From the Guidelines
Treatment for discoid eczema should involve a combination of topical corticosteroids, moisturizers, and trigger avoidance, with the goal of reducing inflammation, restoring skin barrier function, and preventing the itch-scratch cycle that worsens the condition.
Key Components of Treatment
- Topical corticosteroids: Medium to high-potency options like betamethasone valerate 0.1% or mometasone furoate 0.1% applied thinly to affected areas once or twice daily for 7-14 days can reduce inflammation and itching 1.
- Moisturizing: Multiple daily applications of emollients like petroleum jelly, ceramide-containing creams, or thick creams like Eucerin or CeraVe are crucial for repairing the skin barrier.
- Trigger avoidance: Avoiding harsh soaps, fragrances, and irritating fabrics is essential, as these can exacerbate the condition 1.
- Antihistamines: Options like cetirizine 10mg daily or diphenhydramine 25mg at bedtime can help control itching.
- Infection management: Topical antibiotics like mupirocin or oral antibiotics such as flucloxacillin 500mg four times daily for 7 days may be necessary if infection is present.
- Wet wrap therapy: Applying moisturizer, covering with damp bandages, then dry bandages for several hours can provide relief for severe flares.
Considerations and Precautions
- The use of topical corticosteroids should be guided by the principle of using the least potent preparation required to keep the eczema under control, with periodic cessation when possible 1.
- Topical antihistamines and other agents have limited evidence supporting their use in generalized pruritus, with concerns about allergic contact dermatitis and toxicity 1.
- Calamine lotion and topical capsaicin are not recommended due to lack of supporting evidence for their use in treating pruritus associated with discoid eczema 1.
From the Research
Treatment for Discoid Eczema
The treatment for discoid eczema typically involves the use of topical corticosteroids, which have been shown to be effective in reducing inflammation and promoting healing 2, 3, 4.
- Topical Corticosteroids: Potent and moderate topical corticosteroids are probably more effective than mild topical corticosteroids, primarily in moderate or severe eczema 2.
- Application Frequency: Applying potent topical corticosteroids only once a day probably does not decrease the number achieving treatment success compared to twice daily application 2.
- Proactive Therapy: Topical corticosteroids weekend (proactive) therapy is probably better than no topical corticosteroids/reactive use to prevent eczema relapse (flare-ups) 2, 5.
- Emollient Therapy: Emollients can help restore the normal moisturizing process of the skin and may be particularly important in soothing the discomfort of the dry skin conditions often encountered in moderate-to-severe dermatoses 3, 4, 5.
- Patient Education: Patients' fears about using topical corticosteroids may have important implications for compliance with treatment, and education regarding the safety, potency, and appropriate use of topical corticosteroids is necessary 6.
Adverse Events
Adverse events were not well reported and came largely from low- or very low-certainty, short-term trials 2. In trials that reported abnormal skin thinning, frequency was low overall and increased with increasing potency 2.
Other Considerations
There is a need for longer-term trials, in people with mild eczema, to establish the optimal duration of treatment and to assess the effectiveness of different treatment strategies 2, 5.