Don Scott MD
Dermatopathology
Practical Skin Advice
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Donald R. Scott MD has been practicing general dermatology and dermatopathology in Palm Springs California since 1978. His continued focus is based on sound medical solutions that ensure health, well being and a prosperous life.
Fellow Practitioners,
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If you’re wondering why I’ve connected with you here, it’s because I’d like to share some simple, practical advice on managing skin rashes based on over 50 years of clinical experience. Many of you have already seen my posts on approaching skin conditions, so forgive me if this feels repetitive. My intent is not to lecture or speak down to anyone—only to share what has consistently worked for me and may save you and your patients time and frustration.
Much of what I teach centers on the therapeutic use of water (balneotherapy). It’s simple, soothing, effective, and free—patients love it. Once you try these approaches, the reasoning behind them becomes clear. Unfortunately, most medical training programs give little attention to balneotherapy, but I was fortunate at UCLA to learn from a wise professor who planted these ideas early in my career.
The first document, which I call Basic Dermatologic Concepts, is one I’ve shared many times and encourage as many dermatologists as possible to read. It is self-explanatory. Once you understand the principle of “dilute the dilemma,” everything falls into place.
The second document addresses oral issues and is likewise straightforward.
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The third focuses on pediatric care and is especially important—particularly for diaper rashes. Discontinuing plastic diapers is key.
The fourth discusses reducing water exposure. Paradoxically, excessive bathing—especially with soap—often worsens itching and rashes in both children and older adults. While the article focuses on atopic dermatitis, the principles apply equally to adult eczema. The specific product mentioned (Cetaphil) is not essential, but I appreciate that they helped promote this approach. In many cases, simply stopping routine washing for a period of time leads to significant improvement. Odor-prone areas can, of course, be cleaned as needed.
As I often say: “Cleanliness is not next to godliness.”
Practical Skin Advice
The most important message I can give you is the following, “dilute the dilemma®”. Another expression is, “dilution is the solution”. This means when you see a rash or almost any acute skin injury you must soak it.
Use the following formula:
1 Dissolve 1 teaspoon of baking soda in 2 cups of water
2 Soak a washcloth in the solution
3 Soak the affected areas for 30 minutes three times a day
Baking soda compresses are especially effective in solving eyelid rashes (for example) because baking soda doesn’t irritate the eyes.
For more widespread severe rashes, dissolve 2 cups of baking soda in a tub of warm water and soak as much as needed (1 hour, 2-3 times a day). Most simple eruptions will improve within 7-10 days using this simple buffering solution.
Never use topical antibiotics like neomycin or triple antibiotic salves because of their significant allergic properties. They have NO proven efficacy and often cause exacerbation of skin systems. In nearly 50 years of clinical practice, I have NEVER used them. Often when I am called to consult on a patient’s rash that is worsening I always ask about the use of topical antibiotics and stop them immediately.
Even if you use topical antibiotics on rashes and wounds and it heals, it’s not because of the antibiotic effect.
Petrolatum would work just as well. Although soaking with the baking soda formula almost always works and buys time until the skin heals itself.
A common event I see is when a patient is hospitalized for presumed cellulitis (skin infection) especially in the lower extremities that is not responding to systemic antibiotics. Once I stop the topical antibiotics (which are usually being used) and institute soaks the skin eruption usually resolves.
My usual protocol with hospitalized patients who have rashes or wounds that will not heal and perplex their physicians is to start normal saline soaks (4 teaspoons of salt in 4 cups of water) using a washcloth applied to skin for one hour 3-4 times daily. The old adage that salt water heals everything seems to be true.
Salt and baking soda contain sodium which creates a hypertonic solution. As we all know such solutions cause osmosis of water out of cells to dilute the extracellular salts. Therefore bacteria, viruses and inflammatory cells collapse as they become dehydrated. Its simple chemistry you learn in high school. Using these concepts makes it easy for the healthcare professional and patients to deal with most skin dilemmas.
My favorite statement to physicians or patients is to go to the grocery store to get your baking soda or salt and not the “harmacy”.
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Recommended Home Approach for Oral Lesions and Mouth Irritations
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For most oral lesions or other mouth problems I encounter, my initial recommendation is a simple, safe home remedy using baking soda:
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Dissolve one teaspoon of baking soda in a cup of water.
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Use this solution to rinse your mouth as frequently and for as long as possible throughout the day.
