Abstract
Eczema is one of the most steroid-responsive dermatoses. A midpotent corticosteroid preparation will generally suppress the inflammation and clear the rash. If the condition has not improved substantially within 2–4 weeks, a more potent corticoid may be selected. Topical antibiotics such as mupirocin may be used for significant crusting and exudation. Antibacterial compounds or maneuvers such as bleach gels, bleach baths, iodinated ointments, and quinoline-containing ointments may also be used to good effect. Oral antibiotics may be prescribed, but the resident staphylococci are multidrug resistant. The topical antibacterial approaches are conceptually better in light of the concept that staphylococci and their biofilms play the major role in this disease. These organisms are part of the normal flora, so even if they are killed, they will return at some point. Heresy enters the discussion of treatment regarding skin care during and especially after the rash. Even though we believe the rash is initiated by staphylococci and their biofilms occluding the sweat ducts, it is easier to help prevent the disease by treating the genetic component of the condition. This is done by treating the skin exceedingly gently and severely limiting soap, hot water bathing, frequent bathing, and scrubbing. Aggressive moisturizing is also needed. Azathioprine, methotrexate, or another immunosuppressive agent may be needed in severe cases.
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References
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Allen, H.B. (2015). Treatment. In: The Etiology of Atopic Dermatitis. Springer, London. https://doi.org/10.1007/978-1-4471-6545-3_7
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