What is the management of atopic dermatitis (eczema) with drool rash?

From the Guidelines

Management of eczema with dribble rash involves a combination of gentle skin care and topical treatments, with the goal of reducing inflammation, creating a protective barrier against moisture, and preventing further irritation from saliva's digestive enzymes, as recommended by the most recent guidelines 1. To manage eczema with dribble rash, the following steps can be taken:

• Clean the affected area with warm water and a mild, fragrance-free cleanser, then pat dry gently.
• Apply a barrier cream containing zinc oxide or petroleum jelly to protect the skin from saliva irritation.
• For mild inflammation, use a low-potency topical corticosteroid such as 1% hydrocortisone cream twice daily for 3-5 days, as topical corticosteroids are the mainstay of treatment for atopic eczema 1.
• If there's significant redness or inflammation, a moderate-potency steroid like triamcinolone 0.1% may be needed, but use this for no more than 7 days on facial skin.
• Keep the area dry by frequently wiping away excess saliva with a soft cloth and changing bibs regularly.
• Avoid harsh soaps, fragranced products, and fabric softeners that can further irritate the skin, as they remove natural lipid from the surface of the skin 1.
• If there are signs of infection (increased redness, warmth, yellow crusting), consult a healthcare provider as antibiotics may be necessary. It is essential to educate patients and parents on the application of topical preparations, the quantity to use, and the importance of avoiding provoking factors, such as extremes of temperature and irritant clothing 1. The key to successful management is to use the least potent preparation required to keep the eczema under control and to stop corticosteroids for short periods when possible, as recommended by the Taiwan guidelines for the diagnosis and management of pediatric atopic dermatitis 1.

From the FDA Drug Label

Uses temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: eczema Directions for itching of skin irritation, inflammation, and rashes: adults and children 2 years of age and older: apply to affected area not more than 3 to 4 times daily The management of eczema with dribble rash (also known as drool rash) can be done using hydrocortisone (TOP) to temporarily relieve itching associated with minor skin irritations, inflammation, and rashes due to eczema.

• For children 2 years of age and older, apply hydrocortisone (TOP) to the affected area not more than 3 to 4 times daily 2 2.
• For children under 2 years of age, consult a doctor before using hydrocortisone (TOP) 2.

From the Research

Management of Eczema with Dribble Rash

• Eczema, also known as atopic dermatitis, is a chronic relapsing and remitting inflammatory skin disease that can be managed with various treatments, including topical corticosteroids, moisturizers, and proactive therapy 3, 4, 5, 6.
• Topical corticosteroids are a first-line treatment for eczema flare-ups, with potent and moderate topical corticosteroids being more effective than mild topical corticosteroids, primarily in moderate or severe eczema 3.
• Moisturizers are an integral part of eczema treatment, with most moisturizers showing some beneficial effects, such as reducing eczema severity, prolonging time to flare, and reducing the number of flares and amount of topical corticosteroids needed 5.
• Proactive therapy with twice weekly use of topical corticosteroids and calcineurin inhibitors in previously affected areas has been found to reduce the time to the next eczematous flare 6.
• Other treatment options for eczema include wet wrap therapy, anti-histamines, vitamin D supplementation, and systemic antibiotics for infected lesions 4, 6.
• Difficult-to-treat eczema may require re-evaluation of the initial diagnosis, evaluation for contact, food, and inhaled allergens, and consideration of systemic therapies or new biological agents 6.

Treatment Options for Eczema

• Topical corticosteroids:
  • Potent and moderate topical corticosteroids are more effective than mild topical corticosteroids 3.
  • Applying potent topical corticosteroids only once a day probably does not decrease the number achieving treatment success compared to twice daily application 3.
• Moisturizers:
  • Most moisturizers show some beneficial effects, such as reducing eczema severity and prolonging time to flare 5.
  • Urea-containing cream, glycerol-containing moisturizer, and oat-containing moisturizers have been found to be effective in reducing eczema severity and improving skin barrier function 5.
• Proactive therapy:
  • Twice weekly use of topical corticosteroids and calcineurin inhibitors in previously affected areas can reduce the time to the next eczematous flare 6.
• Other treatments:
  • Wet wrap therapy, anti-histamines, and vitamin D supplementation may be considered as adjunctive treatments 4, 6.
  • Systemic antibiotics may be used for infected lesions, but empiric use in uninfected lesions is controversial 6.