What treatment is recommended for excoriated skin?

Treatment for Excoriated Skin

For excoriated skin, apply emollients and moisturizers as the cornerstone of therapy, use topical corticosteroids (such as prednicarbate cream 0.02% or hydrocortisone 1%) for inflammatory changes, and consider topical antimicrobials only if secondary infection is present.

Primary Treatment Approach

Emollients and Moisturizers (First-Line)

• Apply emollients at least once daily to the whole body to restore moisture and prevent further skin damage 1
• Use oil-in-water creams or ointments rather than alcohol-containing lotions or gels, which can worsen dryness 1
• For severe cases, apply greasy emollients such as 50% white soft paraffin with 50% liquid paraffin over the entire affected area 1
• Skin-type-adjusted moisturizers should be selected based on the patient's specific needs 1

Topical Corticosteroids (For Inflammatory Changes)

• Apply topical corticosteroids when erythema and desquamation are present, indicating ongoing eczematous changes 1
• Prednicarbate cream 0.02% is recommended for moderate inflammatory skin reactions 1
• Hydrocortisone 1% cream can be used for milder cases, applied not more than 3 to 4 times daily 2
• Short-term use is preferred to avoid perioral dermatitis and skin atrophy 1

Management of Associated Symptoms

Pruritus Control

• Use urea- or polidocanol-containing lotions to soothe itching 1
• For grade 2/3 pruritus, add oral H1-antihistamines such as cetirizine, loratadine, fexofenadine, or clemastine 1
• Topical polidocanol cream provides additional relief for localized itching 1

Fissure Management (If Present)

• Apply propylene glycol 50% in water for 30 minutes under plastic occlusion nightly, followed by hydrocolloid dressing 1
• Alternatively, use antiseptic baths with potassium permanganate (1:10,000 concentration) or topical silver nitrate solutions to accelerate wound closure 1
• Protect surrounding skin with petroleum jelly 1

Infection Prevention and Treatment

When to Add Antimicrobials

• Apply topical antimicrobial agents only to sloughy or infected areas, not routinely 1
• Consider silver-containing products/dressings for infected excoriated areas, but limit use if extensive areas are being treated due to absorption risk 1
• Take bacterial swabs if secondary infection is suspected (impetiginization with Staphylococcus aureus or streptococci) and start calculated anti-infective treatment 1
• Bacitracin ointment can be applied 1 to 3 times daily to small infected areas 3

Wound Cleansing

• Regularly cleanse wounds and intact skin by irrigating gently with warmed sterile water, saline, or chlorhexidine (1:5000) 1
• Avoid hot showers and excessive use of soaps, which promote dehydration 1

General Care Principles

What to Avoid

• Do not use alcohol-containing lotions or gels, as they enhance dryness and worsen excoriated skin 1
• Avoid greasy creams for basic care in acneiform conditions, as they may facilitate folliculitis 1
• Do not manipulate or pick at the skin, which increases infection risk 1
• Avoid preparations containing sensitizers or irritants 1

Protective Measures

• Use gentle soaps and pH-neutral cleansing formulations 1
• Pat skin dry after bathing rather than rubbing 1
• Apply sunscreen with high SPF (at least SPF30) to exposed areas, as damaged skin is more vulnerable 1

Escalation for Severe Cases

When to Consider Systemic Therapy

• For grade 3 erythema and/or desquamation, short-term oral systemic steroids are recommended 1
• If excoriation is related to underlying psychiatric disorder (excoriation disorder), consider referral for psychotherapy and pharmacotherapy 4, 5, 6

Dressing Application

• Apply nonadherent dressings (such as Mepitel™ or Telfa™) to denuded dermis 1
• Use secondary foam or burn dressings to collect exudate 1

Common Pitfall: Many clinicians apply topical antibiotics routinely to all excoriated skin. This is unnecessary and should be reserved only for areas with clear signs of infection (purulence, warmth, expanding erythema) 1. The foundation of treatment remains aggressive moisturization and appropriate anti-inflammatory therapy 1.