What are the prescription options for an eczema wash?

Prescription Options for Eczema Wash

For patients with eczema, prescription soap substitutes such as Dermol 500 lotion or Dermol 500 cream (containing benzalkonium chloride 0.1% and chlorhexidine 0.1%) are the most effective prescription wash options, as they both cleanse and provide antimicrobial protection. 1

First-Line Prescription Wash Options

Antimicrobial Cleansers

• Dermol 500 lotion - Contains benzalkonium chloride 0.1% and chlorhexidine 0.1%

  • Can be used as a soap substitute
  • Provides both cleansing and antimicrobial protection
  • Particularly useful when there are signs of secondary infection 1

• Dermol 500 cream - Same active ingredients as the lotion

  • More suitable for drier skin types
  • Can be used as both a cleanser and leave-on emollient 1

Medicated Bath Additives

• Oilatum bath - Prescription-strength formulation
• Hydromol bath oil - For severe dry skin
• Balneum Plus bath oil - Contains 5% urea and lauromacrogols 3% 1

When to Use Prescription Washes

1. Signs of infection - When there's evidence of bacterial colonization or infection
2. Severe eczema - For patients with moderate to severe disease
3. Treatment failures - When over-the-counter products have not provided adequate relief
4. Recurrent flares - To help prevent infection-triggered exacerbations

Complementary Topical Treatments

Topical Corticosteroids

For inflammation control, to be used alongside prescription washes:

• Mild: Hydrocortisone 1% (range 0.1-2.5%)
• Moderate: Eumovate (clobetasone butyrate 0.05%)
• Potent: Betnovate (betamethasone valerate 0.1%) or Elocon (mometasone 0.1%)
• Very potent: Dermovate (clobetasol propionate 0.05%) 1

Calcineurin Inhibitors

• Pimecrolimus (Elidel) cream 1% - For adults and children ≥2 years old
  • Used for short periods with breaks in between
  • For use after other prescription medicines have not worked 2

Application Guidelines

1. Frequency: Use prescription washes twice daily
2. Method: Apply to wet skin, massage gently, and rinse thoroughly
3. Amount: Usage at twice daily dosing estimated at 200-400 mL for lotions per week 1
4. Post-washing: Apply prescribed emollients after bathing while skin is still slightly damp

Important Considerations

• Avoid regular soaps - They can strip natural oils and worsen eczema
• pH-neutral synthetic detergents are recommended over traditional soaps 3
• Avoid excessive heat and humidity during washing as these can trigger flares 3
• Do not bathe immediately after applying topical medications as this could wash off the treatment 2

Common Pitfalls to Avoid

1. Using regular soaps - These can be too harsh and drying for eczema-prone skin
2. Insufficient rinsing - Residual product can cause irritation
3. Hot water - Can trigger flares; use lukewarm water instead
4. Vigorous towel drying - Pat skin dry gently instead
5. Neglecting to apply emollients after washing - This is essential to lock in moisture 3

Special Considerations

• For patients with stasis dermatitis, compression therapy should be used alongside prescription washes 3
• For patients taking EGFR-TKIs who develop eczematous reactions, the same prescription washes can be used but with careful monitoring 1
• In children under 2 years, avoid products containing pimecrolimus 2

By following these guidelines and using prescription wash products appropriately, patients can effectively manage their eczema symptoms while maintaining proper skin hygiene.