Eczema is a chronic skin condition that causes itching and other symptoms. The most common type of eczema is atopic dermatitis.

The majority of vaccines are safe for people with eczema to receive. Getting routine vaccinations can help protect you and the people around you from preventable illness.

However, some types of vaccine may pose risks to people who are taking certain medications for eczema. All people with eczema should avoid the live-attenuated smallpox vaccine.

Read on to find answers to common questions about eczema and vaccines.

Eczema doesn’t compromise your immune system. However, some people with moderate to severe eczema take medications that cause their immune system to become less active.

For example, your doctor might prescribe one or more of the following immunosuppressant medications:

  • azathioprine
  • cyclosporine
  • methotrexate
  • mycophenolate mofetil

Biologic therapies may also affect your immune system. Dupilumab (Dupixent) is currently the only biologic approved for the treatment of eczema in the United States.

The following types of vaccine are generally safe for people who are taking immunosuppressant medications or biologic therapies:

  • inactivated vaccines
  • messenger RNA (mRNA) vaccines
  • subunit, recombinant, polysaccharide, and conjugate vaccines
  • toxoid vaccines
  • viral vector vaccines

These vaccines do not contain live viruses or bacteria. They only contain dead viruses or bacteria — or small pieces of viruses or bacteria that can’t cause an infection. This includes COVID-19 vaccines, which can be mRNA or viral vector vaccines.

However, live-attenuated vaccines do contain live viruses or bacteria. They may cause infections in people who are taking immunosuppressant medication or biologic therapies. The effectiveness of a vaccine depends on the degree of immune suppression in a person.

You should talk with your doctor about specific vaccines if you’re taking immunosuppressive medications.

Examples of live-attenuated vaccines used in the United States include:

  • measles, mumps, and rubella (MMR) vaccine
  • rotavirus vaccine
  • smallpox vaccine
  • chickenpox vaccine
  • yellow fever vaccine
  • nasal spray influenza vaccine
  • oral typhoid vaccine

If you’re taking immunosuppressant medication or dupilumab, talk with your doctor before you receive a live-attenuated vaccine. Your doctor may advise you to avoid the vaccine or temporarily adjust your eczema treatment plan before you receive the vaccine.

All people with eczema should avoid the smallpox vaccine, even if they’re not taking medication that affects their immune system.

The benefits of getting an influenza vaccine, or “flu shot,” outweigh the risks for most people with eczema. Getting an annual flu shot reduces your risk of developing the flu and potentially life-threatening complications. Eczema is not a reason to avoid the flu vaccine.

Multiple types of flu vaccine are available in the United States. Only one type contains live influenza virus. It’s formulated as a nasal spray and distributed under the name Flumist Quadrivalent.

If you’re taking immunosuppressant medication or dupilumab, you should avoid Flumist Quadrivalent. Your doctor will likely encourage you to get an injectable flu shot instead.

Injectable flu shots do not contain live virus. They’re generally safe for people with eczema, including those who are taking immunosuppressant medication or dupilumab.

Some flu shots are intramuscular, which means they’re injected into a muscle. Other flu shots are intradermal, which means they’re injected under the skin.

One 2017 study found that intradermal flu shots may be less effective than intramuscular flu shot for some people with eczema.

In general, people with eczema can receive COVID-19 vaccines. This includes people who are taking immunosuppressant medication or dupilumab. None of the COVID-19 vaccines contain live virus.

Getting vaccinated against COVID-19 reduces your risk for developing COVID-19 and having serious complications.

Eczema vaccinatum (EV) is a potential complication of smallpox vaccination in people with eczema.

The live-attenuated smallpox vaccine contains vaccinia, a live poxvirus similar to smallpox, but less harmful. When people with eczema receive this vaccine, the virus can cause a widespread rash, fever, and other symptoms. This reaction can be life-threatening.

This vaccine is typically only given to people in the military and researchers who might be exposed to smallpox. People with a history of eczema should avoid the live-attenuated smallpox vaccine, according to the American Academy of Dermatology.

They should also avoid skin-to-skin contact with anyone who’s received this vaccine within the past 30 days. Accidentally transmitted cases of EV are very rare.

Most cases of eczema develop in early childhood. However, some people develop eczema later in life. The condition can potentially appear at any age.

Experts don’t know exactly what causes eczema. Complex interactions between genetic and environmental factors play a role. Some triggers might contribute, including:

  • changes in hormone levels
  • exposure to air pollution or tobacco smoke
  • certain skin infections
  • psychological stress

Getting vaccinated can help protect you from preventable and potentially life-threatening illness.

Most vaccines are safe for people with eczema. But if you’re taking immunosuppressant medication or dupilumab, you should talk with your doctor before you get any live-attenuated vaccines. Your doctor may advise you to avoid that vaccine or adjust your medication plan before you receive it.

All people with eczema should avoid the live-attenuated smallpox vaccine. It can cause a serious complication, known as eczema vaccinatum.

Talk with your doctor to learn more about the potential benefits and risks of different vaccines.