There are a number of complications associated with eczema:
Bacterial Infections
Bacterial infection is almost inevitable in atopic eczema. This may cause a flare up of symptoms and signs of eczema. Most patients with active eczema will carry Staphylococcus aureus on the skin. Sometimes yellow crusting is seen as with impetigo but more frequently the skin only shows erosions. This bacteria may cause a flare up of itching and inflammation.
Treating the colonization helps with the control of eczema. The use of Bactroban cream in the nose and perineum at night for 5-7 days will suppress staph carriage for some time. If involvement of the skin is localized topical antibiotics such as Mupirocin (Bactroban) or Fucidic acid (Fucidin) are useful. Systemic antibiotics are best if there is extensive skin involvement.
See also: Bacterial Infections
Viral Infections – Herpes Simplex
Infection with herpes simplex in atopic dermatitis is called Kaposi’s varicelliform or eruption of eczema herpeticum. This occurs when there is active atopic dermatitis. There is a sudden outbreak of small pustules and vesicles. They frequently erupt. There is often secondary crusting. There are hemorrhagic areas that become eroded and painful. There are punched out ulcers that are quite distinctive. At times this outbreak can be very localized although it may spread to involve the whole face, chest or arms. Very occasionally it can become generalized. Secondary staphylococcus is very common. When this is extensive it can be potentially life threatening.
Treatment:
Treatment of this involves discontinuation of topical steroids. Tepid water compresses on the affected area can be helpful. Treating the secondary staphylococcus infection with antibiotics such as cloxacillin is vital. The use of oral anti-viral medications such as Acyclovir and Famciclovir or Valacyclovir is also beneficial.
See also: Herpes
Molluscum Contagiosum
This is a pox virus infection. It is much more common in eczema and is often more extensive that in non-atopics. Cryotherapy with liquid nitrogen is preferred treatment by some.
Warts
Warts are more common in people that have eczema.
See also Warts
Fungal Infections
Fungal infections are also common in patients that have eczema.
Allergy to Topical Treatments Including:
- Medication
- Topical steroid creams
- Perfumes
- Preservative
Alternative Therapy Complications:
The risk of hepatotoxicity is documented. There is a case reported of a dilated cardiomyopathy with this.
