Infected Eczema: How to Identify, Treat, and Prevent

Infected eczema showing inflammation with red, dry patch and crusting, likely caused by scratching, leading to a secondary bacterial infection

What if you develop a serious skin infection on top of eczema? We know that it is going to be stressful, both physically and emotionally. That is why we are going to make you aware about all that you need to know about Infected eczema.

Eczema, a group of conditions characterized by inflamed, irritated, and often itchy skin, affects around 31.6 million people (10.1%) in the U.S., with the highest prevalence in early childhood. Subtypes of eczema include atopic dermatitis (AD), contact dermatitis, and stasis dermatitis, with atopic dermatitis being the most common. Over time, eczema can lead to additional health risks, such as asthma, autoimmune conditions, ,secondary infections resulting in infected eczema, poor bone health, sleep disturbances, and even social and economic difficulties.^[1]

This article focuses on one of eczema’s more challenging complications, infected eczema. It will explore what is infected eczema, its causes, symptoms, complications, treatment options, and preventive measures.

What is Infected Eczema?

In eczema, the skin barrier is weakened and the body’s immune defences are disrupted. This compromised skin becomes more susceptible to infections caused by bacteria, viruses and fungi. When these organisms penetrate the skin, they result in infected eczema. The most common culprits behind infected eczema are Staphylococcus aureus and herpes viruses.^[2]

Common Causes of Infected Eczema

Different microorganisms can infect eczema, leading to varying symptoms and severity. Here’s a breakdown of the common types of infections

1. Bacterial Infections

Infections such as impetigo, cellulitis, and abscesses frequently occur in those who are having eczema. They are most often caused by Staphylococcus aureus (S. aureus). Impetigo typically presents with oozing fluid that forms a honey-like crust. Other infections like cellulitis start in a localized area of the skin but can quickly spread, causing redness, swelling, warmth, tenderness, and even fever.

More severe bacterial infections can lead to complications such as bacteraemia (bacteria in the bloodstream), osteomyelitis (bone infection), septic arthritis ( joint infection), endocarditis in heart, and staphylococcal scalded skin syndrome. Symptoms of these complications include fever, lethargy, bone tenderness, joint swelling, and skin peeling. Monitoring markers like C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) can help assess the severity of the infection.

2. Viral Infections

Eczema herpeticum (EH) is a potentially life-threatening viral infection caused by the herpes simplex virus (HSV-1) in individuals with eczema. It manifests as painful skin with vesicles or haemorrhagic crusts and can progress to fever and malaise. Those with severe eczema, food allergies, or asthma are at a higher risk of developing infected eczema due to herpes simplex virus. Systemic eczema herpaticum infection may present with fever, malaise, viremia, and complications including keratoconjunctivitis, encephalitis, and septic shock. Nearly a third of children who are hospitalized for AD infectious complications were related to eczema herpaticum.^[2]

Another viral infection is eczema coxsackium (EC), caused by coxsackie viruses. It presents with extensive vesicles, skin erosion, and symptoms like those seen in hand-foot-mouth disease. Although eczema coxsackium can resemble eczema herpaticum, it is not usually life-threatening and is managed with standard eczema treatments.

3. Fungal Infections

Eczema is also susceptible to fungal infections caused by Candida spp  and dermatophytes (molds). Candida thrives in warm, moist areas such as under the arms, groin, and neck. Dermatophytes cause infections known as tinea or ringworm. These infections may require topical antifungal treatments, but oral medications are sometimes necessary if it is casing persistent infected eczema.

Risk Factors for Infection

1. Skin Barrier Defects

Eczema is inherently associated with skin barrier defects, as seen in increased trans epidermal water loss. Patients with eczema have a thinner superficial layer of skin due to impaired keratinocyte differentiation. This leads to a deficiency in essential skin proteins and lipids resulting in increased susceptibility to environmental allergens and pathogens, raising the risk of recurrent infections.^[2]

2. Immune Dysregulation

In eczema, the immune system becomes dysregulated, leading to an overproduction of inflammatory mediators. These mediators suppress the skin’s natural production of antimicrobial protein particles , further weakening the skin’s defences.  Defensive cell function decreases, heightening infection risk.

3. Staphylococcus aureus Colonization

Up to 90% of individuals with AD are colonized with S. Aureus, which produces toxins that disrupt the skin barrier and amplify inflammation. This bacterium can outcompete beneficial skin flora, increasing the likelihood of developing infected eczema.^[2]

4. Dysbiosis of Skin Flora

Healthy skin hosts a balanced microbiome, which plays a protective role. In eczema, there is a deficiency in beneficial bacteria like Staphylococcus epidermidis, disrupting this balance and facilitating S. aureus colonization and infection.

