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One of the common reasons for eczema to become more severe is a bacterial infection. A bacterium called Staphylococcus aureus is the main culprit, although other kinds of infection are not unknown. Staph. aureus is present on the skin of people with eczema (even when the skin is not particularly inflamed) in much greater concentration than it is found on skin without eczema.
A minority of people with eczema suffer from frequent relapses. Their complaint responds well to antibiotic treatment, but gets worse when the antibiotics are stopped. In many of these people, Staph aureus works to 'switch on' the eczema.
A number of measures can be taken to reduce the levels of Staph aureus on the skin. The most important of these is a good skincare programme. Medicated bath additives and moisturisers containing antiseptics are available for sensitive skin. There is also a range of combined steroid/antibiotic preparations, such as Fucidin H or Fucibet, which address the infection as well as the eczema.
In some people, Staph aureus infection occurs again and again because the person is being reinfected via their nose. A doctor can check if this is the case by taking a nasal swab, and it can be treated with a course of nasal antibiotics such as Bactroban or Naseptin. Sometimes, long courses of antibiotics are necessary for people whose eczema keeps getting reinfected. Unfortunately, if antibiotics are taken for too long, the bacteria may develop a resistance to the treatment.
As well as bacterial infection, other substances can cause eczema to become worse. House dust mites, pollen from flowers and plants and animals all can aggravate the condition of eczema in some people. Other illnesses, such as viral infections, especially herpes, can make the eczema worse as well. Certain substances that come in contact with the skin can aggravate eczema too. These are generally chemicals and cleaning fluids.
It is vital for people with eczema to maintain a good skincare programme. Research has shown that less steroids are needed by those people who moisturise their eczema most frequently. Each skincare programme, or regimen, is individually designed for each patient. The general principle involves bathing instead of showering as much as possible. When the eczema is flaring up, two baths a day might be advisable. People with eczema should avoid regular soap and instead use a substitute, usually a cream that moisturises as well as cleans. (See Moisturising the skin)
Frequent baths reduce the numbers of bacteria on the skin, and remove the dead skin and crust, allowing steroids to get to the skin beneath. Baths are also useful for reducing the level of itching and improving the natural moisture in the skin.
Eczema herpeticum This occurs as a result of the eczema being infected with the herpes simplex virus, the virus that produces cold sores. It is important to avoid skin contact with anyone who has cold sores.
Normally, herpes simplex will be confined to cold sores around the mouth and is a routine condition. However, in a person with eczema the virus can appear anywhere on the skin. In rare cases, it can prove fatal.Eczema herpeticum appears in small clusters and looks like blisters or ulcers. These are initially filled with a clear fluid but this turns to pus. The blisters are scratched and become raw and weepy.
If your eczema becomes worse for no apparent reason or you see blisters on the surface, medical advice is required. With eczema herpeticum the sufferer may have a high temperature and feel very unwell. Be sure to explain all your symptoms to your doctor because this is not a straightforward condition to diagnose.
Sometimes hospital treatment may be required. This type of infected eczema is usually treated with an anti-viral drug acyclovir, which is given by injection or by mouth or as an ointment.
Dr. Rosemary Coleman MD, FRCPI, Consultant Dermatologist
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