We all know that eczema is not infectious – one of the UK National Eczema Society’s messages for very many years. Damaged skin is vulnerable to infection, however, and infected eczema is one of the most common issues raised with the UK National Eczema Society’s helpline. In this article our information team looks at why this might be and what we can do about it.
Broken skin provides an environment where micro-organisms can flourish. As a result, skin infections are not uncommon. Infections may be bacterial, fungal or viral.
Bacterial Infection
Atopic eczema is most often infected by a bacterium called Staphylococcus aureus, which makes the eczema worse and slower to heal. Staph. aureus is found on the skin in less than 10% of healthy individuals.
By contrast, almost everyone who has atopic eczema will have Staph. aureus on their skin somewhere, even thought their skin may not show signs of infection. It is not clear whether the bacteria migrate from the active eczema to areas of skin without eczema or whether people with atopic eczema are simply more susceptible to Staph. aureus colonization than those without eczema.
Colonization is not normally a problem unless the skin is broken. Infection occurs only when the bacteria penetrates the skin’s barrier.
It is likely that people with atopic eczema have an impaired ability to deal with infection. In addition, as we know all too well from practical experience, eczema itches and the natural responses to itch is to scratch. This in turn causes the skin to crack and split and become red and inflamed, warm and moist – a perfect home for bacteria.
This is made worse by the itch-scratch-itch cycle and the vicious cycle that follows. It is also possible that the dry skin of atopic eczema is deficient in certain fatty acids, which may encourage the growth of bacteria.
Viral Infection
The major virus that causes problems in people with eczema is the herpes simplex or cold sore virus. Many people who do not have eczema catch herpes simplex in childhood. It is usually very mild, causing a few mouth or gum ulcers that may not even be noticed.
Our bodies become immune after a first infection by herpes simplex – you tend not to catch it from anyone a second time. However, your own initial virus can become active again causing small, itchy blisters that quickly form a cold sore. This is how herpes simplex usually affects people who do not have eczema.
Herpes simplex is highly contagious and can appear as genital inflammation or conjunctivitis as well as cold sores. For people with eczema, the herpes simplex virus can be much more serious, probably because they have a lowered resistance to viruses. People with eczema should avoid skin-to-skin contact with anyone who has herpes simplex as this virus can infect eczema, giving rise to a condition called eczema herpeticum, which can cause serious illness.
Many children get molluscum contagiosum, but it may be slightly more common in atopic eczema sufferers. Molluscum contagiosum appears as small, smooth, red or flesh-colored bumps, each with a tiny dimple in the center. They often develop on eczema-prone areas such as skin folds behind the knees.
The condition often becomes red and crusted when the body’s immune system is starting to fight against it. This can look alarming, especially if surrounded by eczema, but is in fact a good sign and means that the molluscum contagiosum will clear up soon.
Fungal Infection
Candida or ‘thrush’ is a yeast or ‘fungal’ infection that may develop on skin with eczema, but can also appear on the skin of people without eczema. Candida likes warm, moist folds of skin such as the groin, under the arms and breasts or around the diaper area in babies.
Pityrosporum ovale is also a fungal infection, from the yeast pityrosporum, and can be found on the skin of people with seborrheic eczema. It likes to live where a lot of sebum (the body’s natural grease) is produced – for example, scalp, chest, ear folds and groin. Pityrosporum ovale may well be responsible for seborrheic eczema developing in many people.
Broken skin provides an environment where micro-organisms can flourish. As a result, skin infections are not uncommon. Infections may be bacterial, fungal or viral.
Bacterial Infection
Atopic eczema is most often infected by a bacterium called Staphylococcus aureus, which makes the eczema worse and slower to heal. Staph. aureus is found on the skin in less than 10% of healthy individuals.
By contrast, almost everyone who has atopic eczema will have Staph. aureus on their skin somewhere, even thought their skin may not show signs of infection. It is not clear whether the bacteria migrate from the active eczema to areas of skin without eczema or whether people with atopic eczema are simply more susceptible to Staph. aureus colonization than those without eczema.
Colonization is not normally a problem unless the skin is broken. Infection occurs only when the bacteria penetrates the skin’s barrier.
It is likely that people with atopic eczema have an impaired ability to deal with infection. In addition, as we know all too well from practical experience, eczema itches and the natural responses to itch is to scratch. This in turn causes the skin to crack and split and become red and inflamed, warm and moist – a perfect home for bacteria.
This is made worse by the itch-scratch-itch cycle and the vicious cycle that follows. It is also possible that the dry skin of atopic eczema is deficient in certain fatty acids, which may encourage the growth of bacteria.
Viral Infection
The major virus that causes problems in people with eczema is the herpes simplex or cold sore virus. Many people who do not have eczema catch herpes simplex in childhood. It is usually very mild, causing a few mouth or gum ulcers that may not even be noticed.
Our bodies become immune after a first infection by herpes simplex – you tend not to catch it from anyone a second time. However, your own initial virus can become active again causing small, itchy blisters that quickly form a cold sore. This is how herpes simplex usually affects people who do not have eczema.
Herpes simplex is highly contagious and can appear as genital inflammation or conjunctivitis as well as cold sores. For people with eczema, the herpes simplex virus can be much more serious, probably because they have a lowered resistance to viruses. People with eczema should avoid skin-to-skin contact with anyone who has herpes simplex as this virus can infect eczema, giving rise to a condition called eczema herpeticum, which can cause serious illness.
Many children get molluscum contagiosum, but it may be slightly more common in atopic eczema sufferers. Molluscum contagiosum appears as small, smooth, red or flesh-colored bumps, each with a tiny dimple in the center. They often develop on eczema-prone areas such as skin folds behind the knees.
The condition often becomes red and crusted when the body’s immune system is starting to fight against it. This can look alarming, especially if surrounded by eczema, but is in fact a good sign and means that the molluscum contagiosum will clear up soon.
Fungal Infection
Candida or ‘thrush’ is a yeast or ‘fungal’ infection that may develop on skin with eczema, but can also appear on the skin of people without eczema. Candida likes warm, moist folds of skin such as the groin, under the arms and breasts or around the diaper area in babies.
Pityrosporum ovale is also a fungal infection, from the yeast pityrosporum, and can be found on the skin of people with seborrheic eczema. It likes to live where a lot of sebum (the body’s natural grease) is produced – for example, scalp, chest, ear folds and groin. Pityrosporum ovale may well be responsible for seborrheic eczema developing in many people.
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