What is the treatment for desquamative rash?

Treatment for Desquamative Rash

For desquamative rash, the primary treatment consists of keeping the affected area clean, applying appropriate moisturizers, and using topical corticosteroids when indicated, with additional interventions based on severity and suspected etiology. 1

Initial Management Approach

• Keep the affected area clean and dry, even when ulcerated 1
• Use gentle soaps and shampoos with pH5 neutral formulations and tepid water 1
• Pat skin dry after washing rather than rubbing, using clean and smooth towels 1
• Apply non-perfumed moisturizers to prevent skin dryness 1
• For anti-infective measures, antibacterial moisturizers (e.g., triclosan or chlorhexidine-based cream) may be used occasionally, but avoid overuse as it can irritate the skin 1

Treatment Based on Severity

Mild Desquamation (Grade 1)

• Apply moisturizers regularly to affected areas 1
• Avoid alcohol-containing lotions or gels in favor of oil-in-water creams or ointments 1
• Can typically be managed by nursing staff with minimal intervention 1

Moderate to Severe Desquamation (Grades 2-3)

• In the absence of infection, consider one or more of the following topical approaches 1:

  • Anti-inflammatory emulsions such as trolamine
  • Hyaluronic acid cream
  • Hydrophilic dressings applied to the cleaned area
  • Zinc oxide paste (if easily removable)
  • Silver sulfadiazine or beta glucan cream (apply in the evening after cleaning)

• For moderate to severe cases, topical corticosteroids are the first-line treatment 2, 3

  • Apply to affected area not more than 3-4 times daily 4
  • For adults and children over 2 years of age 4
  • Choice of corticosteroid potency depends on the site of the rash 5

Management of Pruritus (Itching)

• Topical hydrocortisone can temporarily relieve itching associated with the rash 4
• Skin moisturizers and urea- or polidocanol-containing lotions can soothe pruritus 1
• For grade 2/3 pruritus, systemic treatment with oral H1-antihistamines such as cetirizine, loratadine, or fexofenadine may provide relief 1

Management of Suspected Infection

• If infection is suspected 1:

  • Use best clinical judgment for identifying infection
  • Consider swabbing the area to identify infectious agents
  • Apply topical antibiotics only when infection is confirmed (not prophylactically)
  • Check blood granulocyte counts, particularly if the patient is receiving concomitant chemotherapy
  • Perform blood cultures if there are additional signs of sepsis and/or fever

• Staphylococcus aureus is the most frequently detected infectious agent in secondarily infected rash 1

• Abscesses may require incision and drainage to prevent sepsis 1

Special Considerations

• For xerotic (dry) and eczematous skin 1:

  • Avoid dehydrating body care such as hot showers and excessive use of soaps
  • Apply emollients at least once daily to the whole body
  • For erythema and desquamation indicative of eczema, use topical steroid preparations

• For fissures 1:

  • Consider topical application of propylene glycol 50% in water for 30 minutes under plastic occlusion nightly
  • Follow with application of hydrocolloid dressing
  • Antiseptic baths with potassium permanganate (1:10,000) or topical silver nitrate solutions may accelerate wound closure

• For severe cases that don't respond to topical treatments, referral to a dermatologist is recommended 1

Monitoring and Follow-up

• Skin reactions should be assessed at least once a week 1
• For moderate to severe cases, management by an integrated team comprising dermatologists, nurses, and other specialists as required 1
• Severe cases should be managed primarily by a wound specialist 1