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43 Boronia Road, Boronia VIC 3155
Tel: 03-9739-8951
Email: admin@greaterknoxpharmacy.com.au
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Eczema, Dermatitis and Dry Skin

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1. Dry Skin

Dry skin by itself isn't a medical worry, although serious cases can result in cracks and fissures that invite infection and inflammation. The real issue is discomfort — dry skin can be sore, tender to the touch, and often itchy.

The fact is that despite the long lists of obscure ingredients and the pseudoscientific hokum, all moisturisers help with dry skin for a pretty simple reason: they supply a little bit of water to the skin and contain a greasy substance that holds it in.

Emollients and moisturisers are most effective when applied immediately after bathing but can also be applied at other times.

The brand of moisturiser rarely makes a difference.

Factors that are important are:

  • the frequency of moisturising.The more often the better.
  • the greasiness of the preparation. The greasier the better.
  • presence of humectants (e.g. Urea, Lactic Acid, Glycerin, etc.)

Table: Summary of moisturiser properties
Advantages Disadvantages
Least greasy


Most greasy
Face or mildly dry skin Lotion
💧
  • Provide a cooling effect
  • Easy to apply especially to hairy areas
  • Good for summer, humid weather or oily skin
  • Usually not moisturising enough
  • Much more likely to sting
  • May contain preservatives, fragrance or other ingredients than can cause irritation
Aqueous cream
💧💧
  • Good for body and large areas
  • Better moisturisers than lotions
  • Easy to spread
  • Can sting
  • May contain preservatives, fragrance or other ingredients than can cause irritation
Body and moderate to very dry Creams
💧💧💧
  • Easy to spread
  • Urea, lactic acid or glycerin are very effective for very dry skin
  • Can sting
  • May contain preservatives, fragrance or other ingredients than can cause irritation
Ointments
💧💧💧💧
  • The best to lock in moisture
  • Rarely sting
  • Greasy and may be harder to spread
  • May clog pores and cause acne

2. Eczema (aka Atopic Dermatitis or Atopic Eczema)

2.1 Background

Eczema and Dermatitis are often used interchangeably by medical professionals. Eczema has also been used to refer to Atopic Dermatitis. Other common types of Dermatitis include: Contact Dermatitis, Hand/Foot Dermatitis, Seborrheic Dermatitis, Cradle Cap and some types of Nappy Rash.

Dermatitis is characterised by skin inflammation and itching. They can present as a red rash that is usually itchy, dry, and sometimes scaly.

Dermatitis is NOT contagious.

Why some people develop eczema or dermatitis is not well understood. It is common for people with dermatitis to have other allergies. This suggests that inherited (genetic) factors increase the tendency to develop dermatitis.

In people with dermatitis the skin does not retain moisture very well, which causes it to dry out easily. This makes the skin more open to allergens and irritants. These can trigger the skin to release chemicals that make the skin itchy. Scratching itchy skin causes more chemicals to be released, making the skin feel itchier. This scratch and itch cycle can cause discomfort, disrupt sleep and affect quality of life.

Atopic Dermatitis (Eczema) usually starts before the age of 1, but can present for the first time in adults as well.

Eczema is characterised by itch, and is most commonly found in the creases of elbows, wrists, neck and behind the knees.

Many people with dermatitis may already have other allergies, or can develop other allergies, such as allergic rhinitis (hay fever), asthma, food allergy, or dust mite allergy. Studies have shown that up to 30% of infants with eczema, with a family history of allergy, will develop food allergy, and up to 40% develop asthma and/or allergic rhinitis (hay fever).

Principles of management are generally the same for all types of Dermatitis, and the rash can often be treated successfully.

Eczema responds well to topical corticosteroids.

2.2 Symptoms

  • Dry, red skin
  • Very itchy

2.3 Improve Skin Condition

Improve Skin Condition

Daily bathing is not harmful if soap and bubble bath are avoided and emollient is liberally applied immediately afterwards.

  • Use soap substitutes (eg aqueous cream, soap-free bars, soap-free wash).
  • If the skin is very dry, use dispersible oils when bathing. If showering, spray the oil onto wet skin immediately after the shower. If having a bath, add the oil to the bathwater.
  • If the skin is very itchy, make an oatmeal bath (put half a cup of oats in a sock or stocking and add this to the bathwater).

