Eczema (Atopic Dermatitis) Complications

Skin infections

Eczema raises your risk of skin infections, including certain types of:

• bacterial infections
• viral infections
• fungal infections

If you develop a skin infection, it may cause uncomfortable symptoms and make your eczema worse. In rare cases, the skin infection may spread to other tissues and organs and cause severe complications.

To lower your risk of skin infections:

• Wash your hands regularly.
• Bathe and shower regularly.
• Clean and cover cuts or other wounds.
• Avoid close contact with people who have symptoms of active skin infections.
• Avoid sharing personal hygiene products, such as washcloths, towels, and razors.

Using lukewarm rather than hot water, a gentle soap or cleanser, and moisturizer can help limit dry skin. This may help prevent cracks in your skin, where infectious microbes could enter.

Below, we describe a few types of infections that are more common than average in people with eczema.

Staph infection

The bacteria Staphylococcus aureus is the most common cause of skin infections in people with eczema, reports the International Eczema Council Skin Infection Group.

This type of bacteria lives on the skin of most people with atopic dermatitis. It can cause symptoms of a staph infection, although some people never develop symptoms.

Common symptoms of a staph infection include:

• swollen skin
• warm or hot skin
• oozing or crusting

Sometimes, staph infections also cause pustules or pus-filled abscesses to form.

If you develop a staph infection, your doctor may prescribe antibiotics to treat it.

Eczema herpeticum

The herpes simplex virus 1 (HSV-1) typically causes oral herpes or cold sores around or inside your mouth.

But sometimes, the virus can spread across wide areas of skin and cause an infection known as eczema herpeticum. People with atopic dermatitis have an increased risk of this infection.

Eczema herpeticum causes clusters of small, itchy and painful blisters across wide areas of skin. It may also affect your eyes, which can cause vision loss if left untreated.

In rare cases, eczema herpeticum may spread to other organs and cause potentially life threatening complications.

To lower your risk of contracting HSV-1, avoid kissing or receiving oral sex from anyone who has an active cold sore. You should also avoid sharing objects that have touched their mouth.

If you develop eczema herpeticum, your doctor will prescribe antiviral medication to treat it.

Eczema vaccinatum

If you have eczema, getting the traditional smallpox vaccine can cause an infection known as eczema vaccinatum.

The traditional smallpox vaccine contains live vaccinia virus, which is related to the smallpox virus. This vaccine is generally safe for most people but not those with eczema.

Eczema vaccinatum develops when the vaccinia virus spreads throughout your body.

Potential symptoms include:

• open skin sores
• high fever
• body aches
• pale, clammy skin
• feeling generally unwell

To prevent eczema vaccinatum, your doctor will advise you to avoid getting the traditional smallpox vaccine. Members of your immediate family or household should also avoid this vaccine. If they receive it, they could potentially transfer the live vaccinia virus to you.

If a national smallpox outbreak occurs, you might be eligible to receive an alternative form of smallpox vaccine that doesn’t contain the live vaccinia virus. According to the National Eczema Association (NEA), the U.S. government has stockpiled 20 million doses of alternative vaccines for people who can’t receive the traditional vaccine.

If you develop eczema vaccinatum, your doctor will prescribe antiviral medication to treat it.

Fungal skin infections

Fungal or yeast infections can potentially worsen skin inflammation in people with eczema. This may cause eczema symptoms to get worse.

Examples include Malassezia and Candida albicans yeast infections. These types of yeast are commonly found on skin, but they can cause an infection if they multiply to high numbers.

If you develop a yeast infection, your doctor will prescribe antifungal medication to treat it.

Signs that your eczema is infected

Potential signs and symptoms of infected skin include:

• skin discoloration, which may look pink, red, purple, brown, or black
• scaly, crusty, or oozing lesions or sores
• rash, blisters, or pustules
• pain or tenderness
• itchiness
• swelling
• warmth

Eczema can cause similar symptoms, so it may be challenging to tell whether you have symptoms of a skin infection, an eczema flare, or both.

If you develop new or worse skin symptoms, let your doctor know. They’ll examine your skin and may collect a sample of tissue or fluid from the affected area for testing. Your recommended treatment will depend on the specific cause of your symptoms.

In severe cases, skin infections may spread to other parts of your body and become systemic. This may cause symptoms such as fever, chills, and a general feeling of unwellness. Systemic infections may cause life threatening complications and require immediate treatment.

Asthma and allergies 

If you have eczema, you have increased risk of:

• asthma
• allergic rhinitis
• food allergy

These allergic conditions aren’t complications of eczema, but they’re comorbidities that occur more often than average in people with eczema. Some of the same genetic, environmental, or immune factors may contribute to the development of both eczema and these allergic conditions.

Asthma causes wheezing and other breathing difficulties, which may be triggered by:

• exercise
• mold
• dust mites
• cockroaches
• pet dander
• air pollution
• disinfectants
• respiratory infections

Allergic rhinitis is also known as hay fever, which causes reactions to environmental allergens such as pollen and dust mites. Common symptoms include:

• itchy nose, mouth, eyes, or skin
• stuffy or runny nose
• sneezing
• watery eyes

Food allergy causes allergic reactions to certain types of food. These reactions can cause a wide variety of symptoms, which vary from mild to potentially life threatening.

If you develop an allergic condition, your doctor will advise you to avoid triggers or allergens that cause a reaction. Triggers or allergens vary from one person to another.

Your doctor may also prescribe asthma or allergy medication or other treatments.

Mental health 

Symptoms of eczema or the challenges of managing this condition may negatively affect your:

• stress levels
• sleep quality
• attention or concentration
• body image or self-esteem

People with eczema also have an increased risk of anxiety and depression.

Stress and other mental health challenges may in turn trigger a flare in eczema symptoms.

If you’re experiencing high levels of stress or other mental health challenges, consider talking with your doctor. They may recommend a combination of the following:

• lifestyle changes, including changes to limit or relieve stress
• counseling with a mental health professional
• antidepressants or other medication

They might also recommend changes to your eczema treatment plan to help reduce symptoms and limit the impacts on your quality of life.

The takeaway

If you have eczema, following your recommended treatment and practicing good hygiene and skin care are important for protecting your skin and reducing your risk of complications such as skin infections.

Some people with eczema also develop comorbidities, such as asthma or allergies.

Eczema-related challenges may also contribute to stress or other mental health challenges.

Let your doctor know if you develop changes in your skin symptoms or overall health. They can help you identify the cause and recommend appropriate treatment.