2] We realize that the huge amount of diseases solved or at least greatly improvable by the use of Ruffini Method may lead to disbelief in the medical world and academic environment because there is really little or no knowledge of why the hypochlorous acid is so crucial to the disintegration of the virus, the prokaryotic cells, fungi, of protozoa and parasites. [1, 2] Furthermore, these five families of pathogens are the responsible of the several dermatological diseases, hence determining the vast list that in our experience we have been greatly managed for decades. The hypochlorous acid that is formed as a reaction to the application of sodium hypochlorite has the characteristic of breaking the hydrogen bonds of some components of the membrane and / or cell wall including the viral envelope. As soon as these bonds cleaved, hypochlorous acid has a very careful capacity of meeting other components of the microorganism (as it happens for example for the helicase protein of Human Papilloma Virus (HPV). At this point it also splits the hydrogen bonds of DNA destroying it with no possibility of recovery. [18, 20]The application time can range from a minimum of 30 seconds to a maximum of 90 seconds (in rare cases up to 120 seconds). This variation depends on the consistency of the tissue (dermis or mucosa) and the type of structure of the pathogen. [1, 2]
5. Pathogens With Ruffini Method, we have widely experienced that the topical use of Sodium hypochlorite between 6% and 12% is useful for the cure of pathologies of the skin and mucosa by direct application and it promises to treat over one hundred diseases and disorders of the skin and mucous membranes often insidious and resistant to any type of traditional treatments. From dermatitis to fungal infections of the skin and nails, the human papilloma virus, from injuries to inflammation, from wasp stings and burns from jellyfish to sunburns, from herpes sores to shingles, and very interesting it fights greatly against MRSA infections including the fearsome infected diabetic foot infections of MRSA.[3, 6, 11, 18, 20, 31-35] In particular, it acts against five classes of pathogens: Virus; Bacteria; Fungals; Protozoa; Parasites There are also other situations in which the use of sodium hypochlorite turned out to be very useful: Insect bites; Burns from jellyfish and stinging plants; Burns and burns home; Accidental and surgical wounds; Personal and domestic hygiene The areas covered by Ruffini method are: Dermatology; Gynecology; Surgery; Ophthalmology; Accident skin; Personal hygiene; Ambient, Household room and work; Veterinary Medicine Sodium Hypochlorite cure diseases of the skin and mucous membranes, but not all of them, indeed from this type of treatment are specifically excluded: Genetic diseases; Autoimmune diseases; Allergic diseases; Neurological manifestations; Psychosomatic manifestations
6. General methodology General rule of Ruffini Method is to apply the product at specific % with specific time[1, 2]. It can be used in all the body districts of humans and animals. Skin coverings, genitals, hair, mucosae (lips, mouth,vagina, penis, nasal mucosae, rectus). (Figs. 3- 21) For any specific treatment and disease we have published a manual of Ruffini Method. When applied the Ruffini Method, the burning feeling is normal (but is not negative in any way indeed is the time in which the substance is eliminating the pathogenic cell is disintegrating and its genetic code). When this heat is felt, this is a good sign, meaning that the substance is working to the best of its activity. Sodium hypochlorite deprives temporarily hair fat that is deposited. The hair will be even more soft and shiny as before. Using on the lips: In the case of pathology labial apply Sodium Hypochlorite between 6% and 12% (depending on the disease to be treated) on the area where it appeared and leave for 60 seconds (even better to do this at the first symptoms). Do not ingest the product. The burning does not indicate negative but positive in that it is the moment when the substance is' breaking up the cell and the DNA of the pathogen (virus, microbes, protozoan or fungus).
7. Summary of Properties of NaClO - Excellent germicidal function against almost all kinds of microbes, viruses, molds and spores, but not be able to deactivate Giardia Lambia and Cryptosporidium. - Does not work in dirty conditions and also on some metals, it is corrosive. - If in contact with H2O2 (hydrogen peroxide), there is a total loss of its efficacy. - With the decay, it changes in salt (NaCl) and Oxygen. - Only the respect of correct ideal storage temperature, closure and darkness of the content facilitates still useful life of the formula, to an average content and still usefulness of ppm (active chlorine). - It discolors clothes and could damage them inexorably.
