Eczema

When eczema becomes infected, antibiotics and anti-fungal treatments

Infected eczema was something that a lot of young people had experienced. Eczema itself is not infectious or contagious (it cannot be spread to another person), but it can become infected if germs set in. A skin infection can then be contagious for other people, as is the case with impetigo (a common infection which comes in two forms – bullous and non-bullous). Infections can be difficult to avoid because eczema makes the barrier function of the skin less effective (see more in ‘What causes eczema?’). Scratching damages the skin which makes it easier for bacteria, viruses or fungi to take hold. Cutting nails short is one way to limit likely injuries to the skin from scratching.
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Cleanliness was stressed as important for avoiding infections. Anissa says you should have clean hands when applying emollients and steroid creams. She adds that putting make-up on top broken skin risks infection. Katie-Lauren heard that you can limit spreading an infection like folliculitis by moisturising downwards on the skin (rather than upwards, which might more easily block or damage the hair follicles). Shams also talked about clean clothes.

However, it’s not possible or practical to avoid all germs. Laura is very aware of how often she uses her hands and that she picks up germs when using public transport. At the same time, many found washing their hands often and using some kinds of soaps irritated their eczema. Abid says you shouldn’t let worry about infections stop you from doing things you want to and that it’s not helpful to be “overly cautious”. A few had heard about the ‘hygiene hypothesis’ which suggests that a lack of exposure to germs in childhood could be a factor in developing eczema (see also causes).

There are different kinds of infections that can develop with eczema. Not everyone knew the names of the infections they had developed, but some included: impetigo, eczema herpeticum (an infection of the eczema with herpes/cold sore virus) folliculitis (an infection of the hair follicles), cellulitis (an infection of the deeper layers of the skin). Vicky, Hazel and Sarah also had chickenpox when they were younger which combined with their eczema to make it more severe.
Symptoms of infected eczema

Some people found it difficult working out if their eczema was infected at first. Jessica’s vulval eczema symptoms were so bad that she says she wouldn’t know if it had become infected. Others had symptoms that were very different to their normal eczema and so they knew there was a problem. Some symptoms and signs of infected eczema include:
  • inflamed skin (swollen, hot, red)
  • blistered skin, ‘boils’ and cysts
  • pus/weepy fluid (often yellow or green) coming out of the skin and crusts or scabs
  • painful skin – “like you’ve got cuts everywhere”
  • high temperature (fever)
  • feeling unwell and tired
  • becoming confused and forgetful
Infections can develop in/on eczema anywhere on the body. Aisha remembers getting infected eczema on her scalp, which was difficult to treat with creams and ointments. The eczema on George’s leg became very cracked and infected.
Getting medical help and treating infected eczema

Because it’s not always obvious if eczema is infected, it’s important to get help from medical professionals. Some infections, such as eczema herpeticum (a viral infection), are serious and need medical attention right away. Naomi says she doesn’t like going to the GPs but accepts that she must for infections. Anissa feels like doctors only take her eczema seriously when it becomes infected. Diagnosing an infection is not always straightforward.
Eczema can become so infected that the person has to go to hospital and stay over for treatment, as was the case for Himesh, Vicky and Georgia. This can be very upsetting, especially for young children, and mean missing weeks of school. Himesh says getting an infection can feel like a “waste” of all the effort put into controlling eczema.
Some kinds of skin infections can be treated with antibiotics (in the form of tablets, creams, injections or IV drips). Other kinds of skin infections are fungal (such as ring worm) and are treated with antifungal creams or tablets. Most people had been prescribed antibiotic tablets by their GPs which cleared up the infections. Maham says it took about a week for infected eczema on her face to heal with antibiotics.
If the infection of the eczema is contagious, the person will usually be kept away from others for a few days to avoid passing it on. This was the case for Himesh who had to stay in a special room on his own whilst he was in hospital for impetigo. 

There were some concerns and downsides to antibiotics taken for skin infections. Katie-Lauren had heard “loads of warnings about using antibiotics” and was worried that they might not work when she really needed them. However, she said that she trusts her doctor to know what’s best and will take antibiotics when prescribed them.
Some people had scars from their eczema having become infected. Vicky, Sarah and Hazel had scars from when they had chickenpox in combination with eczema. For more on scars and lasting marks from eczema, also see the section in Eczema symptoms: what does eczema look and like?.
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