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Atopic Eczema and Infections

Infections are usually caused by bacteria and viruses. They may upset your child's eczema in different ways. Bacterial and viral infections of the skin are treated differently. This short handout will tell you more about the sorts of infections that can occur in eczema and what you can do about them.

General Infections (chicken pox, flu, measles etc)

Although some children's eczema appears to get worse after a viral infection, many others appear to improve. At the moment, there is no good evidence to suggest that any particular infection will make your child's eczema worse or better, and the flare ups and clear periods after infections are probably due to the variable nature of the condition. Similarly, there is no evidence that any of the common childhood vaccinations will make eczema worse and these should not be withheld from your child.

Secondary Infections.

This refers to infections of areas of the skin involved by eczema. A normal, healthy skin is important to defend our bodies from external bacteria and viruses. Two types of secondary infection are important in eczema:

1 Bacterial. The commonest secondary bacterial infection in eczema is due to Staph aureus. This affects eczema by irritating the skin and also indirectly through upsetting the immune system. Even when your child's eczema is clear, Staph aureus is often found on the normal looking skin. This is because Staph aureus likes dry skin. Occasionally, secondary infection may be due to other bacteria called streptococci - this is why your doctor will sometimes take a swab from your child's skin to see whether this organism is also present.

What does secondary bacterial infection in atopic eczema look like?
When the skin becomes secondarily infected with bacteria the eczema becomes very red, it may weep a lot and produce golden, dry crusts. Occasionally, you may see small blisters filled with yellowish white cloudy pus. Staph aureus is one of the commonest aggravating factors for eczema in young children and it is helpful if you learn to recognise the above features and act early to prevent worsening of your child's condition.

What should I do about secondary bacterial infection if I think it is present?
You should go to your doctor as early as possible. Your doctor will probably prescribe oral antibiotics for your child to take for 10-14 days. If your child is not allergic to penicillin, your doctor will usually prescribe flucloxacillin as Staph aureus is treated by this type of penicillin. If your child is allergic to penicillin, then erythromycin is usually tried instead. For milder cases of infection, your doctor may prescribe an antibiotic ointment such as Fucidin ointment or Mupirocin ointment and this may be effective if applied regularly to the skin for 7 days.

What can I do to prevent my child's eczema from becoming infected in the future?
The most important thing is to not allow your child's skin to dry out. Dry skin creates a good home for Staph aureus. Regular use (i.e. 2-3 times per day) of an emollient such as white soft paraffin mixture or aqueous cream may help to discourage infection by Staph aureus. If your child has frequent episodes of infected eczema, then using a topical corticosteroid with an added antibiotic or antiseptic agent may also be useful. You should discuss this further with your doctor.

2 Viral. Occasionally, the cold sore virus (herpes simplex) can spread quite rapidly on a patch of eczema. Usually, this occurs on the face. In the early stages, you will see lots of small blisters filled with clear fluid surrounded by a bright red halo on the surface of the skin. Within 1-2 days, these blisters break quickly to leave lots of small round breaks in the skin surface. The area may become very sore, and your child may feel generally unwell. If you think that this problem is occurring in your child, then you should go and see your doctor as soon as possible. If the problem is due to herpes simplex virus, then the condition is easily treated by a 5 day course of a drug called acyclovir. Secondary infection with herpes simplex virus is far less common than secondary infection with Staph aureus. If you have a cold sore, you should avoid kissing your child.

3 Chicken pox (herpes zoster) and oral steroids.
If your child has recently (within one month) had steroids by mouth for his/her asthma and has come into contact with chicken pox or has already developed chicken pox, please see your GP at once. This is because some additional protection can be given to prevent the chicken pox from becoming severe.

Summary

1 Secondary infection by bacteria called Staph aureus is one of the commonest reasons why eczema can flare in childhood.

2 Infected eczema appears very red and it may weep clear fluid and occasionally form yellow pus spots.

3 If you think your child's eczema is infected, then see your doctor who will normally prescribe a course of flucloxacillin medicine or an antibiotic ointment.

4 Regular use of a moisturiser may discourage further infections by Staph aureus.

5 Occasionally the cold sore virus (herpes simplex) can spread on a patch of eczema. If you think this has happened, see your doctor as soon as possible so that he/she can confirm the diagnosis and prescribe a 5 day course of acyclovir tablets.

6 If your child develops chicken pox within one month of taking steroids by mouth, see your GP as soon as possible for a course of acyclovir.

© Professor Hywel C Williams, Sister Sandra Lawton Staff Nurse Sue Newham Queen's Medical Centre, Nottingham, 1995