What is the treatment for long-term dermatitis?

Question

Hi doctor,

I have severe dermatitis on almost all parts of my lower body, arms and hands. Many times I wake up at night due to itching.

I have tried Clobetasone Butyrate ointment, but it is only sometimes effective and too expensive.

In addition, I need help contacting a doctor. Do you have any advice?

Should I be able to avoid scratching just through willpower?

A long-term condition that started on the hands. A previous dermatologist suspected nasal carriage of staphylococcus aureus, and I performed a test but never heard back. Over the last year, it has spread from my hands to about half of my body but spread discontinuously (that has appeared at random places rather than moving out from the hands).

The hand issue began three years back. My doctor gave me Fusidic acid and antibiotics when I sought help two years back, and the problem was solved for a while. For the last year, I have had the problem over much of my body, but it has become worse since I moved to another city, as I have not been using Clobetasone butyrate so much (less available and more expensive). It is now terrible and severely impacting my sleep and stopping me from showering because it is so sore.

Clobetasone butyrate and Lanolin ointment, whenever I feel they are needed, have them available.

I have used Mometasone Fusidic Acid and Bentamethasone in the past.

I got a swab test done for nasal carriage for staphylococcus last year: however, I did not get results. Also the test was done only for my hands, as the rest of my body was not bad then.

Answer 1

Hi,

Welcome to icliniq.com.

I suggest the below daily care advice.

Keep the skin lubricated or moisturized.
Use ointment (such as petroleum jelly), cream, or lotion two to three times a day.
Moisturizers should be free of alcohol, scents, dyes, fragrances, or chemicals that you are allergic to.
Having a humidifier in the home may also help.
Moisturizers and emollients work best when they are applied to wet skin. These products soften the skin and help it retain moisture. After washing or bathing, pat the skin dry and apply the moisturizer immediately.
Different types of emollients or moisturizers may be used at different times of the day. But mostly, you can apply these substances as often as you need to keep your skin soft.
Avoiding anything that you observe makes your symptoms worse. These may include foods, such as eggs, in a very young child. Always discuss this with your healthcare provider first.
Avoid wool and other scratchy fabrics. Instead, use smooth, textured clothing and bedding, such as cotton.
Avoid sweating, and be careful not to overdress during warmer weather.
Avoid strong soaps or detergents, as well as chemicals and solvents.
Sudden changes in body temperature and stress may cause sweating and worsen your condition.
Certain triggers cause allergy symptoms.
Avoid smoking marijuana, brinjal or eggplant, and opioid drugs (they can worsen itching).
During washing or bathing: Bathe less often and keep water contact as brief as possible. Short, cooler baths are better than long, hot baths.
Use gentle skincare cleansers rather than traditional soaps. Use these products only on your face, underarms, genital areas, hands, and feet or to remove visible dirt.
Refrain from scrubbing or drying the skin too hard or for too long.
After bathing, it is essential to apply lubricating cream, lotion, or ointment on the skin while it is damp. This will help trap moisture in the skin.
The rash itself, as well as the scratching, often causes breaks in the skin and may lead to infection. Keep an eye out for redness, warmth, swelling, or other signs of infection.

I suggest the below treatment plan:

Use urea-based moisturizer, multiple times in a day.

Tab Levocetrizine 5 mg for itching at night

Topical steroid (like Mometasone) on affected areas twice a day.

I would like to have a look on the pictures to comment further on the need for antibiotics and oral steroids.

Consult a specialist doctor, talk to him or her, and start the medicines with their consent.

Thank you.