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EczemaNet Article
Infection Common in Patients with Atopic Dermatitis
The red, cracked, and unbearably itchy skin that develops when
atopic dermatitis (AD) flares is not only uncomfortable. It also
makes one more susceptible to infection. To help patients and their
caretakers cope, this article explains:
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Why people with AD are more susceptible to infection
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How to recognize the signs and symptoms of infection
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When to seek medical care
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What you can do at home to reduce the risk of infection
Why people with AD are more susceptible to infection
Research shows that about 90% of people with AD have the
Staphylococcus aureus (staph) bacteria present on their skin. By
comparison, less than 5% of people without AD have staph on their
skin. When a person with AD scratches, the skin often breaks. This
allows microorganisms on the skin, such as bacteria, viruses, and
fungi, to enter the body. Additionally, a study shows that people
with AD cannot produce effective amounts of two natural antibiotic
proteins that the immune system needs to fight infection.1
With staph constantly present on the skin and the immune system
unable to adequately fight infection, it is easy to see why people
with AD develop infections when their skin flares and they scratch.
How to recognize the signs and symptoms of infection
Children and teens with AD are especially prone to developing skin
infections caused by staph (bacteria) and herpes simplex (virus).
Fungal infections may also occur. It is important to recognize the
signs and symptoms of infection, and consult your dermatologist as
soon as they appear. An untreated infection may be the reason AD
does not respond to treatment. Signs and symptoms to watch for are:
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Honey-colored crusting and pus-filled blisters. When a bacterial
infection, such as one caused by staph, occurs, honey-colored crusts
usually form. This is a sign of infection. Another sign is the
appearance of pus-filled blisters that form over patches of AD.
These blisters may pop, weep, and form crusts.
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Redness. When the skin becomes infected with bacteria, it becomes
very red. Widespread red scaly patches and plaques that may crust
and discharge pus, usually indicate a staph infection.
Streaking or spreading redness also indicates infection.
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Swelling/Inflammation. If the area feels enlarged or unusually
warm, it may be infected.
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Fever. When infection develops, the body’s temperature sometimes
rises to create an unfavorable environment for the microorganisms,
such as bacteria, viruses, or fungi, causing the infection.
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Lesions that resemble cold sores or fever blisters. These may be
signs of eczema herpeticum, a viral infection that also causes cold
sores. Eczema herpeticum can spread rapidly.
In the early stages, you will see numerous small blisters filled
with clear fluid that are surrounded by bright red halos. Within one
or two days, the blisters will break, leaving small round breaks in
the surface of the skin. The skin may become very sore, and the
patient will feel quite ill.
Even a person with mild AD can develop a severe infection from the
virus. For this reason, it is important to seek medical attention if
you see these signs. In rare cases, eczema herpeticum can be
life-threatening.
Be sure to keep children with AD away from anyone who has a cold
sore.
When to seek medical care
You should contact your dermatologist whenever you believe an
infection has developed. Dermatologists recommend that the infection
be treated early to prevent the condition from becoming worse.
Your dermatologist will determine what is causing the infection and
usually prescribe medication. Antibiotics are used to treat
infections caused by bacteria, such as staph or strep. Some
antibiotics are applied to the skin; others come in pill or liquid
form.
It is important that the patient take all antibiotics exactly as
directed. When a patient does not finish taking an antibiotic, there
is a chance that the infection will not clear. While the patient may
feel better, some bacteria can remain. When this happens, the
infection becomes increasingly hard to treat because the remaining
bacteria can develop a resistance to the medication. When the
medication is given again and it no longer works, this is called
“antibiotic resistance.”
Diluted bleach baths may be recommended for some patients to help
reduce the number of bacteria on their skin. If so, your
dermatologist will provide you with instructions for preparing these
baths. It is important that this therapy not be tried at home unless
prescribed. In some cases, phototherapy (treatment with light) may
be recommended to reduce the bacteria colonizing the skin and to
reduce inflammation. Topical steroids or topical calcineurin
inhibitors, such as pimecrolimus or tacrolimus, may be prescribed to
reduce overall skin inflammation.
Antibiotics that treat bacterial infections are not effective at
treating viral infections. The herpes simplex virus may be treated
with a medication called acyclovir, which comes in pill and liquid
form. Acyclovir also can be given as a shot. Other medications used
to treat this viral infection are famciclovir and valacyclovir.
In addition to prescribing medication, your dermatologist will
review your skin care routine to make sure you are doing everything
possible at home to prevent future flare-ups, which can lead to
infection.
What you can do at home to reduce the risk of infection
The key to preventing infection is to eliminate flare-ups. Here are
some tips that can reduce flare-ups:
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Identify and eliminate potential triggers. Triggers cause the
skin to flare. Common triggers include wool, soaps, pet fur,
perfumes, cosmetics, and household cleaners. Observe when flare-ups
occur to learn what irritates the skin, and avoid future contact
with these triggers.
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Keep skin moisturized. When the skin becomes dry and itchy, the
desire to scratch becomes overwhelming. Regular use of a
non-irritating moisturizer can keep the skin from becoming dry and
itchy. Skin should be moisturized frequently throughout the day and
always after bathing while the skin is still moist.
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Avoid excessive bathing. The bath should be short, the water
lukewarm, and the soap mild. Be sure the soap does not irritate the
skin, and use the soap only when needed. Your dermatologist can tell
you how often to bathe.
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Keep indoor temperature and humidity consistent. Using a
humidifier in the winter and air conditioning in the summer can
help.
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Avoid contact with anyone who has cold sores or chicken pox. Cold
sores are caused by the herpes simplex virus. People with AD can
develop eczema herpeticum when exposed to the herpes simplex virus.
The virus that causes chicken pox, varicella zoster, also should be
avoided.
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Reduce stress as much as possible. Know what causes stress, such
as taking a test or competing in a sporting event, and develop
strategies for managing the stress.
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Apply cold, wet wraps. If itching becomes intense, ask your
dermatologist if you should apply a cold, wet wrap. This therapy can
effectively relieve itching.
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Minimize perspiring. One’s own perspiration often irritates the
skin and causes a flare-up. Avoid overheating, and do not wear
synthetic fabrics, such as polyester, which trap perspiration.
Dermatologists recommend wearing cotton and dressing in layers to
avoid overheating. Taking breaks when exercising also may be
helpful.
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Keep fingernails short. Short nails decrease the likelihood that
scratching will puncture the skin. Keeping nails short and wearing
cotton gloves at night may help prevent scratching that punctures
the skin while asleep.
For more information about preventing flare-ups, see “Preventing
Flare-ups”.
Reference:
1 Ong PY et al. “Endogenous antimicrobial peptides and
skin infections in atopic dermatitis.” New
England Journal of Medicine. 2002. October 10;347(15):1151-60.

An educational program brought to you by the American Academy of
Dermatology. |
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You should see a dermatologist immediately if your child
has atopic dermatitis and:
• Develops chicken pox
• Took oral steroids within
the last 30 days and has
come into contact with
chicken pox |
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Signs of
Infection |

The honey-colored crusts
indicate that this patient may have a staph infection.
(Photo used with permission of Moise L. Levy, MD)
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This patient has a staph infection.
In this case, the most obvious sign is blistering. Some of the
blisters have popped; some still contain fluid.
(Photo
used with permission of the American Academy of Dermatology National
Library of Dermatologic Teaching Slides)

This child has eczema herpeticum, a
viral infection that can spread rapidly when the patient has atopic
dermatitis.
(Photo used with
permission of the American Academy of Dermatology National Library
of Dermatologic Teaching Slides) |
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