These details are only a general guide. Individual circumstances differ and the National Eczema Society does not prescribe, give medical advice or endorse any products or treatments. We hope you find this information useful but they do not replace, and should not replace, the essential guidance which can be given by your doctor or nurse.
This fact sheet explains the relationship between infection and eczema. Causes of infection and details of treatment are fully covered.
Skin affected by eczema tends to develop small cracks and fissures on the surface. This provides entry points for bacteria that can cause infection. Infection makes eczema worse and treatment more difficult. The skin can become more cracked, which leads the way to further infection. Breaking this cycle of infection is the key to successful treatment.
WHAT CAUSES infection in Eczema?
The commonest cause of infection in eczema is a bacterium known as Staphylococcus aureus. It thrives on the weepy, broken skin of eczema. When infected there may be over one hundred million bacteria on a patch of eczema just the size of a finger nail.
It is now known that Staphylococcus aureus is found on the skin of virtually everyone with atopic eczema, even when there are no obvious signs of infection or eczema, whereas it occurs on the skin of less than one per cent of people who do not have eczema . Recent studies have shown that Staphylococcus aureus can trigger off eczema in areas of the body away from the bacteria. For example, if the bacteria are found on the forearm, it can cause a flare up of eczema in the crease of the elbow joint.
There is growing scientific evidence that infection with Staphylococcus aureus makes atopic eczema worse and hinders healing. The number of bacteria on the skin has been found to multiply with the increasing severity of the eczema. Staphylococcus aureus has been shown to produce toxins that trigger an exaggerated reaction from the body's defense system. It is thought that this over-reaction itself causes part of the problem.
This process is rather like a large, enthusiastic over army fighting against a few invaders and trampling the ground to pieces in the process!
ARE THERE ANY OTHER CAUSES OF infection in Eczema?
Streptococci are another group of bacteria related to the family Staphylococci which may lead to infection in eczema.
Candida or 'thrush' is a yeast infection that may develop on skin with eczema. Warm, moist folds of skin such as in the groins, under the breasts or around the area Nappy babies are in the areas most likely to become infected with Candida. Skin infected with Candida looks and feels itchy red and sore. There may be tiny yellow pustules. This can often be treated with a topical cream anti-fungal/steroid combination.
Ringworm is a fungal infection particularly common between the toes (athlete's foot). It can often look like eczema, visit your GP for a correct diagnosis. In people with eczema an anti-fungal/steroid combination can be used.
Chickenpox is caused by the Varicella zoster virus. If a child with eczema develops chickenpox, emollient therapy should be continued. Aqueous calamine cream can be used to help relieve Itching.
Wet wrapping and topical Steroids should not be used while the chickenpox is active, but may be continued when the scabs have dried out. In some children the eczema subsides while the chickenpox is active.
The cold sore virus Herpes simplex can cause severe infection in anyone with eczema because they have a lowered resistance to the virus. Therefore, it is advisable to avoid contact between anyone with eczema and a person who has the cold sore virus. This might even mean that a mother should not kiss her child if she has Herpes simplex and the child has eczema.
A condition known as' eczema herpeticum 'may develop if eczema becomes infected with Herpes simplex. The symptoms are flu-like and the skin feels sore and tender rather than itchy and there may be small BLISTER present on the face, hands and fingers. If you suspect eczema herpeticum you should always seek medical attention. Eczema herpeticum may require treatment with an anti-viral drug such as acyclovir.
HOW CAN I TELL IF Eczema IS INFECTED?
Infected atopic eczema looks red and angry and is usually 'weepy' with a yellowish crust. Yellow pus-filled spots may also be present (pustules) and small red spots around the body hairs (folliculitis). The skin feels hot, itchy and sore, which leads to more scratching. This in turn damages the outer layers of the skin and creates cracks and moisture which allows more bacteria to grow. This can set up a vicious circle. If the eczema becomes very infected there may be a general feeling of illness, together with a raised temperature.
If repeated attacks of eczema are infected suffered your doctor may take a swab from the skin to be sent to the microbiology laboratory. This is a quick, painless procedure and can help confirm what organism is causing the infection. It can also show which antibiotics should be effective as treatment.
The possibility of infection should always be considered in eczema that is getting worse or not responding to emollient or topical steroid treatment.
CAN I PREVENT INFECTION?
Because Staphylococcus aureus is found on the skin of almost everyone with atopic eczema, it is difficult to prevent infection. However, by treating the infection with the most appropriate medication, both the bacteria and eczema can be kept under control.
Restoring the skin's barrier to infection by reducing dryness and cracking will help to reduce the entry points for bacteria. Intensive emollient therapy will improve the barrier function of the skin.
Other simple prevention measures include a daily bath or shower using a soap substitute and good hygiene when applying creams (a pump dispenser or spoon is more hygienic than dipping your fingers into a pot of emollient). If infections keep occurring other members of the family may need to have swab tests to see if they are carrying any skin bacteria.
WHAT TREATMENT IS AVAILABLE FOR INFECTED Eczema?
Bacterial infection of eczema should be treated with specific antiseptics or antibiotics.
These can be applied topically as a cream, ointment or lotion. Studies have shown that topical antibiotics are successful in cases where pustules are present under the skin or when the skin is cracked, broken or weeping, giving easy access for bacterial infection.
Combination creams that contain both a topical steroid to help combat inflammation and an antibiotic to fight the infection may be prescribed by the doctor. Antibiotics can also be taken by mouth, usually several times a day for one or two weeks.
Where thrush or ringworm is a suspected steroid / Antifungal preparation may be used. In the moist skin folds cream containing a steroid, Antifungal and antibacterial properties is sometimes needed.
Sometimes a specific antibiotic bath additive may be recommended by your doctor to help fight infection. Strong antiseptics should not be used because they can cause irritation. When infection is being treated, it is important to continue with emollient therapy to help feed moisture back into the skin.
WHEN SHOULD I SEE THE DOCTOR?
If the eczema is getting worse, is not responding to treatment or looks infected, you should return to see your doctor. If flu-like symptoms develop with a raised temperature and the eczema worsens, then seek medical advice.
Wet wrapping should not be used on infected eczema as the moist conditions provide an ideal breeding ground for further bacterial growth. If you are using the wet wrapping technique and suspect that the skin is becoming infected, seek the advice of your doctor.
TREATMENTS AVAILABLE FOR Eczema
Dry cracked skin
Intensive therapy emollient
Eczema without infection
Intensive emollient therapy, Topical Steroid
Infected Eczema
Intensive emollient therapy, Topical steroid / antibiotic combination
Severely infected Eczema
Intensive emollient therapy, Topical steroid / antibiotic combination, Oral antibiotic
FURTHER INFORMATION
This fact sheet is one of a series provided as a service by the National Eczema Society to give up-to-date, practical help. More detailed information on this and other eczema-related subjects is available to members of the National Eczema Society. Membership of the Society costs just £ 20 per year.
Members receive a comprehensive information pack and copies of the Society's quarterly journal, Exchange. They also have unlimited access to the Society's Information Service. Membership of the National Eczema Society also offers people affected by eczema the opportunity to talk with others who share similar problems and experiences.