Acute Eczema Treatment
Management of Eruptive Stage of Dermatitis Causing Itchy Skin Rash
Feb 14, 2009
Acute eczema can appear de novo as the first attack of inflammatory skin diseases or can occur as an exacerbation of an existing itchy skin rash. It typically presents with oozing, redness and swelling of the affected area. A stinging or burning sensation followed by pain and itching are the main symptoms. The commonest examples of acute eczema presenting as itchy skin rashes are contact dermatitis or an acute exacerbation of atopic eczema in children.
The treatment of acute eczema involves general measures applicable to all types of eczema whatever be the cause and specific measures related to the itchy skin rash.
Acute Eczema Treatment: General Measures
The sudden appearance of eczema can be alarming and distressing for an individual. The intense burning sensation, itching and soreness can deprive the patient of sleep and cause further stress. Hence rest and reassurance are the first steps in the management of acute eczema. The general measures are described in the article titled ‘How to Treat Eczema’.
Acute Eczema Treatment: Specific Measures
- All types of acute eczema will benefit from astringent soaks. Lukewarm potassium permanganate solution (1:10000 dilution) or aluminum acetate solution (Burrow’s solution BP) are the best choices for this. This is what you can do at home: Take half a liter of lukewarm water and add two pinches of potassium permanganate powder (the solution turns light brownish pink). Soak a multilayered soft cotton cloth or gauze pad in this solution and keep the eczematous area compressed with the soak for 2-3 minutes. Remove from the skin and repeat till the oozing and the crusted debris are removed. Repeat this wet soak or compresses 2-3 times daily till the eczema dries up.
- Aqueous creams, bland emollients: After the soaks, apply aqueous creams and bland emollients to the eczema to soothe and cool the itchy skin rash.
- Topical steroids: Moderate to potent strength topical steroids help to reduce the inflammation and heal the eczema. These should be used sparingly on the face and body folds to avoid the side effects of topical steroids.
- Wet wrapping technique. When there is extensive involvement of the body area, wet wrapping or two pajama treatment is used to control the eczema and relieve the itchy skin rash.
- Secondary infection. In the presence of secondary bacterial infection, patient may come with pus discharge instead of the usual watery discharge from the eczematous skin accompanied with fever, body pain and lymph node enlargement in the region. In such cases, antibiotics should be given to control infection.
- Combined steroid antibiotic creams: If a bacterial infection is suspected in the itchy skin rash caused by eczema, a combination steroid-antibiotic cream will give better results than the steroid alone.
- Sedative antihistamines like hydroxyzine, trimeprazine will help to control the itching.
- Removal of the cause, systemic steroids in allergic contact dermatitis, antifungal-mild steroid combination on seborrheic dermatitis and desensitization treatment in allergic dermatitis.
Topical Steroid Use in Acute Eczema
Topical corticosteroids are very effective in controlling the acute phase of eczema. The choice of the type of topical corticosteroids depends upon the site and severity of the itchy skin rash. Generally mild to moderate strength creams are preferred over the face and body folds and near the genitals. The application should not be more than two weeks at a stretch.
How to Avoid Side Effects of Topical Steroids in Acute Eczema
Prolonged use of topical steroids can cause topical and systemic side effects. Hence the use of topical steroids should be limited to shorter periods only. Once the acute stage is over, tacrolimus or pimecrolimus can replace steroids. These are free from the common side effects of topical steroids.
Reference: Eczema, in Rook’s Textbook of Dermatology, 7th Edition, 2004
Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.
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