From the Guidelines
Axillary eczema treatment should prioritize the use of topical corticosteroids as the mainstay of treatment, with the goal of using the least potent preparation required to keep the eczema under control, as recommended by the British Association of Dermatologists and the Research Unit of the Royal College of Physicians of London 1.
Key Considerations
- Gentle cleansing with mild, fragrance-free soaps and lukewarm water, followed by thorough drying of the area, is essential for managing axillary eczema.
- Topical corticosteroid creams, such as hydrocortisone 1% for mild cases or triamcinolone 0.1% for moderate cases, should be applied twice daily for 7-14 days to reduce inflammation.
- For severe or persistent cases, a stronger prescription steroid like fluocinonide 0.05% may be needed, but its use should be limited to 2 weeks to avoid skin thinning.
- Regular moisturizing with fragrance-free emollients, such as CeraVe or Vanicream, after bathing is crucial for maintaining the skin barrier.
- Potential irritants, including harsh soaps, fragranced products, and tight clothing, should be avoided.
- If significant itching is present, an oral antihistamine like cetirizine 10mg daily can be helpful.
- In cases with suspected bacterial infection, topical antibiotics like mupirocin or oral antibiotics may be necessary.
- If symptoms persist beyond 2-3 weeks of treatment or worsen, consultation with a healthcare provider is necessary to consider alternative treatments, such as calcineurin inhibitors like tacrolimus 0.1% ointment, for long-term management 1.
Additional Recommendations
- Time for explanation and education is essential for effective management of axillary eczema 1.
- Adequate amounts of emollients should be prescribed and used liberally.
- Attempts to eradicate the house dust mite are not currently recommended, and dietary restriction is of little or no benefit in adults, and in children, it is worth trying only in selected infants under professional supervision 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Axillary Eczema
- Topical corticosteroids are the first-line treatment for atopic dermatitis flare-ups, including axillary eczema 2
- Topical calcineurin inhibitors, such as pimecrolimus and tacrolimus, can be used in conjunction with topical corticosteroids as first-line treatment 2, 3
- Maintenance therapy consists of liberal use of emollients and daily bathing with soap-free cleansers to help restore the epidermal barrier and reduce skin inflammation 2, 3
- Proactive therapy with twice weekly use of both topical corticosteroids and calcineurin inhibitors in previously affected areas has been found to reduce the time to the next eczematous flare 3
- Ultraviolet phototherapy is a safe and effective treatment for moderate to severe atopic dermatitis when first-line treatments are not adequate 2
- Antistaphylococcal antibiotics are effective in treating secondary skin infections, but empiric antibiotics use in uninfected lesions is controversial 3
Additional Therapies
- Wet wrap therapy, anti-histamines, and vitamin D supplementation can be considered as adjunctive treatment options 3
- Local antiseptic measures, such as bleach baths, and topical antimicrobial therapies can be considered in patients with high bacterial colonization 3
- Systemic therapies, such as oral immunosuppressives, can be used in difficult-to-treat cases, but are limited by their side effect profiles 3
- New biological agents have been investigated with promising results, but are currently cost prohibitive for most patients 2, 4
Treatment Efficacy
- Pimecrolimus, tacrolimus, and moderate-potency topical corticosteroids are among the most effective treatments for atopic dermatitis, including axillary eczema 4
- Crisaborole and difamilast are intermediately effective, but with uncertain harm 4
- Topical antibiotics alone or in combination may be among the least effective treatments 4