EczemaNet Article
Infection Common in Patients with Eczema

The red, cracked, and unbearably itchy skin that develops when eczema (atopic dermatitis) flares is not only uncomfortable. It also makes one more susceptible to infection. To help patients and their caretakers cope, this article explains:

• Why people with atopic dermatitis are more susceptible to infection

• How to recognize the signs and symptoms of infection

• When to seek medical care

Why people with atopic dermatitis are more susceptible to infection
Research shows that most (about 90%) of people with atopic dermatitis have the Staphylococcus aureus (staph) bacteria on their skin. By comparison, fewer than 5% of people without atopic dermatitis have staph on their skin. When a person with atopic dermatitis scratches, the skin often breaks. This allows microorganisms on the skin, such as bacteria, to enter the body. Additionally, a study shows that people with atopic dermatitis 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 effectively fight infection, it is easy to see why infections develop.

How to recognize the signs and symptoms of infection
Children and teens with atopic dermatitis 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 atopic dermatitis does not respond to treatment. Signs and symptoms to watch for are:

• 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 atopic dermatitis. These blisters may pop, weep, and form crusts.

• Redness. When bacteria infect the skin, the skin becomes very red. Widespread red scaly patches and plaques that may crust and ooze pus usually indicate a staph infection.
  
  Streaking or spreading redness also indicates infection.

• Swelling/Inflammation. If the area feels enlarged or unusually warm, it may be infected.

• Fever. When infection develops, the body’s temperature sometimes rises to create an unfavorable environment for the microorganisms causing the infection.

• 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. Bright red halos surround the blisters. Within one or two days, the blisters 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 atopic dermatitis 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 atopic dermatitis 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 early treatment 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. This is especially important to remember. The patient may feel better, but 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 on 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.

More Information
Infections and Eczema: What You Can Do to Reduce the Risk

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.

All content solely developed by the American Academy of Dermatology