What are the treatments for eczema and ringworm?

Treatment for Eczema and Ringworm

Eczema Treatment

For eczema management, emollients should be applied 3-8 times daily as the foundation of treatment, with topical corticosteroids as first-line prescription therapy for flares, and topical calcineurin inhibitors preferred for facial and intertriginous areas. 1

First-line Treatment for Eczema

1. Skin Care and Moisturizing

   • Apply emollients 3-8 times daily, even when skin appears normal
   • Ointments are preferred over creams for dry, irritable rashes
   • Use gentle, pH-neutral synthetic detergents instead of soap
   • Avoid irritants such as perfumes, deodorants, and alcohol-based lotions

2. Topical Corticosteroids for Flares

   • Potency selection based on location and severity:
     • Mild potency: For face, intertriginous areas, and children
     • Moderate potency: For maintenance therapy on trunk and extremities
     • Potent: For severe flares on thicker skin areas
   • Application frequency: Once daily application is as effective as twice daily for potent corticosteroids 2
   • Duration: Limit use to short periods (2-4 weeks maximum) to minimize adverse effects
   • Weekend therapy: Proactive weekend application can prevent flares (25% relapse rate vs. 58% with reactive treatment) 1, 2

3. Topical Calcineurin Inhibitors (TCIs)

   • Preferred for sensitive areas (face, intertriginous areas)
   • Don't cause skin thinning unlike corticosteroids
   • Tacrolimus 0.03% ointment is preferred for facial atopic dermatitis
   • Apply twice daily to affected areas

Managing Infections in Eczema

• For signs of infection: Use antiseptic washes with aqueous chlorhexidine 0.05%
• Consider bleach baths with 0.005% sodium hypochlorite twice weekly for prevention
• If clinically indicated, oral antibiotics may be necessary (e.g., doxycycline 100mg twice daily)

Advanced Therapy for Severe Eczema

• For severe cases not responding to topical treatments:
  • Consider referral for narrowband UVB phototherapy
  • Evaluate for systemic therapy options under specialist supervision
  • Short courses of oral corticosteroids (<7 days) may be considered for severe acute flares

Important Considerations

• The order of application between emollients and topical corticosteroids does not significantly affect treatment outcomes 3
• Corticosteroid phobia is common (72.5% of patients worry about using them) and may lead to non-compliance 4
• Properly educate patients about appropriate use and safety of topical corticosteroids
• Abnormal skin thinning is rare (only 1% in studies) when corticosteroids are used appropriately 2

Ringworm Treatment

For ringworm (tinea corporis), apply terbinafine cream once daily (morning or night) for 1 week to affected areas. 5

Application Instructions for Terbinafine

1. Wash the affected skin with soap and water and dry completely before applying
2. For adults and children 12 years and older:
   • Use the tip of the cap to break the seal and open the tube
   • Apply once daily for ringworm for 1 week
   • Wash hands after each use
3. For children under 12 years: Consult a doctor

Additional Considerations for Ringworm

• Keep affected areas clean and dry
• Avoid sharing personal items that may contact the infected area
• Wash clothing, bedding, and towels in hot water to kill the fungus
• Continue treatment for the full prescribed duration even if symptoms improve

Common Pitfalls to Avoid

1. Corticosteroid Misuse

   • Using high-potency corticosteroids on face or intertriginous areas
   • Prolonged use leading to skin atrophy, striae, and telangiectasia
   • Abrupt discontinuation causing rebound flares

2. Inadequate Moisturizing

   • Failure to maintain regular emollient use even when skin appears normal
   • Insufficient frequency of application (less than 3 times daily)

3. Infection Management

   • Missing signs of secondary infection requiring antimicrobial treatment
   • Failure to address Staphylococcus aureus colonization in persistent cases

4. Treatment Adherence

   • Patient fears about corticosteroid side effects leading to undertreatment
   • Discontinuing treatment prematurely when symptoms improve