What is the treatment for underarm dermatitis?

Treatment for Underarm Dermatitis

For underarm dermatitis, the first-line treatment consists of identifying and avoiding irritants, using gentle cleansers, applying moisturizers regularly, and using topical corticosteroids for flare-ups. 1

Initial Management

Identify and Avoid Triggers

• Remove potential irritants such as harsh soaps, detergents, fragrances, and deodorants that may be causing or exacerbating the dermatitis 2, 1
• Use lukewarm or cool water for washing the underarm area rather than hot water which can further damage the skin barrier 1
• Pat dry gently rather than rubbing the affected area 1

Cleansing Recommendations

• Use dispersible creams as soap substitutes to cleanse the underarm area 2
• Choose soaps/cleansers without allergenic surfactants, preservatives, fragrances, or dyes 1
• Avoid disinfectant wipes for cleaning the affected area 2

Treatment Approach

First-Line Treatment

• Apply moisturizers immediately after bathing to damp skin for maximum effectiveness 2, 1
• Use fragrance-free moisturizers with petrolatum or mineral oil as these are most effective and least allergenic 2
• Apply a topical corticosteroid such as hydrocortisone 1% cream to affected areas not more than 3-4 times daily for adults and children over 2 years of age 3
• For mild to moderate cases, low to medium potency topical corticosteroids are recommended to minimize side effects 1

For Irritant Contact Dermatitis

• Identify and avoid irritants 2
• Apply barrier creams (humectants) which may be helpful but are equivalent to regular moisturizers 2
• Use topical steroids when conservative measures fail, but be cautious of potential steroid-induced damage with prolonged use 2

For Allergic Contact Dermatitis

• Patch testing should be considered to identify specific allergens 2, 1
• Avoid identified allergens 2
• Apply topical corticosteroids to mitigate flares 2

Advanced Therapy for Persistent Cases

When First-Line Treatment Fails

• For recalcitrant cases, consider stronger topical steroids for limited periods 2
• Topical calcineurin inhibitors (tacrolimus, pimecrolimus) can be used as steroid-sparing agents, especially for sensitive skin areas like the axillae 4, 5
• Tacrolimus 0.1% ointment has shown efficacy in treating dermatitis and may improve skin hydration more than corticosteroids 4, 6

For Secondary Infections

• If bacterial infection is present (indicated by crusting, weeping, or punched-out erosions), consider antistaphylococcal antibiotics 2
• Antiseptic solutions (e.g., silver sulfadiazine 1%, polyhexanide 0.02%-0.04%) may be beneficial for infected dermatitis 2

Special Considerations

Nighttime Care

• Apply moisturizer at night followed by loose cotton clothing to create a less occlusive environment 2
• For severe cases, consider the "soak and smear" technique: soak the affected area in plain water for 20 minutes and immediately apply moisturizer to damp skin nightly for up to 2 weeks 2, 1

Common Pitfalls to Avoid

• Avoid applying known allergens or irritants to the affected area 2
• Do not use very hot water for washing 2
• Avoid occlusion without underlying moisturizer application 2
• Do not use superglue to seal inflammatory or healing fissures 2

When to Refer to a Dermatologist

• When dermatitis does not improve after 6 weeks of treatment 1
• For suspected allergic contact dermatitis requiring patch testing 2, 1
• When there is a change in baseline dermatitis pattern 1
• For recalcitrant cases that may require phototherapy or systemic therapy 2, 7