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Brush your teeth and tongue with the baking soda solution, then leave a small residue along the gum lines (do not rinse immediately after brushing).
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Adjust the frequency and duration based on the severity of your symptoms—more intensive use for more bothersome issues, less for milder ones.
Most oral lesions are more challenging to diagnose precisely than to manage symptomatically. This approach helps “dilute the dilemma” by providing gentle, soothing relief while buying time for further evaluation if needed. It is generally harmless, and many patients appreciate a straightforward home remedy that makes sense and feels proactive.
Consistency and diligence are key to seeing potential benefits.
Important note: If symptoms persist despite this regimen, additional evaluation—including specific treatments and likely a biopsy—may be necessary. Always continue your diagnostic workup as appropriate and consult your healthcare provider for personalized advice.
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Advice for Children’s Rashes
This advice is important, especially for children and infants presenting with troublesome (enigmatic) skin eruptions, especially diaper rashes. Disposable (plastic) diapers are the main culprit.
Soak the child often in warm water with baking soda. Use ½ cup of baking soda in a small tub or basin. This allows the baby to play while being treated. Topical prescriptions may not be needed.
This simple step gives anxious parents something practical to do while a proper diagnosis is being made—it helps “dilute the dilemma.” Baking soda is a safe, simple, and effective buffering compound. Parents love straightforward solutions like this. While it may not cure every condition, I see no contraindications for its use.
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I firmly believe that routine bathing with any soap in infants can damage their developing acid skin barrier and prevent the normal skin microbiome from establishing properly. This disruption invariably contributes to eczema.
The science supporting this view is growing and being published regularly. See next article.​​
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Cetaphil® Regimen in Atopic Dermatitis Patient Instructions
The following is a handout I often give to my patients:
AVOID EXCESSIVE SWEATING. Itching is increased by excessive sweating, especially when the skin is inflamed. So dress lightly, preferably in cotton clothing and avoid vigorous exercise in hot weather.
AVOID CONTACT WITH WOOLEN MATERIALS. The prickly wool fibre in contact with your skin may trigger itching (and scratching). Do not wear woolen clothing next to your skin, play on woolen rugs or sit on wool covered chairs.
AVOID THE USE OF SOAP. Soap is irritating to atopic skin so do not bathe in soap and water. This means
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NO BATH until the eczema has cleared. Instead, cleanse and lubricate the skin with Cetaphil Lotion.
THE CETAPHIL ROUTINE. Apply Cetaphil Lotion to the entire body, pouring a liberal amount in your hand and rubbing it vigorously onto the skin until a lather is formed. Wipe off the lather gently with a soft cloth (such as a diaper). Only if the skin is very dirty is it necessary to wipe vigorously, in which case apply more Cetaphil Lotion. The purpose is not only to cleanse, but also to leave a thin film of Cetaphil on the skin. This cleansing-lubricating routine should be done at least twice daily.
SHAMPOOING THE SCALP. During the period of soap and water avoidance, shampooing the scalp may be a problem. If there is no eczema of the face a soap and water shampoo is permissible, providing the neck and body are protected by adequate draping with towels. If there is eczema of the face and neck you can cleanse the hair by soaking it with Cetaphil Lotion, working up a lather and then drying with a soft towel.
WHEN YOUR ECZEMA IMPROVES. Once the eczema is under control, you may tentatively try one water bath a week. This should be brief, in lukewarm water and followed by the application of Cetaphil Lotion. You will continue the once weekly bathing and twice daily use of Cetaphil Lotion application for many months.
USE OF A CORTICOSTEROID CREAM OR LOTION. This is prescribed along with the Cetaphil routine to help control the inflammation and itching of eczema. Use the cream or lotion sparingly two or three times daily, and whenever there is itching apply a little more cream or lotion to the itching area so that the desire to scratch is relieved.
ORAL MEDICATIONS. (A) Sometimes it is necessary to use an anti-histamine medicine at bedtime: This will be prescribed only if indicated to reduce itching and promote restful sleep. (B) In the presence of secondary skin infection an oral antibiotic may be prescribed. This will be continued for at least ten days and you should take the full course even though you may feel the infection has gone.
QUESTIONS. If you have a question or don't understand any part of this routine make a point of asking me about it.
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PRINTABLE HANDOUTS FOR YOUR PATIENTS
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(this can be handed out to patients with atopic eczema or adults with eczema)​
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