II. Management: General Measures

  1. Avoid Provocative Factors
    1. Excessive bathing (see below)
    2. Rough clothing (see Pruritus Management)
    3. Excessive sweating
    4. Avoid products with perfumes or dyes (use clear and free products)
  2. Wear comfortable clothing
    1. See Pruritus Management
  3. Skin barrier protection (Skin Lubricants)
    1. See bathing below
    2. Apply immediately after patting dry from bathing
    3. Skin Lubricant lotions (e.g. Lubriderm)
      1. Apply lotion frequently throughout the day
      2. Avoid lotions with Alcohol (drying)
      3. May also apply creams (e.g. Cerave, Vanicream) during day
    4. Skin Lubricant creams or oils (Eucerin or Vaseline) are more moisturizing than lotions (but more "goopy")
      1. Bedtime application
      2. Severe cases

III. Management: "Do not bath, Soak!"

  1. Add Bath Emollients (Bath Oils)
  2. Limit soap use (Causes skin drying)
    1. Use a Mild Soap for general skin areas 2 times weekly
      1. See Mild Soaps
      2. Examples: Unscented Dove or Cetaphil Skin Cleanser
    2. Daily use of soap only in groin or axilla
    3. Spare legs, arms, and torso
  3. Decrease bath frequency, length, and Temperature
    1. Limit bathing to a brief, tepid bath
  4. Immediately after bath:
    1. Briefly pat dry
    2. Apply skin barrier protection (Skin Lubricant)

IV. Management: Topical Agents

  1. Alpha-Hydroxy acid Moisturizers (e.g. Eucerin Plus)
    1. Apply after warm water soaks
  2. Topical Corticosteroid ointment (Triamcinolone for 4-5 days)
    1. Indications: Visible pink or red dermatitis

V. Management: Dyshidrotic Eczema of hands

  1. See Hand Washing
  2. Apply Moisturizing Lotions to hands 10-20 times daily
    1. Apply after each time Hand Washing, after patting Dry Skin, but while skin is still moist
    2. Following hand sanitizer, hands must be completely dry before applying Moisturizer to prevent trapping Alcohol
  3. Moisturizer should be worked in and hands dry before applying gloves
  4. Consider non-soap cleansers (e.g. cetaphil) with lukewarm water
  5. Alcohol-based hand sanitizers may cause less dryness than soap and water
    1. However, soap and water are needed to clean soiled hands
  6. Apply petroleum jelly at bedtime under over-glove
    1. Cotton liner with Vinyl over-glove for Hand Washing
    2. Allerderm (Hypoallergenic glove supplier)
  7. Moderate to severe exacerbations
    1. Continue protocol above
    2. Add 2 weeks of a moderate to high potency Topical Corticosteroid
      1. If need to repeat Corticosteroids, give at least 1 week break before reusing
  8. References
    1. (2020) Presc Lett 27(6):31-2

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