In addition to using emollients and topical steroids you may need to draw on other forms of treatment when managing atopic eczema.
Infection makes eczema worse and treatment more difficult.
What causes infection in eczema?
Bacteria, fungus and virus can cause infection in eczema.
A bacterium called Staphylococcus aureus, which thrives on weepy and broken skin, is very common in eczema. This bacterium is found on the skin of virtually everyone with atopic eczema, even when there are no signs of infection.
Infection with Staphylococcus aureus makes eczema worse, hinders healing and multiplies as the eczema becomes more severe.
Fungal infections are common in everyone, but people with eczema may be more vulnerable. Candida (‘thrush’) is a yeast infection that often develops in warm moist skin folds.
Tinea (‘ringworm’) can be found all over the body, often as isolated patches, or in-between the toes (known as ‘athlete’s foot’).
Herpes simplex, the cold sore virus, can cause severe infection (known as eczema herpeticum) in anyone with eczema due to a lower resistance to the virus.
Therefore it is advisable to avoid contact with anyone who has a cold sore.
How can I tell if my eczema is infected?
If you think your skin is infected, you should see your doctor as soon as possible so that it can be treated. Look out for the following signs:
Eczema becomes suddenly worse, with redness, itching and soreness.
- The skin is weepy with clear or yellow fluid.
- The skin has blisters, or red/yellow pus spots appear.
- You have a raised temperature, flu-like symptoms or swollen glands in the armpit, neck and groin.
Symptoms are sore and tender skin (rather than itchy). There may be small, cherry-red blisters on areas of skin, which appear very quickly.
Generally, people feel unwell and have flu-like symptoms. If you suspect eczema herpeticum, seek urgent medical treatment.
What treatments are available for infected eczema?
Bacterial infection – antibiotic cream or ointment (sometimes combined with a topical steroid), or for more widespread infection antibiotic syrup or tablets. Antiseptic emollients may also be advised.
Fungal infection – usually antifungal creams and ointments (may be combined with topical steroids).
Viral infection – antiviral tablets or, if very severe and admission to hospital is required, drugs given via a drip.
Paste bandages and Wet wraps
Special bandages and garments can be used on part or all of the body to help moisturise the skin and also to protect it from the damage caused by scratching. Bandages and garments should NEVER be used on infected skin.
Paste bandages contain emollient and other helpful things such as coal tar and calamine while wet wrapping combines a dry outer bandage and a wet inner bandage over a layer of emollient and some times a topical steroid.
Bandaging helps the skin absorb the emollient better, reduces itchiness and makes the skin more comfortable. You should ask a dermatologist or dermatology nurse to show you how to wet wrap properly and safely. We have a booklet on these therapies, please contact our Helpline if you would like a copy.
Although complementary therapies are not a cure for eczema, some people find them very helpful, especially when used in combination with conventional medicine. You should always let your doctor/nurse know if you are thinking of trying any kind of complementary therapy and must not suddenly stop using the treatment that has previously been prescribed for you.
If you want to try a complementary therapy make sure you go to a properly trained and registered practitioner (you can find these through a therapy’s governing body). Ask in advance how much the treatment is going to cost. Complementary medicine can be very expensive
Safety is also a consideration. People often think because a cream or product is labelled ‘natural’ it is safe to use. Herbal remedies can have powerful, and even dangerous, side effects. In addition, some pots of Chinese and African herbal creams have been found to contain potent topical steroids and even life threatening ingredients (e.g. arsenic).
Make sure that any cream you intend to use has an ingredients list on the pot or tube. Ask in advance how much the treatment is going to cost. The National Eczema Society fact sheet about complementary medicine can be downloaded from the related documents to the right of this page.
We still do not know enough about the role of diet in eczema. Many carers believe that their child’s eczema is caused by something in their diet but only a small number of children, generally under age 3, with eczema are helped by changes in diet and, even in those who are, they will still need to use a good skin-care routine to protect against other triggers. In other words, it is rarely diet alone that triggers eczema.
Keeping an accurate diary of what your child eats and of the condition of the eczema can be useful. Signs that food may be playing a role in a child’s eczema include worsening of the eczema, itching or abdominal pain, swelling and redness. Always consult a doctor or dietician before you make any changes, especially long term, to a child’s diet.
There is no specific diet for the treatment of eczema as the type and number of food triggers can differ a lot between children. The most common food triggers are cow’s milk and eggs, but many other foods including Soya, wheat, fish and nuts are common.
There is no 100% reliable test for identifying which foods trigger eczema. An exclusion diet is therefore the only way of finding out whether a food is a trigger or not. It involves:
Removing all sources of the suspected food or foods for two to six weeks to bring about an improvement in the eczema
Giving the child the suspected food to bring about a return (or worsening) of the eczema
- Removing the suspected food trigger to bring about the improvement in the symptoms for the second time.
Exclusion Diets should be supervised by a healthcare professional. Parents and carers should never attempt an exclusion diet on their own and it is important that the diet chosen is the right one and nutritionally correct. The National Eczema Society fact sheet about diet and eczema in children can be downloaded from the related documents to the right of this page.
Topical immunomodulators are a fairly recent development in the treatment of atopic eczema. The term immunomodulator refers to a drug that is able to modulate or alter the immune system in some way. This helps to reduce inflammation and redness.
They are not steroids and therefore do not have the concerns about potential skin thinning associated with inappropriate use or overuse of topical corticosteroid treatments. Protopic ointment and Elidel cream are both topical immunomodulators.
They are however relatively new treatments and so their long term effects are less well known and trials are ongoing to assess the long-term side effects of this new treatment.
The National Eczema Society fact sheets about both Protopic ointment and Elidel cream can be downloaded from the related documents to the right of this page if you'd like to explore these treatments further.
Treatments for more severe eczema
Other treatments for very severe eczema include Ciclosporin, Azathioprine, oral steroids and ultraviolet light treatment. The latter should not be confused with using a sun lamp which is not advisable if you have eczema.
These treatments are generally prescribed by dermatologists and in cases where the eczema does not respond to the treatments. If you want to find out more about these drugs and how they work, you will find more information in our fact sheets about Ciclosporin and Azathioprine in the related documents to the right of this page. We also have a booklet on additional treatments for more severe eczema. Please contact our Helpline if you would like a copy.
You and your doctor or nurse may need to look at environmental and other circumstances that may be triggering or aggravating the eczema. The presence of pets, the nature of your work, or aspects of your home environment, for example, can all affect eczema.