Frequent use of emollients (moisturisers) to improve skin condition is essential :

  • Use greasier emollients for drier skin
  • Use a less greasy product in hot, humid weather
  • Simple inexpensive preparations are as effective as expensive or compounded preparations

2.4 Manage Aggravating Factors

Some factors that aggravate atopic dermatitis are unavoidable, including weather changes, dry weather, concurrent upper respiratory tract infection and stress.

Aggravating factors that can be avoided or managed include overheating, skin irritants, allergens and infections.

Minimise contact with irritants such as:

  • soap, shampoo, bubble bath
  • rough clothing, wool, sheepskin, carpet, sand, grass
  • heavily chlorinated pools or spas.

2.5 Treatment

  1. Identify and avoid aggravating factors when possible.
  2. Improve Skin Condition.
  3. Moisturisers should be applied liberally at least twice daily, particularly after bathing, even when eczema is under control.
  4. Use lukewarm water and emollient soap substitutes or fragrance-free bath oils.
  5. Apply topical corticosteroids. This is the main treatment for all age groups.
    • once daily is usually sufficient
    • apply liberally, not sparingly
    • apply to all areas of inflammation (not just the worst), then apply an emollient elsewhere (emollient is not needed on top of the corticosteroid)
    • until the dermatitis has gone and the skin is completely clear

2.5.1 Choice of Corticosteroid

Choose according to site and severity of the dermatitis:

  • Use a mild potency corticosteroid for sensitive areas such as face, armpit, groin and nappy area. Specialists can recommend more potent corticosteroids for up to two weeks.
  • Use moderate potency corticosteroids on the rest of the body.
  • Use a potent corticosteroid on thick-skinned areas.
  • Ointments work better and sting less.
  • Use creams for an acute weeping rash.
  • Use lotions or gels for hairy areas.

Face
Face
Agent Dose / Duration Notes
Mild Hydrocortisone 1% Use once daily until the skin is completely clear. If not responding after 7 days, use a stronger topical corticosteroid for a limited time
Severe Methylprednisolone Aceponate 0.1% Use once daily for 7 - 14 days When the skin clears, continue to use moisturiser, otherwise send for specialist advice
Trunk and Limbs
Trunk and Limbs
Agent Dose / Duration Notes
Mild Triamcinolone Acetonide 0.02% Use once daily until the skin is completely clear When the skin clears, continue to use moisturiser
Severe Methylprednisolone Aceponate 0.1%

OR

Mometasone Furoate 0.1%
Use once daily until the skin is completely clear If response is slow, consider modified dressings before sending for specialist advice
Fingers, Wrists, Ankles, Feet
Fingers, Wrists, Ankles, Feet
Agent Dose / Duration Notes
Mild Betamethasone Dipropionate 0.05%

OR

Betamethasone Valerate 0.1%

OR

Mometasone Furoate 0.1%
Use once daily until the skin is completely clear When the skin clears, continue to use moisturiser
Severe Betamethasone Dipropionate 0.05%

OR

Betamethasone Valerate 0.1%

OR

Mometasone Furoate 0.1%

PLUS

modified dressings
Use once daily until the skin is completely clear When the skin clears, continue to use moisturiser, otherwise send for specialist advice
Scalp (Adult)
Scalp (Adult)
Agent Dose / Duration Notes
Mild Betamethasone Dipropionate 0.05% lotion

OR

Methylprednisolone Aceponate 0.1% lotion

OR

Mometasone Furoate 0.1% lotion or hydrogel
Use once daily until the skin is completely clear If there is no response, seek specialist advice
Severe Betamethasone Dipropionate 0.05% lotion

