From the FDA Drug Label
Topical corticosteroids are generally applied to the affected area as a thin film from two to three times daily depending on the severity of the condition.
The treatment for purpuric rashes with crusts in contact dermatitis may involve the use of topical corticosteroids, such as triamcinolone acetonide, applied to the affected area as a thin film from two to three times daily depending on the severity of the condition 1.
- Key points:
- Apply a thin film of topical corticosteroids
- Frequency: two to three times daily
- Consider the severity of the condition when determining treatment However, it is essential to note that if an infection develops, the use of occlusive dressing should be discontinued and appropriate antimicrobial therapy instituted.
From the Research
Purpuric rashes with crusts can appear in contact dermatitis, and the treatment involves a combination of topical corticosteroids and proper wound care. The most recent and highest quality study 2 suggests that contact dermatitis is a common inflammatory skin disease caused by exposure to contact allergens and irritants, and it can manifest in different forms, including purpuric rashes with crusts. The treatment for purpuric rashes with crusts in contact dermatitis involves:
- Medium to high-potency topical corticosteroids such as triamcinolone 0.1% or fluocinonide 0.05% applied twice daily to affected areas for 7-14 days to reduce inflammation and itching
- Gentle cleansing with mild soap and water followed by application of antibiotic ointment like mupirocin 2% three times daily to prevent secondary infection
- Wet dressings or compresses with saline solution for 15-20 minutes before applying medications to help remove crusts and soothe the skin
- Oral antihistamines such as cetirizine 10mg daily or hydroxyzine 25mg three times daily to help control itching
- In severe cases with extensive purpura or signs of vasculitis, a short course of oral prednisone starting at 0.5-1mg/kg/day with a taper over 2 weeks may be necessary These treatments work by suppressing the inflammatory response triggered by contact allergens, reducing vascular damage that causes purpura, and preventing bacterial colonization of damaged skin. Complete allergen identification and avoidance is essential for long-term management to prevent recurrence, as suggested by 3, 4, 5, and 6. It is also important to restore the skin barrier and reduce skin inflammation through multiple treatments, such as emollients, topical corticosteroids, and antihistamines, as well as systemic corticosteroids and immunosuppressants, as recommended by 2.