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- Its function is for sure, only if the surface is cleaned, and then, the cleaning of the area is essential and essential in order to complete a desired action, moreover, is a very unstable substance and inactivated by organic substances. - With acids, it develops Chlorine and in aqueous solutions it slowly releases chlorine thus tending to disinfect the solvent. - It is the salt of hypochlorous acid and the anion of the Chlorine. - To the ideal storage temperature, i.e. around 2-4 degrees centigrade there is much less time decay. At around 37 degrees, it increases the hydrolysis cell improving its full potential power. Is a powerful biological molecule oxidizing, very active on the walls and prokaryotic virus particles (envelope and core). - It has an oxidizing property much lower than those of 'hypochlorous acid. The reduction potential is equal to 0,878 volts, while that of 'hypochlorous acid. It is equal to 1.61 volts. - Close to 15%, the density is greater than water and consequently settles. - The dilution water containing metals, sunlight and the reduction of the pH make even more unstable. - The amount of chlorine accepted by 'European Union in drinking water is 0.1mg / L. - In countries where the taste of chlorine in drinking water is seen as a guarantee of quality (eg. in USA), the accepted value is 10 times that of Europe: 1 mg / L. - The O.M.S. accepts a concentration of 0.5 mg / L of chlorine in drinking water but, observed, there is no negative effect to health even at 5 mg / L (10times). - It is the most recommended and used disinfectant worldwide. - Its smell, quickly disappear simply with washes of H2O2 (water peroxide). It is not poisonous. It is not allergenic. It helps eliminate arthritic pain and inflammation with prostate simple serial application on the skin away from the sites involved (eg. on the inner face of elbows). - Can decrease the PCR (C-reactive protein) and ESR (Speed Erythrocyte) consequently reducing the pain from inflammation in report of their blood values. - Strongly more efficient than all other alternatives of disinfectants - It is used despite all the talk as a benchmark for all disinfectants. - Hypochlorous Acid, is equipped with a high oxidizing power and is able to damage all the cells of prokaryotic and viral particles. - At acid pH is formed Hypochlorous Acid with a higher antimicrobial activity, at pH alkaline ion is formed mainly hypochlorous but with minor antimicrobial activity. The maximum activity of Hypochlorous acid is noticed at pH of around 5 which allows only a minimal Ionic dissociation, while decreases in higher pH. - The disinfectant power is expressed as available chlorine, in parts per million (Ppm). - Large amplitude antimicrobial, viral and fungal spectra. - Low concentrations of chlorine produce a strong increase in the permeability of cytoplasmic membrane. The chlorine entering the inside of the cell shape forms Chloramines that accumulating, give rise to cell deaths. - On the spore,s Chlorine, with increased permeability causes the breakage of the external casings. - Already at about pH 5 there is denaturation of proteins and enzymes -SH groups, coagulation of structural proteins of the microbe. - pH, concentration, temperature, organic matter and ammonia, affect the antimicrobial activity of chlorine. - The efficacy improves at higher temperatures at around 37 degrees Celsius. - The greater amount of Hypochlorous Acid undissociated is present at about pH 5. - Proteins supplement the chlorine in their molecules forming N-chlorine compounds (Chloramines), whereas the lipids, especially polyunsaturated fatty acids, incorporate Chlorine even at higher values. The phenomenon of incorporation increases with decreasing pH. - Adding small amounts of iodine increases the antimicrobial activities. - It never allows the resistance against virus, bacteria and fungi. - Contact with ammonia forms the Chloramine (irritant) therefore expected urine tract infections (UTI) where it is right to proceed before emptying and then washing neutral bladder quote. - The salt water (Fe ++, Mn ++, Nitrates) inactivate the product. - It must not be exposed to the direct sunlight and in a cool place. - It can cause dangerous situations, such as swelling of the packages and their possible explosion. - For every 10 ° C increase, (up to 37C °), it increases in 50% its antimicrobial strength. - Chlorine has the ability to destroy the chains of the cytoplasm enzyme, (in prokaryotic cells in a few ml) thus blocking the life cycle of the microbe and, even more simply in fungi and viruses. - The unit of measurement ppm (parts per million), is derived from a ratio of units of measurement and, when the result of the ratio is in the order of a millionth, it says 1 ppm more practical 0.000001. For example, the milligram (mg) can be written as 1 ppm on a Kg, (1 million milligrams).