OR

Methylprednisolone Aceponate 0.1% lotion

OR

Mometasone Furoate 0.1% lotion or hydrogel
Use once daily until the skin is completely clear If there is no response, seek specialist advice
Scalp (Child)
Scalp (Child)
Agent Dose / Duration Notes
Mild Desonide 0.05% lotion Use once or twice daily until the skin is completely clear If there is no response, seek specialist advice
Moderate Methylprednisolone aceponate 0.1% lotion Use once daily until the skin is completely clear If there is no response, seek specialist advice
Severe Mometasone Furoate 0.1% hydrogel Use once daily until the skin is completely clear If there is no response, seek specialist advice
Axillae (armpit) and groin
Axillae (armpit) and groin
Agent Dose / Duration Notes
Mild Hydrocortisone 1%

OR

Desonide 0.05% lotion
Use once daily until the skin is completely clear. If not responding after 7 days, use a stronger topical corticosteroid for a limited time
Severe Methylprednisolone Aceponate 0.1% Use once daily until the skin is completely clear If there is no response in 7 days, seek specialist advice

3. Contact Dermatitis

3.1 Background

A common workplace skin condition, predominantly affecting the hands.

  • It is caused by skin contact with external agents.
  • Contact dermatitis may result from:
    • exposure to a high concentration of a highly irritating chemical, or
    • repeated exposure to a weaker irritant
  • Cumulative irritant contact dermatitis can occur after a few months or several years. A person may suddenly develop dermatitis even when exposure to the same irritant in the past was not an issue.
  • Even after visible healing, skin may be more sensitive to irritation, so preventive measures must be followed.

3.2 Symptoms

  • Red, scaly or swollen skin
  • May be itchy
  • Irritant Contact Dermatitis decreases in intensity after 1-2 days
  • Allergic Contact Dermatitis takes 2-3 days to become further aggravated

3.3 Treatment

Before starting pharmacological treatment:

  • Assess exposure to irritants and allergens at home, workplace and school
  • Assess all topical preparations used for irritant or allergic potential
  • Avoid contact with irritants and wear protective gloves
  • Improve skin condition and use emollients often, especially after finishing work

Face
Face
Agent Dose / Duration Notes
Mild Hydrocortisone 1% Use once daily until the skin is completely clear. If not responding after 7 days, use a stronger topical corticosteroid for a limited time
Severe Methylprednisolone Aceponate 0.1% Use once daily for 7 - 14 days When the skin clears, continue to use moisturiser, otherwise send for specialist advice
Hands
Hands
Agent Dose / Duration Notes
Mild Betamethasone Dipropionate 0.05%

OR

Betamethasone Valerate 0.1%

OR

Mometasone Furoate 0.1%
Use once daily until the skin is completely clear When the skin clears, continue to use moisturiser
Severe Betamethasone Dipropionate 0.05%

OR

Betamethasone Valerate 0.1%

OR

Mometasone Furoate 0.1%

PLUS

modified dressings
Use once daily until the skin is completely clear
  • When the skin clears, continue to use moisturiser, otherwise send for specialist advice
  • If response is slow, consider using modified dressings
Feet
Feet
Agent Dose / Duration Notes
Mild Betamethasone Dipropionate 0.05% Use once daily until the skin is clear for up to four weeks When the skin clears, continue to use moisturiser
Severe Betamethasone Dipropionate 0.05% in optimised vehicle Use once daily until the skin is clear for up to four weeks
  • Use emollients (eg glycerine 10 to 20% in sorbolene cream, urea 10% cream [with or without lactic acid 5%]) when dryness or cracking is prominent
  • For chronic dermatitis that does not respond to these measures, refer for expert advice
Genital and pubic area
Genital and pubic area
Agent Dose / Duration Notes
Mild Methylprednisolone Aceponate 0.1% Use once daily until the skin is clear for up to one week If there is no response, seek specialist advice
Severe

4. Seborrheic Dermatitis (Adults)

4.1 Background

A chronic relapsing condition that affects mainly the scalp, but can present on the cheeks, side of the nose, eyebrows and eyelids.

4.2 Symptoms

  • Skin flakes on scalp, hair, eyebrows

4.3 Treatment

Mild / First line / Dandruff Daily shampoo use till scalp clears Daily
Severe / Unresponsive to first line Anti-fungal shampoo (e.g. Cedel, Selsun, Nizoral) 2 - 7 times per week
Add a steroid lotion if anti-fungal shampoo is not sufficient (e.g. Diprosone, Advantan, Elocon, Novasone, or Zatamil) Once daily at night for 7 nights

5. Cradle Cap

5.1 Background

  • Most common in babies 3 - 12 weeks, and appears as thick, waxy, yellow scales on the scalp and sometimes on the eyebrows.
  • Not painful nor itchy.
  • Not contagious, and unrelated to hygiene.
  • Most cases are self limiting and clear in a few weeks.

