A number of complications can arise with atopic dermatitis. Some are relatively common; others extremely rare:

• Hand dermatitis
• Skin infections
• Eye complications
• Exfoliative dermatitis

Anyone experiencing one of the complications described below should contact a dermatologist, or visit an emergency room if the condition becomes life-threatening. 

Hand Dermatitis
Hand dermatitis is frequently seen in people with a history of atopic dermatitis, especially adults. The condition often begins with dry, chapped hands that later become patchy, red, scaly and inflamed. Some patients report a seasonal worsening of hand dermatitis, usually during the winter. Hand dermatitis is commonly aggravated by:

• Repeatedly wetting the hands
• Repeated hand washing with soaps, detergents or disinfectants
• Repeatedly exposing the hands to water and cleansing or disinfecting agents while doing everyday tasks, such as laundry and washing dishes

Treatment: This usually consists of:

• Avoiding exposure, as needed, to factors that aggravate the hand dermatitis
• Using topical moisturizers and medications as prescribed by a dermatologist

Topical corticosteroids are frequently part of the treatment plan. Numerous corticosteroids of various types and strengths are available, and dermatologists prescribe these as needed to accommodate the individual patient’s needs. These medications are not suitable for every patient. It is extremely important that patients use these medications only as prescribed.

When one is not able to limit exposure to water and harsh soaps, detergents, disinfectants or other irritant chemicals, hand dermatitis can become tremendously difficult to treat. This tends to happen when a job or occupation requires constant exposure to such irritants. Teens and others considering a possible job or occupation should take this into consideration. Choosing an occupation that does not involve repeated exposure will help minimize future risk.

Skin Infections
Recurrent bacterial, fungal and viral skin infections are a frequent complication of atopic dermatitis. It is believed that the lesions of atopic dermatitis provide an environment that allows bacteria, fungi and viruses to easily invade the skin and replicate.      

Bacterial Infections. The lesions of atopic dermatitis provide an environment that can harbor several types of harmful bacteria. One of the most commonly found bacteria — and the one most likely to produce recurrent and/or serious infections — is Staphylococcus aureus, (S. aureus), better known as "staph." Studies have shown that S. aureus is far more common on the skin of patients with atopic dermatitis than on the skin of persons who do not have this condition. S. aureus may be harbored in atopic dermatitis skin lesions, on unaffected skin or in the nose of the patient.

While the S. aureus organisms may be present without causing any apparent symptoms, a reservoir of S. aureus creates the potential for infection. The typical signs and symptoms of an infection are:

• Yellowish-orange or honey-colored crusting (impetigo) over the lesions.
• Pus-producing lesions
• Infected, inflamed hair follicles (folliculitis)
• Fever
• Fatigue
• Swollen lymph nodes

Treatment. Anti-staphylococcal drugs are usually effective in treating an acute S. aureus infection. If the infection occurs again and again, a reservoir of S. aureus may be present. If present, it is treated with an appropriate antibiotic.

Viral Infections. When herpes simplex, the virus that causes cold sores, enters an atopic dermatitis skin lesion, it can cause eczema herpeticum—a severe and potentially life-threatening infection. While not common, eczema herpeticum occurs in people of all ages and in males and females. Often those infected do not know that they have been exposed to the herpes simplex virus.

The first indication of infection occurs 5 to 12 days after exposure to the virus and typically appears as multiple itchy, watery blisters that occur on skin previously affected by atopic dermatitis. If these blisters are not treated, they can become progressively worse as illustrated by these stages:

1.       Multiple itchy, watery blisters over an area of skin, usually where atopic dermatitis lesions were present. (5 to 12 days after exposure)

2.       Blisters tend to disseminate or "crop" into adjacent areas of skin.

3.       Blisters may bleed, become encrusted, and erode—at this stage they are extremely painful.

4.       The viral infection spreads to cover the entire body, with associated fever and swollen lymph nodes. Secondary bacterial infection frequently develops in large, eroded areas of skin.

During all stages, fever is usually present and the person feels ill. The first episode of eczema herpeticum usually runs its course in 2 to 6 weeks if left untreated. However, letting the disease run its course is not recommended as eczema herpeticum can be life-threatening. Subsequent outbreaks tend to be milder, unless the patient has an underlying immunodeficiency condition.

Treatment. Since eczema herpeticum is potentially life-threatening, medical care should be sought. When therapy begins early, eczema herpeticum can be effectively treated. Several anti-viral medications are available, and a dermatologist can prescribe the one best suited for the individual. Pain medications also may be helpful.

Other viruses that may complicate atopic dermatitis include molluscum contagiosum and human papillomavirus. If a virus is suspected, a dermatologist may order diagnostic tests to determine which virus is involved so that proper therapy can be prescribed.

Eye Complications
Eye complications tend to be most common in patients with severe atopic dermatitis. When these complications occur, the associated eyelid itching can be almost unbearable. Some eye complications can lead to permanent eye damage and loss of vision. Signs and symptoms of eye complications include:

• Inflammation of the eyelid (blepharitis) and the lining of the eyelids (conjunctivitis), with symptoms of extreme itching, burning, watering of the eyes and mucous discharge.
• Inflammation of the inner lining of the eyelids that causes a cobblestone pattern to develop under the eyelids. Symptoms include extreme itching and eye watering.
• Cornea becomes deformed, probably due to constant hard rubbing of the eyes caused by excruciating eyelid itching.

Treatment: These signs and symptoms should be reported to a dermatologist immediately, so that the condition can be diagnosed and treated. Sometimes complications affecting the eye require the help of an ophthalmologist.

Exfoliative Dermatitis
A rare complication of severe atopic dermatitis, exfoliative dermatitis is an inflammatory skin disorder. Lesions can cover most of the skin’s surface, and severe cases may be life threatening. Signs and symptoms include:

• Generalized skin redness
• Skin scaling
• Itch
• Oozing lesions
• Crusting lesions
• Fever
• Toxicity that affects organs other than the skin
• Secondary bacterial or viral infection (can be a major complication)
• Water loss from oozing lesions may cause the body to become dehydrated

Treatment: Some cases of exfoliative dermatitis resolve spontaneously. However, medical treatment should begin as soon as possible to prevent life-threatening complications from developing. Treatment may require hospitalization.

References
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Kolmer HL, Taketomi EA, Hazen KC et al. “Effect of combined antibacterial and antifungal treatment in severe atopic dermatitis.” J allergy Clin Immunol 1996; 98:702-707.

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