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8. Pathologies treated successfully with Ruffini Method * Exclusive of Medical Intervention Acne * Actinomycosis * Acute coryza (prevention only) Adenovirus & Rhinovirus * Apthae Atopic dermatitis Balanite Balanoposthitis Balamutiasi * Basidiobolomycosis * Burns (1st and 2nd degree) Burns (3rd and 4th grade) * Buruli ulcer * Candida (all subtypes) Caries ( cariogenic environment) Chalazion * Chancroid * Chlamydia * Chromoblastomycosis * Chronic mucogenetic candida * Chronic sinusitis (microbially infected) * Clostridium Infections * “Combustiforme” Staphylococcal syndrome * Condyloma Contact dermatitis Cosmetics (odors) Cutaneous anthrax Cutaneous larva migrans Cutaneous leishmaniasis * Dandruff Dermatomycoses Disease Fournier * Dranculosis (Guinea worm) * Dry dental prosthesis (not of metal) Duhring Dermatitis * Entomophtoromycosis * Erysipelas * Erythema multiforme * Erythema nodosum * Erythrasma * Feoifomicosi * Ficomicosi * Fistula * Folliculitis Folliculitis decalvans * Folliculorum mite Granuloma * Hansen's disease (leprosy) * Hematomycosis (cutaneous) * Herpes simplex 1 Herpes simplex 2 Herpes Varicella Zoster 3
Hidradenitis suppurativa * Infected diabetic foot (nonischemic) * Insect bites (in general) Intertrigo Invasive aspergillosis Primary Surface * Itching (not allergic) Loiasis * Maduromycosis * Marjolin ulcer * Molluscum MRSA skin infections * MST (indoor and / or outdoor) * Mucormycosis * Mycetoma * Necrotizing fasciitis * Norwegian scabies Onychomycosis Oral rinses Osteomyelitis (in open segment) * Papillomavirus (HPV) Parasites Paronychia (Whitlow or whitlow) Pediculosis (Head Lice) Penicilliosi * Perifollicolite Pimply Pyomyositis (found in muscle) * Pitiosi * Pityriasis rosea * Processionary (stinging) Protozoa Pseudofolliculitis Psoriasis (just itching) Rosacea (Couperose) * Scabies Schistosomes animals Seborrheic dermatitis * Sicosis Skin abscesses * Sporotrichosis * Stinging (jellyfish, nettles, stinging in general) Stings of bees, wasps, hornets and Bombi Streptococcal cellulitis and others * Syphilis skin * Tinea (all forms) Tinea Nigrans Palmaris Treponematosi endemic * Trichosporon cutaneum (White stone) Viral pharyngitis (sore throat) Warts (Municipalities, Plane and Piane) * Wounds Zygomycosis *
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9. Some of the hundreds of clinical cases treated successfully in both human medicine and Veterinary medicine
Fig. 3 Mite otititis in a dog.
Fig. 4 Purulent Dermatitis in a cat.
Fig. 5 Digital dermatitis in a dog.
Fig. 6 Leishmaniosis in a dog.
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Fig. 7 Pyodermitis in a dog.
Fig. 8 Onychomycosis.
Fig. 9 HPV medical report (from positive result to HPV to negative after only 2 internal lavages).