5. Lifestyle related

If you are used to scratch the skin affected with eczema, skin gets damaged, making it easier for pathogens to enter and infect the compromised skin

Using irritating substances like harsh soaps or wearing tight clothing can worsen eczema lesions, making them prone to infection.

Signs and Symptoms of Infected Eczema

Infected eczema presents with additional symptoms beyond the typical itchiness, dryness, and flakiness of regular eczema. Symptoms of eczema include :

• Increased redness and swelling
• Warm or hot skin
• Pus-filled blisters or fluid-filled bumps
• Systemic symptoms – like fever, chills, fatigue, and swollen lymph nodes.

Comparison Table: Regular Eczema vs. Infected Eczema

Complications of Untreated Infected Eczema

Untreated infected eczema can lead to severe complications, including:

• Sepsis – The infection can spread to the bloodstream.
• Eczema Herpeticum – A potentially life-threatening viral infection.
• Scarring and Permanent Skin Damage – Resulting from prolonged or untreated infections.
• Eye Complications – If the infection spreads to the eyes.
• Can cause bone, joint, heart infection and staphylococcus scalded skin syndrome

Treatment Options for Infected Eczema

The treatment for infected eczema depends on the severity and type of infection:

1. Bacterial Infections

Mild Infections – Can be treated with topical antibiotics like mupirocin ointment for 5-10 days. Regular skincare, including emollients and corticosteroids, should be maintained.

Moderate to Severe Infections – Oral antibiotics, are often required , specifically targeting S. Aureus or MRSA. For serious cases, hospitalization and intravenous antibiotics may be necessary.^[2]

2. Viral Infections

Eczema Herpeticum – Requires immediate antiviral treatment, such as acyclovir, even before confirmatory testing. Severe cases may necessitate hospitalization for intravenous antiviral therapy.

3. Recurrent Infections

Patients with recurrent infections might benefit from decolonization strategies, including intranasal mupirocin and antiseptic washes like dilute bleach baths or chlorhexidine.

Remember, it is important to treat the underlying eczema to reduce the recurrence rate of infected eczema. So,

• Keep the affected area clean and moisturized
• Use emollients and prescribed creams
• Avoid scratching and using known irritants

Preventing Infected Eczema

Taking preventive measures can reduce the risk of developing infected eczema. You’ll be surprised to see how simple but effective these preventive measures are!

1. Proper Hygiene and Application of Treatments

• Wash Hands – Before applying topical treatments, wash your hands thoroughly.
• Decant Emollients – Use a metal spoon to scoop out emollients from tubs to prevent contamination. Pump dispensers are preferable.
• Avoid Sharing Personal Items – Refrain from sharing towels, bedding, or clothing if the eczema is infected.

2. Antiseptic Measures

• Antiseptic Washes –  Triclosan, chlorhexidine gluconate, and sodium hypochlorite are effective in reducing S. aureus on the skin.
• Bleach Baths – A diluted sodium hypochlorite solution can help manage recurrent infections. Consult with your doctor before trying bleach baths and use only products with the correct concentration, such as Milton Sterilising Fluid.^[3]

3. Daily Skin Care

• Use – topical corticosteroids or calcineurin inhibitors for eczema areas and emollients for unaffected skin.
• Cover open wounds to prevent further infection.
• Avoid known eczema triggers.

4. Personal Hygiene Practices

• Frequent Hand Washing – Wash hands with soap and water or use an alcohol-based sanitizer.
• Regular Bathing – Daily baths or showers can reduce bacteria.
• Avoid Reusing Personal Hygiene Items – Do not reuse towels, razors, or brushes.

5. Environmental Hygiene

• Regularly clean high-touch surfaces and wash linens in hot water.
• Wash hands after touching pets. ^[2],[3]

When to See a Doctor

Seek medical attention if you notice signs of infection, such as increased redness, warmth, pus, or systemic symptoms like fever. After a detailed history and thorough examination your healthcare provider will decide on what type of infection you have, what specific treatment you need , for how long. Prompt treatment is essential to prevent complications.

Infected eczema is a complication of underlying eczema types like atopic or stasis dermatitis. Learn more about the different forms in our eczema overview.

FAQs

How can I tell if my eczema is infected?

 Infected eczema will show signs like increased redness, swelling, warmth, pus-filled blisters, and systemic symptoms like fever or swollen lymph nodes. They will be different from the usual eczema you often have.

What’s the fastest way to treat infected eczema?

Treatment duration depends on severity. Mild infections use topical antibiotics, while more severe cases may require oral or intravenous antibiotics. Consult a healthcare professional for proper diagnosis and treatment.

Can infected eczema spread to others?

Yes, infected eczema can be contagious, especially if caused by bacteria, fungi, or viruses. Avoid sharing personal items and maintain strict hygiene to prevent transmission.