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Sub Acute Eczema Treatment

Management of Crusted, Scaly Dermatitis

Feb 15, 2009 Hanish Babu

Sub acute eczema treatment has some distinct features from that of acute and chronic eczema. The management of the crusted,scaly dermatitis calls for specific measures.

When the oozing dries up after the acute stage of eczema, the skin becomes dry, crusted and scaly in sub acute eczema. The redness may still be there, albeit in reduced amount, most of the swelling and the stinging and burning sensations disappear. Itching may be more pronounced than burning sensation in sub acute eczema.

Sub Acute Eczema: Special Considerations

If an acute attack of eczema fails to clear after 3-4 weeks and the sub acute stage continues unabated, it is time for an overall review of the situation.

Is the triggering factors still present and aggravating the eczema?
Are you receiving proper treatment?
Has the treatment been carried out effectively?
Are you intolerant to any medications used?

Sub Acute Eczema Treatment

Rest is essential if the sub acute eczema is extensive. Bed rest, or even hospitalization, may be required in severe cases. The general principles on how to treat eczema apply to sub acute eczema also.
Hospitalization is helpful in a number of ways in extensive sub acute eczema. The causative factors can be investigated and allergen tests carried out. The treatment can be carried out under supervision and the progress noted on a daily basis. If there is worsening of the condition, the treatment regimen can be modified without delay. The rest and relief reduce stress and hasten the healing. Rapid resolution of the eczema on admission and equally rapid relapse on discharge is indicative of some allergens in the house or workplace. Some patients with plant and flower allergies (e.g. chrysanthemum sensitivity) may get an exacerbation in hospital bed itself when visitors bring a generous bunch of flowers!
Topical treatment of sub acute eczema involves topical steroids belonging to the moderately potent classes of topical corticosteroids to start with and steroid sparing immune-modulators like tacrolimus as a maintenance therapy.
The steroids and the immune-modulators are alternated with emollients to reduce the dryness and sooth the skin.
The two pajamas treatment is useful in controlling extensive sub acute eczema.
Cleaning and bathing need not be discouraged, though prolonged hot soaks and use of normal soaps should be avoided as these can increase the dermatitis and itching due to increased dryness caused by evaporation and detergents in the soap. A detergent free soap is advisable for patients with sub acute eczema. Bath oils should be used very carefully, especially in the elderly, as the bathroom tiles can become slippery.
Once the inflammation is reduced, the topical steroids or immune-modulators may be gradually withdrawn and a maintenance application of the emollients continued.

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.

The copyright of the article Sub Acute Eczema Treatment in General Medicine is owned by Hanish Babu. Permission to republish Sub Acute Eczema Treatment in print or online must be granted by the author in writing.

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