Fig. 10 Dyshidrosis.
Fig. 11 Tinea Corporis.
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Fig. 12 Verruca piana (flat wart).
Fig. 13 Wasp sting.
Fig. 14 Psoriasis.
Fig. 15 Herper Varicella Zoster.
Fig. 16 Herpes Simplex.
Fig. 17 Diabetic foot Ulcera.
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Fig. 18 Retro auricular granuloma.
Fig. 19 Severe chronic MRSA Infection.
Fig. 20 MRSA infection.
Fig. 21 Recurrent Chronic purulent right Eye infection.
11. General Dosages - For open wounds and mucous membranes: 6- 9 %. - If you want a useful step in acting also in subcutaneous areas: 9- 12 % (eg. decalvans folliculitis). Only on some tropical diseases not present in the Western world: 15 %. For any correct method please consult Dr. Ruffini [1, 2] Acknowledgments We would like to warmly thank Mr Paolo Alessandro Ruffini, Mr Valerio Droga, Mr Damiano Luzietti and Mr Danilo Coral for their great support in Ruffini Method field.
References [1] [2] [3] [4] [5]
Ruffini, G.V., Droga, Curarsi con la candeggina? Guida pratica al metodo Ruffini, per trattare oltre 100 malattie con meno di un euro. Ed. 2014.Ruffini & Droga publ. Ruffini, G., Metodo Ruffini. www.metodoruffini.it Byström, A. and G. Sunvqvist, The antibacterial action of sodium hypochlorite and EDTA in 60 cases of endodontic therapy. International Endodontic Journal, 1985. 18(1): p. 35-40. Siqueira, J., et al., Evaluation of the effectiveness of sodium hypochlorite used with three irrigation methods in the elimination of Enterococcus faecalis from the root canal, in vitro. International Endodontic Journal, 1997. 30(4): p. 279-282. Gambarini, G., M. De Luca, and R. Gerosa, Chemical stability of heated sodium hypochlorite endodontic irrigants. Journal of endodontics, 1998. 24(6): p. 432-434.
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[6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20]
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en, B.H., K.E. Safavi, and L.S. Spångberg, Antifungal effects of sodium hypochlorite and chlorhexidine in root canals. Journal of Endodontics, 1999. 25(4): p. 235-238. Estrela, C., et al., Mechanism of action of sodium hypochlorite. Brazilian dental journal, 2002. 13(2): p. 113-117. Tay, F.R., et al., Reduction in antimicrobial substantivity of MTAD after initial sodium hypochlorite irrigation. Journal of endodontics, 2006. 32(10): p. 970-975. Mohammadi, Z., Sodium hypochlorite in endodontics: an update review. International dental journal, 2008. 58(6): p. 329-341. Parnes, C.A., Efficacy of sodium hypochlorite bleach and" alternative" products. Journal of Environmental Health, 1997. 59(6): p. 14. Rutala, W.A. and D.J. Weber, Uses of inorganic hypochlorite (bleach) in health-care facilities. Clinical Microbiology Reviews, 1997. 10(4): p. 597-610. Sauer, D. and R. Burroughs, Disinfection of seed surfaces with sodium hypochlorite. Phytopathology, 1986. 76(7): p. 745-749. Baron, S., Bacteriology. 1996. Hawgood, B.J., Doctor Albert Calmette 1863–1933: founder of antivenomous serotherapy and of antituberculous BCG vaccination. Toxicon, 1999. 37(9): p. 1241-1258. Hawgood, B.J., Albert Calmette (1863–1933) and Camille Guérin (1872–1961): the C and G of BCG vaccine. Journal of medical biography, 2007. 15(3): p. 139-146. Myers, R.L., The 100 most important chemical compounds: a reference guide. 2007: ABC-CLIO. Anft, B., Friedlieb Ferinand Runge: A forgotten chemist of the nineteenth century. Journal of Chemical Education, 1955. 