From the Guidelines
For a contact, allergic, or pruritic local rash, the most effective treatment is to apply a topical corticosteroid cream like hydrocortisone 1% three to four times daily for up to two weeks to reduce inflammation and itching, as recommended by the most recent guidelines 1. When managing a contact, allergic, or pruritic local rash, it is essential to:
- Identify and remove the irritant if possible
- Clean the affected area with mild soap and water
- Apply a topical corticosteroid cream, such as hydrocortisone 1%, to reduce inflammation and itching
- Consider oral antihistamines, like cetirizine or loratidine, for more severe symptoms 1 Some key points to consider:
- Calamine lotion is not recommended due to lack of evidence supporting its use in pruritus management 1
- Topical capsaicin is not recommended for general pruritus management, except in uraemic pruritus 1
- Cold compresses applied for 10-15 minutes several times daily can provide relief
- Avoid scratching to prevent infection and skin damage
- Keep the area clean and dry, and wear loose-fitting clothing to reduce irritation If the rash covers a large area, appears infected, doesn't improve within a week, or is accompanied by fever or difficulty breathing, seek medical attention immediately, as recommended by guidelines for managing toxicities associated with immune checkpoint inhibitors 1.
From the FDA Drug Label
Directions for itching of skin irritation, inflammation, and rashes: adults and children 2 years of age and older: apply to affected area not more than 3 to 4 times daily children under 2 years of age: ask a doctor for external anal and genital itching, adults: when practical, clean the affected area with mild soap and warm water and rinse thoroughly gently dry by patting or blotting with toilet tissue or a soft cloth before applying apply to affected area not more than 3 to 4 times daily children under 12 years of age: ask a doctor
For contact, allergic, or pruritic local rash, the instructions are to:
- Apply hydrocortisone to the affected area not more than 3 to 4 times daily for adults and children 2 years of age and older 2
- Ask a doctor for children under 2 years of age or children under 12 years of age 2
- For external anal and genital itching, clean the area with mild soap and water, and gently dry before applying hydrocortisone 2
From the Research
Contact/Allergic/Pruritic Local Rash Instructions
- For the treatment of inflammatory skin conditions such as psoriasis and atopic dermatitis, topical corticosteroids are an essential tool 3
- Topical corticosteroids can cause adverse effects such as atrophy, striae, rosacea, telangiectasias, purpura, and other cutaneous and systemic reactions, especially with prolonged use, large area of application, higher potency, occlusion, and application to areas of thinner skin 3
- When prescribing topical corticosteroids, the quantity depends on the duration of treatment, frequency of application, skin location, and total surface area treated, and correct patient application is critical to successful use 3
- For acute irritant dermatitis, the efficacy of topical corticosteroids is controversial, as they may reduce the inflammatory response but also reduce skin barrier recovery and allow further penetration of irritants 4
- Oral corticosteroids are sometimes prescribed for atopic dermatitis, but their use is associated with a higher risk of side effects, and steroid-sparing systemic agents may be a better long-term option 5
- Allergic reactions to glucocorticoids, including anaphylaxis, can occur, and careful challenge testing is necessary to select safe glucocorticoids for future treatment 6
- Immediate hypersensitivity reactions to corticosteroids can be confirmed through skin testing and oral graded challenge, while delayed hypersensitivity contact dermatitis can be identified through patch testing 7
- Cross-reactivity patterns have been observed in delayed hypersensitivity contact dermatitis, but not in immediate hypersensitivity reactions 7