What is the treatment for spongiotic dermatitis, also known as acute eczematous dermatitis (eczema)?

From the Guidelines

Treatment of spongiotic dermatitis should start with topical corticosteroids, such as triamcinolone 0.1% or betamethasone 0.05% cream, applied twice daily for 1-2 weeks to reduce inflammation and itching, as recommended by the most recent guidelines 1.

Key Considerations

• For mild cases, low-potency steroids like hydrocortisone 1% may suffice, while moderate to severe cases require medium to high-potency formulations.
• Moisturizers should be applied regularly, preferably immediately after bathing while skin is still damp, to repair the skin barrier.
• Choose fragrance-free, hypoallergenic products like CeraVe, Cetaphil, or Vanicream.
• Avoid known triggers such as harsh soaps, fragrances, certain fabrics, and environmental allergens.

Additional Treatment Options

• For severe or widespread cases, oral antihistamines like cetirizine 10mg daily or diphenhydramine 25mg every 6 hours can help control itching.
• If these measures fail, consider short courses of oral corticosteroids like prednisone (starting at 40mg daily with a taper over 2 weeks), or immunomodulators such as tacrolimus 0.1% ointment or pimecrolimus 1% cream applied twice daily, as suggested by recent guidelines 1 and 1.

Rationale

These treatments work by suppressing the inflammatory response and reducing the immune reaction in the skin, which helps resolve the characteristic spongiosis (fluid accumulation between skin cells) that defines this condition. The use of topical corticosteroids as a first-line treatment is supported by the most recent and highest quality study 1, which provides the best available evidence for the management of atopic dermatitis.

From the FDA Drug Label

ELIDEL Cream is a prescription medicine used on the skin (topical) to treat eczema (atopic dermatitis). ELIDEL Cream is for adults and children age 2 years and older who do not have a weakened immune system. Use ELIDEL Cream exactly as prescribed. Use ELIDEL Cream only on areas of your skin that have eczema. Use ELIDEL Cream for short periods, and if needed, treatment may be repeated with breaks in between. Stop ELIDEL Cream when the signs and symptoms of eczema, such as itching, rash, and redness go away, or as directed by your doctor

Treat spongiotic dermatitis with pimecrolimus (TOP) cream, by applying a thin layer of ELIDEL Cream only to the affected skin areas, twice a day, as directed by the physician 2.

• Key considerations:
  • Use the smallest amount of ELIDEL Cream needed to control the signs and symptoms of eczema
  • Stop ELIDEL Cream when the signs and symptoms of eczema go away, or as directed by the physician
  • Do not use ELIDEL Cream continuously for a long time
  • Do not use ELIDEL Cream on children under 2 years old
  • Do not use ELIDEL Cream on malignant or pre-malignant skin conditions
  • Bacterial and Viral Skin Infections should be resolved before commencing treatment with ELIDEL Cream 2.
• Common side effects:
  • Application site burning
  • Application site reaction
  • Infections and infestations
  • Nasopharyngitis
  • Upper respiratory tract infection
  • Skin infection
  • Influenza
  • Folliculitis
  • Sinusitis
  • Pharyngitis
  • Tonsillitis
  • Bronchitis
  • Viral infection
  • Gastroenteritis
  • Chickenpox
  • Herpes simplex
  • Pyrexia
  • Application site irritation
  • Cough
  • Nasal congestion
  • Rhinorrhea
  • Asthma
  • Rhinitis
  • Wheezing
  • Epistaxis
  • Dyspnea
  • Abdominal pain
  • Sore throat
  • Vomiting
  • Diarrhea
  • Nausea 2

From the Research

Treatment Options for Spongiotic Dermatitis

• Topical corticosteroids are a common treatment for spongiotic dermatitis, including conditions such as eczema and contact dermatitis 3
• The potency of topical corticosteroids can vary, with stronger potencies being more effective for moderate or severe eczema, but also carrying a higher risk of adverse effects 4, 5
• Topical corticosteroids can be applied once or twice daily, with similar effectiveness for both frequencies 5
• Proactive treatment with topical corticosteroids, such as applying them twice weekly to prevent relapse, may be effective in preventing eczema flare-ups 5

Application and Formulation

• Topical corticosteroids are available in various formulations, including ointments, creams, lotions, gels, foams, and shampoos 4, 6
• The quantity of topical corticosteroid prescribed depends on the duration of treatment, frequency of application, skin location, and total surface area treated 4
• Correct patient application is critical to successful use, and patients may be taught to apply topical corticosteroids using the fingertip unit method 4

Safety and Efficacy

• Topical corticosteroids are generally safe and effective for treating eczema, but can cause adverse effects such as skin thinning, especially with prolonged use or high potency 4, 5
• The risk of adverse effects increases with prolonged use, large area of application, higher potency, occlusion, and application to areas of thinner skin such as the face and genitals 4
• There is limited data on the long-term safety and efficacy of topical corticosteroids, and further research is needed to determine the optimal duration of treatment and potential risks 5