How to manage erythema with a small open area at home?

Home Management of Erythema with Small Open Area

For erythema with a small open area at home, use a dispersible cream as a soap substitute, apply emollients after bathing, and use the least potent topical corticosteroid that effectively controls symptoms. 1

Initial Assessment and Cleansing

• Avoid regular soaps and detergents as they remove natural lipids from the skin surface, which is particularly problematic for already dry skin 1
• Use a dispersible cream as a soap substitute to cleanse the affected area 1
• Gently clean the area before applying any treatment 2
• Look for signs of infection such as crusting, weeping, or grouped punched-out erosions which may indicate bacterial or viral infection 1

First-Line Treatment

• Apply emollients after bathing to provide a surface lipid film that retards evaporative water loss from the epidermis 1
• Use the least potent topical corticosteroid preparation required to control symptoms 1
• Apply topical treatments no more than twice daily (some newer preparations require only once daily application) 1
• For adults and children over 2 years: apply a small amount of topical treatment (equal to the surface area of a fingertip) to the affected area 1-3 times daily 2
• The area may be covered with a sterile bandage if needed 2

Management of Secondary Infection

• If bacterial infection is suspected (indicated by crusting or weeping):

  • Flucloxacillin is usually the most appropriate antibiotic for treating Staphylococcus aureus 1
  • Use erythromycin when there is resistance to flucloxacillin or in patients with penicillin allergy 1
  • Phenoxymethylpenicillin should be given if β-hemolytic streptococci are isolated 1

• If viral infection (herpes simplex) is suspected (indicated by grouped, punched-out erosions):

  • Oral acyclovir should be given early in the course of the disease 1, 3
  • For ill, febrile patients with eczema herpeticum, intravenous acyclovir is required 1, 3

Additional Supportive Measures

• Keep nails short to prevent scratching and secondary infection 1
• Avoid extremes of temperature which can exacerbate symptoms 1
• Avoid irritant clothing such as wool; cotton clothing is more comfortable and recommended 1
• For severe itching, sedating antihistamines may be useful as a short-term adjuvant during flares 1

When to Seek Medical Attention

• If there is no improvement with home treatment after a few days 1
• If there are signs of spreading infection (increasing redness, warmth, pain) 1
• If fever develops, especially with grouped vesicles or erosions (may indicate eczema herpeticum requiring urgent treatment) 3
• If there is diagnostic uncertainty about the cause of the erythema 1

Special Considerations for Different Types of Erythema

• For lichenified eczema, ichthammol (1% in zinc ointment) or coal tar preparations may be particularly useful 1
• For dyshidrotic eczema (on hands/feet), medium to high potency topical corticosteroids may be needed for acute flares, followed by tapering to maintenance therapy 4