What is the treatment for a rash in the axilla?

Treatment of Rash in the Axilla

The treatment of axillary rash should include topical corticosteroids, appropriate antibiotics if infection is suspected, and addressing underlying causes while maintaining good skin care practices. 1

Initial Assessment and General Approach

• Axillary rashes require specialized attention due to the unique properties of this area - increased humidity, high density of hair follicles and sweat glands, and friction from opposing skin surfaces 2
• The treatment approach depends on the specific cause, but general principles apply to most axillary rashes 1
• Identify and treat predisposing conditions such as excessive moisture, friction, and skin irritants 1

First-Line Treatment Options

Topical Therapy

• Apply topical low to moderate potency corticosteroids such as hydrocortisone 2.5% to reduce inflammation 1, 3
• For adults and children over 2 years: apply hydrocortisone to affected area no more than 3-4 times daily 3
• Use alcohol-free moisturizers, preferably containing 5-10% urea, at least twice daily to maintain skin barrier function 1
• If infection is suspected (yellow crusts, discharge, painful lesions), obtain bacterial cultures before starting antimicrobial therapy 1

Antimicrobial Therapy

• For suspected bacterial infection in the axilla, topical antibiotics such as clindamycin 2% or erythromycin 1% cream may be used 1
• For more extensive infection, oral antibiotics may be necessary, with specific recommendations for axillary infections including 1:
  • Metronidazole 500 mg every 8 hours plus
  • Ciprofloxacin 400 mg IV every 12 hours/750 mg oral every 12 hours, or
  • Levofloxacin 750 mg every 24 hours, or
  • Ceftriaxone 1 g every 24 hours

Specific Approaches Based on Rash Type

For Inflammatory/Eczematous Rashes

• Apply topical corticosteroids such as prednicarbate cream 0.02% 1
• For severe cases with significant inflammation, consider short-term oral systemic corticosteroids (e.g., prednisone 40 mg daily for 7 days) 1
• Avoid skin irritants such as harsh soaps, solvents, or disinfectants 1

For Acneiform Rashes

• For mild to moderate acneiform rashes, use topical antibiotics (clindamycin 2% or erythromycin 1%) 1
• For moderate to severe cases, add oral antibiotics such as doxycycline 100 mg twice daily or minocycline 100 mg twice daily for at least 2 weeks 1
• Reassess after 2 weeks; if no improvement, consider referral to a dermatologist 1

Preventive Measures and Skin Care

• Avoid frequent washing with hot water as this can irritate and worsen axillary rashes 1
• Use mild, non-soap cleansers to clean the affected area 1
• Wear loose-fitting, breathable clothing to reduce friction and occlusion 4
• Apply sunscreen (SPF 15 or higher) to exposed areas if applicable 1
• Avoid antiperspirants if they appear to trigger or worsen the rash 5

When to Consider Referral

• If the rash does not improve after 2 weeks of appropriate treatment 1
• For severe cases with extensive involvement or signs of systemic infection 1
• When the diagnosis is unclear or the rash is recurrent despite appropriate treatment 2

Special Considerations

• For pregnant patients with axillary rashes, consult with an obstetrician before prescribing systemic medications 6
• For children under 2 years with axillary rashes, consult a pediatrician before applying topical corticosteroids 3
• For patients with recurrent axillary rashes, consider prophylactic measures such as regular use of moisturizers and avoiding known triggers 1