From the Research
I strongly recommend applying a topical corticosteroid cream, such as hydrocortisone 1%, to the affected areas 2-3 times daily for relief of the itchy rash, which appears to be a contact dermatitis reaction to sodium hypochlorite wound packing. This treatment approach is supported by the most recent and highest quality study on topical corticosteroids, which highlights their effectiveness in treating inflammatory skin conditions such as contact dermatitis 1.
For more severe itching, an oral antihistamine like diphenhydramine 25-50mg every 6 hours as needed or cetirizine 10mg daily may provide additional relief. However, it's essential to note that the evidence for topical antihistamines is mixed, with only topical doxepin demonstrating significant efficacy in reducing pruritus 2.
The patient should avoid scratching the affected areas to prevent secondary infection. Cool compresses with clean water may also help soothe the irritated skin. This reaction is likely due to the irritant properties of sodium hypochlorite (bleach) on the skin, which can disrupt the skin barrier and cause inflammation. The healthcare team should consider using protective barriers around the wound during future sodium hypochlorite applications to minimize contact with surrounding skin. If the rash worsens, spreads, or develops signs of infection (increased redness, warmth, swelling, or drainage), the treatment plan should be reassessed promptly.
It's also worth considering alternative topical treatments, such as TriCalm hydrogel, which has been shown to be effective in reducing itch intensity and duration in a study published in 2015 3. However, the most recent and highest quality study on topical corticosteroids 1 takes precedence in guiding treatment decisions.
Key considerations for the treatment plan include:
- Avoiding scratching to prevent secondary infection
- Using cool compresses to soothe the skin
- Considering alternative topical treatments, such as TriCalm hydrogel
- Monitoring for signs of infection and reassessing the treatment plan as needed.