Infected atopic eczema looks red and angry, and is usually ‘weepy’ with a yellowish crust. Yellow pus-filled spots may also be present and small red spots around the body hairs (folliculitis). The skin feels hot, itchy and sore, which leads to more scratching. Scratching damages the outer layers of the skin and creates cracks allowing more bacteria to grow.
Occasionally the glands may swell and there may be an enlargement of lymph nodes in the neck, groin and armpits. Lymph nodes filter out bacteria and stop them from entering the bloodstream. Swollen lymph nodes can be tender to the touch. Infection should always be suspected if the eczema suddenly worsens or does not respond to emollient or topical steroid treatment.
Candida appears red, itchy and sore and there may also be tiny yellow pustules.
Eczema herpeticum produces small blisters, containing clear fluid or yellow pus, which break open and ulcerate the skin. Mild attacks are fairly common but in more serious cases, the virus spreads quickly on first infection. A high temperature and a general feeling of being unwell usually accompany it.
This form of eczema herpeticum is very dangerous and it is essential to contact a doctor immediately and to ask him or her if the symptoms could be eczema herpeticum.
Diagnosing Infection
Dermatologists, dermatology nurses and general practitioners with a special interest in dermatology may be able to tell if eczema is infected just by looking at it. Patients who have already experienced infection are also likely to recognize the signs and symptoms.
However, it is not always clear if eczema is infected, which can make diagnosis difficult. 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 to confirm what is causing the infection and can also show what antibiotics should be effective as treatment. Skin swabs frequently show the presence of Staph. aureus on the skin, but may also reveal additional bacteria called streptococci.
Treating Infected Eczema
Treatment depends upon the type of infection. Staph. aureus can be treated in several ways. For mild infections emollients and topical steroids, together with a bath oil containing an antiseptic may be sufficient. Sometimes a combination cream or ointment may be prescribed.
Combination creams and ointments contain both a topical steroid to help combat inflammation and an antibiotic to fight the infection. If the eczema is heavily infected, oral antibiotics may be prescribed that help to quickly bring the infection under control, but it is important to continue to use emollients to help restore the skin barrier.
Antiviral drugs such as acyclovir are used to treat eczema herpeticum orally, by injection or in the form of a cream or ointment. If the eczema herpeticum is severe, a few days in the hospital may be needed to get the infection under control.
Candida is usually treated with an antifungal cream that can be prescribed by your doctor or dermatology nurse or bought over the counter from a pharmacist.
Using a medicated shampoo or an anti-yeast shampoo can treat Pityrosporum ovale on the scalp but will depend on the severity of the eczema. These shampoos are available from pharmacies. Several antifungal creams, with or without a mild steroid, are available to treat seborrheic eczema on other parts of the body.
There is no specific medicine to clear molluscum contagiosm. It is up to the body’s own immune system to get rid of the infection and unfortunately this can take months.
Infection and Your Other Treatments
Eczema patients who are using the topical immunomodulators Protopic and Elidel should not continue to use them if their eczema becomes infected. Speak to your doctor if you are using these products and suspect that your eczema may be infected.
Never use wet wrap bandages with infected eczema, as the moist, warm environment created by wet wraps is a perfect breeding ground for bacteria.
If your eczema is infected and you normally use emollient ointments, it may be worth asking your doctor to consider prescribing in addition an emollient cream to use some or all of the time while the infection persists. This is because in some people the ointment – which is occlusive – can also ‘trap in’ the infection.
Whatever emollients you are using, remember that it is easy to spread infection – both on your own skin and your child’s skin – and also to pass it from one person to another.
Pump dispensers reduce the risk, as does good hand hygiene before and after putting on emollients. If you do not have a pump dispenser, use a clean spoon to take the emollient out of the pot, rather than using your fingers.
Prevention of Infection in Eczema
Restoring the skin’s barrier to infection, be reducing dryness and cracking will help to reduce the entry points for bacteria. Intensive emollient therapy, with moisturizing creams and ointments, soap substitutes and emollient bath oils are essential. Daily baths and showers can help to prevent infection.
If someone in the family has a cold sore, it is important to refrain from sharing towels and face cloths. Ensure that you change bed linen regularly and wash it in a hot wash.
Even if you take preventative measures it is not always possible to stop eczema becoming infected. However, by treating with the most appropriate medication, the infection can be cleared and the eczema can be kept under control.
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