5.2 Treatment

  • Soften the scales by using baby oil (mineral oil), vegetable oil (coconut oil), or light moisturising cream or lotion overnight.
  • Wash the scalp with baby shampoo the next morning.
  • If there is no improvement within a week, or if it is severe, consult your doctor who may recommend a short course of a mild steroid cream or antifungal treatment.

6. Diaper Dermatitis (Nappy Rash)

6.1 Prevention

  • Use highly absorbent disposable nappies rather than cloth nappies, but if this is not possible change cloth nappies every 2 hours and avoid plastic overpants or nappy liners.
  • Use a soap substitute and dispersible bath oil for bathing.
  • Use a damp cloth and soap substitute for cleaning the nappy area (avoid baby wipes).
  • Apply a barrier preparation (e.g. zinc and castor oil cream, liquid paraffin 10% in zinc paste, dexpanthenol ointment, zinc oxide cream) after every nappy change.

6.2 Treatment

Initially For red severe cases Dose / Duration Notes
Hydrocortisone 1%

+

Candida treatment (e.g. Nystatin, Miconazole, Clotrimazole)

+

Zinc Oxide
Methylprednisolone Aceponate 0.1%

+

Candida treatment

+

Zinc Oxide

OR

Triamcinolone Acetonide 0.02%

+

Candida treatment

+

Zinc Oxide
  • Use corticosteroid twice daily until the rash resolves.
  • Use Candida treatment + Zinc Oxide after each nappy change except when applying the corticosteroid.
  • Avoid more potent steroids for the nappy area.
  • If there is no response, investigate other possible causes.

8. Appendix

8.1 Corticosteroid Potency

Note: Efficacy does not always correlate with potency
Potency Agent Strength Brands Form Availability
Mild Hydrocortisone 0.5% Dermaid 0.5% cream, lotion OTC
1% Sigmacort, Cortic DS, Dermaid 1%, others cream, ointment OTC, Prescription
Moderate Betamethasone Valerate 0.02% Antroquoril, Betnovate ⅕, Celestone M, Cortival ⅕ cream Prescription
0.05% Betnovate ½, Cortival ½, cream Prescription
Triamcinolone 0.02% Aristocort, Tricortone cream, ointment Prescription
Potent Betamethasone Dipropionate 0.05% Diprosone, Eleuphrat cream, ointment, lotion Prescription
Betamethasone Valerate 0.1% Betnovate cream, ointment Prescription
Methylprednisolone Aceponate 0.1% Advantan cream, ointment, fatty ointment, lotion Prescription
Mometasone Furoate 0.1% Elocon, Novasone, Zatamil, others cream, ointment, gel, lotion OTC, Prescription
Very Potent Betamethasone Dipropionate 0.05% in optimised vehicle Diprosone OV ointment Prescription

8.2 Modified Dressings

8.2.1 Wet Dressing

Take a bath or shower and lightly pat skin dry. Apply topical corticosteroid to affected skin. Cover treated skin with damp (wrung-out) wet dressings. Soak dressings in water that is a comfortable temperature. For babies, use a jumpsuit as the dressing. For older children and adults, use pyjamas, elasticated tubular bandages, towels, sheets, cotton socks (for feet) or cotton gloves (for hands). Wrap up in a towel or wear dry clothes on top, to keep warm and ensure the damp layer is in close contact with the skin. Remove the wet dressings after 15 to 60 minutes. Dry the skin, then apply an emollient.

8.2.2 Soak and Smear

Soak in a warm bath of plain water for 20 minutes just before bedtime. Don’t dry skin after getting out of bath. Smear affected skin with large amounts of corticosteroid. Put on old pyjamas or loose clothes (still don’t dry the skin). Moisturise the skin the next morning. Do this every night for 4 to 14 nights until the skin inflammation clears.