32(11): p. 566. McClendon, E., Disinfectant in a disposable wipe for killing viral agents and infectious microorganisms, phenol, xylenol and sodium hypochlorite. 1991, Google Patents. CASTROROSAS, J. and E. Escartin, Incidence and germicide sensitivity of Salmonella typhi and Vibrio cholerae O1 in alfalfa sprouts. Journal of food safety, 1999. 19(2): p. 137-146. Sanekata, T., et al., Evaluation of the antiviral activity of chlorine dioxide and sodium hypochlorite against feline calicivirus, human influenza virus, measles virus, canine distemper virus, human herpesvirus, human adenovirus, canine adenovirus and canine parvovirus. Biocontrol science, 2010. 15(2): p. 45-49. Heggers, J., et al., Bactericidal and wound-healing properties of sodium hypochlorite solutions: the 1991 Lindberg Award. Journal of Burn Care & Research, 1991. 12(5): p. 420-424. Albrich, J.M., C.A. McCarthy, and J.K. Hurst, Biological reactivity of hypochlorous acid: implications for microbicidal mechanisms of leukocyte myeloperoxidase. Proceedings of the National Academy of Sciences, 1981. 78(1): p. 210-214. Byström, A. and G. Sundqvist, Bacteriologic evaluation of the effect of 0.5 percent sodium hypochlorite in endodontic therapy. Oral Surgery, Oral Medicine, Oral Pathology, 1983. 55(3): p. 307-312. Eleraky, N.Z., L.N. Potgieter, and M.A. Kennedy, Virucidal efficacy of four new disinfectants. Journal of the American Animal Hospital Association, 2002. 38(3): p. 231-234. Baker, N.A., et al., Scanning electron microscopic study of the efficacy of various irrigating solutions. Journal of endodontics, 1975. 1(4): p. 127-135. Hsiao, A., The effect of sodium hypochlorite, gibberellic acid, and light on seed dormancy and germination of wild buckwheat (Polygonum convolvulus) and cow cockle (Saponaria vaccaria). Canadian Journal of Botany, 1979. 57(16): p. 1735-1739. Fayer, R., Effect of sodium hypochlorite exposure on infectivity of Cryptosporidium parvum oocysts for neonatal BALB/c mice. Applied and Environmental Microbiology, 1995. 61(2): p. 844-846. Silva, L.A., et al., A clinical trial to assess the use of sodium hypochlorite and oxytetracycline on the healing of digital dermatitis lesions in cattle. The Canadian Veterinary Journal, 2005. 46(4): p. 345. Gerba, C.P. and D. Kennedy, Enteric virus survival during household laundering and impact of disinfection with sodium hypochlorite. Applied and environmental microbiology, 2007. 73(14): p. 4425-4428. Estrela, C., et al., Efficacy of sodium hypochlorite and chlorhexidine against Enterococcus faecalis: a systematic review. Journal of Applied Oral Science, 2008. 16(6): p. 364-368. Siqueira, J.F., et al., Antibacterial effects of endodontic irrigants on black-pigmented gram-negative anaerobes and facultative bacteria. Journal of endodontics, 1998. 24(6): p. 414-416. Waltimo, T., et al., Clinical efficacy of treatment procedures in endodontic infection control and one year follow-up of periapical healing. Journal of Endodontics, 2005. 31(12): p. 863-866. Huang, J.T., et al., Treatment of Staphylococcus aureus colonization in atopic dermatitis decreases disease severity. Pediatrics, 2009. 123(5): p. e808-e814. Ryan, C., et al., Novel sodium hypochlorite cleanser shows clinical response and excellent acceptability in the treatment of atopic dermatitis. Pediatric dermatology, 2013. 30(3): p. 308-315. Wong, S.m., T.G. Ng, and R. Baba, Efficacy and safety of sodium hypochlorite (bleach) baths in patients with moderate to severe atopic dermatitis in Malaysia. The Journal of dermatology, 2013. 40(11): p. 874-880.
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