What is the treatment for infected eczema involving the axillae (armpits) and chin?

Treatment for Infected Eczema in the Axillae and Chin

For infected eczema involving the axillae (armpits) and chin, use topical mupirocin cream three times daily for 10 days, combined with a low-potency topical corticosteroid for these sensitive areas. 1, 2

Initial Management of Infected Eczema

Antimicrobial Treatment

• Topical antimicrobials:
  • Mupirocin cream applied three times daily for 10 days is the first-line treatment for secondarily infected eczema of limited severity 1
  • Mupirocin cream has shown superior bacteriological success (50%) compared to oral antibiotics (28%) in treating infected eczema 1
  • For widespread or severe infection, consider oral antibiotics such as doxycycline 100mg twice daily or minocycline 50mg twice daily for 6 weeks 2

Anti-inflammatory Treatment

• Topical corticosteroids:
  • Use low-potency topical corticosteroids for the face, chin, and intertriginous areas like the axillae 2
  • Apply once daily for less than 2 weeks to minimize adverse effects 2
  • Medium-potency corticosteroids should be avoided in these sensitive areas due to risk of skin atrophy 2

Alternative Anti-inflammatory Options

• Topical calcineurin inhibitors (TCIs):
  • Tacrolimus or pimecrolimus are preferred for facial and intertriginous areas as they don't cause skin atrophy 2
  • These are particularly valuable for longer-term management after the infection has resolved 2

Supportive Care

Cleansing and Antiseptics

• Use antiseptic washes with aqueous chlorhexidine 0.05% for cleansing infected areas 2
• Consider bleach baths with 0.005% sodium hypochlorite twice weekly to help prevent recurrent infections 2

Moisturization

• Apply fragrance-free emollients multiple times daily, especially after bathing 2
• For intertriginous areas like axillae, creams are preferable to ointments to avoid occlusion and maceration 2

Lifestyle Modifications

• Avoid irritants such as perfumes, deodorants, and alcohol-based lotions 2
• Use gentle, pH-neutral synthetic detergents instead of soap 2
• Wear loose-fitting, cotton clothing to reduce friction and sweating in the axillae 2
• Keep nails short to minimize damage from scratching 2

Follow-up and Monitoring

• Schedule follow-up within 1-2 weeks to assess treatment response 2
• Consider referral to dermatology if:
  • No improvement after 2-3 weeks of appropriate treatment
  • Recurrent infections despite proper management
  • Diagnostic uncertainty persists 2

Important Considerations

Evidence Strength and Nuances

• While older research suggested topical antibiotics add little to what topical corticosteroids alone achieve in infected eczema 3, more recent studies demonstrate superior bacteriological clearance with mupirocin cream compared to oral antibiotics 1
• Mupirocin cream has been shown to be as effective as or superior to oral antibiotics in experimental skin infections 4
• Patient preference and compliance are better with topical mupirocin compared to oral antibiotics 1, 5

Common Pitfalls to Avoid

• Avoid using medium or high-potency corticosteroids on the face, chin, and intertriginous areas due to increased risk of skin atrophy 2
• Don't continue topical corticosteroids beyond 2 weeks in these sensitive areas 2
• Be cautious about using ointment formulations in the axillae, as they can cause occlusion and worsen maceration 2
• Watch for signs of contact dermatitis to topical medications, which may require patch testing if symptoms persist despite treatment 2