What ointment is used to treat a rash?

Treatment of Rash with Topical Ointments

For most rashes, apply a medium- to high-potency topical corticosteroid ointment (such as triamcinolone 0.1% or clobetasol 0.05%) to the body, but use only low-potency hydrocortisone (1-2.5%) on the face to avoid skin atrophy. 1

Potency Selection Based on Location

• Body/trunk/extremities: Use Class I high-potency steroids like clobetasol propionate 0.05%, halobetasol propionate, or betamethasone dipropionate cream or ointment 1
• Face/neck: Use only Class V/VI low-potency steroids such as hydrocortisone 2.5%, desonide, or aclometasone to prevent skin atrophy, telangiectasia, and other facial complications 1
• Scalp/groin: Medium-potency options like betamethasone valerate 0.1% or mometasone furoate 0.1% are appropriate 1

Formulation Choice

• Ointments are preferred over creams for most rashes because they provide better drug penetration and are more effective, though patient preference may guide selection given the range of potencies available 2, 3
• Use creams if skin is weeping or oozing; use ointments if skin is dry 1
• Avoid alcohol-containing gel formulations as they may enhance dryness 1

Severity-Based Treatment Algorithm

Mild Rash (Grade 1: <10% body surface area)

• Apply topical corticosteroids as above twice daily 1
• Add emollients and moisturizers regularly to prevent xerosis 1
• Consider oral antihistamines (cetirizine/loratadine 10 mg daily or hydroxyzine 10-25 mg QID) for pruritus 1

Moderate Rash (Grade 2: 10-30% body surface area)

• Continue topical corticosteroids with intensified application 1
• Add topical antibiotics (erythromycin, metronidazole, or nadifloxacin) if signs of infection present 1
• Consider short-term use (2-3 weeks) of higher potency steroids, then reassess 1
• Oral tetracyclines (doxycycline 100 mg twice daily or minocycline 50 mg twice daily) for 6 weeks if pustular component present 4

Severe Rash (Grade 3: >30% body surface area)

• Add systemic corticosteroids: prednisone 0.5-1 mg/kg/day (or methylprednisolone equivalent) until rash resolves to grade 1 or lower 1, 4
• Continue topical steroids as adjunctive therapy 1
• Rule out systemic involvement with CBC, comprehensive metabolic panel 1

FDA-Approved Indications

Hydrocortisone topical is FDA-approved to "temporarily relieve itching associated with minor skin irritations, inflammation, and rashes due to eczema, psoriasis, poison ivy/oak/sumac, insect bites, detergents, jewelry, cosmetics, soaps, and seborrheic dermatitis" 5

Critical Pitfalls to Avoid

• Never use high-potency steroids on the face—this causes irreversible atrophy, telangiectasia, and steroid rosacea 1, 3
• Obtain bacterial cultures before starting antibiotics if infection is suspected to avoid diagnostic challenges 4
• Limit super-high-potency steroids to 3 weeks maximum; high/medium-potency can be used up to 12 weeks; low-potency has no time limit 3
• Avoid prolonged occlusion with high-potency steroids as this dramatically increases systemic absorption and adverse effects 3, 6
• Do not use in the genital area if vaginal discharge is present, and do not use for diaper rash without physician consultation 5

Special Populations

• Children: Use lower potencies and shorter durations due to increased absorption and higher risk of systemic effects 3
• Pregnant/lactating patients: Topical corticosteroids can be used safely with appropriate potency selection 3
• Large body surface areas: Exercise caution with highly potent preparations due to risk of adrenal axis suppression 6

Application Technique

• Apply once or twice daily using the fingertip unit method: one fingertip unit (from fingertip to first joint crease) covers approximately 2% body surface area in adults 3
• Taper topical steroids as clinically feasible once rash resolves rather than abrupt discontinuation 1