Treatment of Localized Red, Scaling Skin Bumps

Initial Treatment Approach

Reassess after 2 weeks; if no improvement or worsening occurs, consider alternative diagnoses or treatment escalation 1

If infection develops (painful lesions, pustules, yellow crusts, or discharge), discontinue occlusive dressings and obtain bacterial cultures 1, 2
Obtain cultures when there is progression despite treatment, painful lesions, pustules, or discharge 2
If bacterial infection is confirmed, switch to appropriate antibiotics: clindamycin 300-450 mg orally three times daily or TMP-SMX 1-2 DS tablets twice daily for suspected MRSA 2
For severe infections unresponsive to oral antibiotics, consider IV vancomycin 15-20 mg/kg every 8-12 hours or linezolid 600 mg IV twice daily 2

Failure to obtain cultures in treatment-resistant cases can lead to prolonged ineffective therapy, particularly when bacterial superinfection is present 2

Very potent topical steroids applied to lesional skin are recommended with strength of recommendation A for psoriasis (well-demarcated plaques with silvery scale) 3
Consider combination therapy with topical vitamin D analogues to augment efficacy for psoriasis 4
For localized disease, topical corticosteroids alone may be sufficient for psoriasis 5, 6