Complications

Bacterial infection
My son’s eczema became much worse and wasn’t
improving with the creams. The GP said it was infected
and gave him a course of antibiotics. What caused this
infection, and can it be dangerous?
We all have micro-organisms on our skin called Staphylococcus
aureus. In eczematous skin, the barrier function is not working
effectively, and micro-organisms that come into contact with the
skin are more likely to initiate an inflammatory response. It is
thought that there are more Staphylococcus organisms on
eczematous skin, and this can lead to clinical infection.
A bacterial infection on the skin generally has a localised effect,
seen as redness, weeping, crusting and odour. If extensive areas
are affected, this can lead to symptoms of general malaise and fever
arising from a toxic reaction to the chemicals released as part of
the process of fighting the infection in the skin. There is evidence
that a toxin produced by Staphylococcus aureus can cause a flare
of eczema elsewhere on the skin so it is often treated with
antibiotics by mouth to try to prevent this. If you or your son
recognises that there is an infection present and seeks treatment
from your GP, you should find that it settles quickly with no danger
to your son.
My daughter’s eczema is raw and weepy. Does this mean
that it is infected?
Not necessarily. An acute eczema does present as inflamed weeping
skin, which can be made worse by scratching and can then become
infected. The more chronic, or long term, an area of eczema
becomes, the more likely it is to be dry and thickened. If your
daughter had chronic eczema that suddenly became wet and weepy,
it would be quite likely that an infection had triggered this change.
Signs of clinical infection are pain, swelling, odour and pus. As
previously mentioned, eczematous skin may harbour the bacterium
Staphylococcus aureus; if the skin appears to be infected, a swab
can be taken to identify the bacteria responsible and the antibiotics
that will work.When I saw the specialist recently, she took swabs from
my nose and skin. Later, she wrote to say I had an
infection and gave me some nose cream. Why treat the
nose for a skin infection?
Bacteria that can cause infection on the skin can sometimes be
harboured in the nose. If we see people who have been troubled
with recurrent flares and infections of the skin, we will often carry
out a nose swab to see whether they are a carrier of Staphylococcus
aureus. As in your case, a positive swab can be treated effectively
with a nasal ointment called mupirocin (Bactroban). This will
reduce the bacterial count and prevent further infective flares. It
seems that bacteria living inside the nose often survive despite
courses of antibiotics given by mouth so this extra treatment is
necessary to help to prevent a recurrence. In difficult cases, we
often ask for similar swabs to be taken from other people living
with you in case they are harbouring the bacteria. Like you, they
will not have any signs of infection in the nose – we call this
‘carriage’ as the bacteria are just being carried inside the nose
without causing local infection.I have quite widespread eczema that has been good
recently, but I have developed what looks like a shaving
rash on my legs! Can I still apply my creams?
It sounds as though you are doing your best to treat your eczema
and keep your skin in good condition with moisturisers. In eczema
management, we use very greasy moisturisers as these help to
manage the dryness of the skin, but they can cause the small hair
follicles on the skin’s surface to become blocked. Once the follicles
are blocked, folliculitis (an inflammation of the hair follicle) can
develop, which tends to look like a shaving rash. This can
commonly be seen after using paste bandages or when the weather
has been hot and sticky. You can still use creams to treat the
eczema, but it would be helpful to follow the guidance below to
avoid further bouts of folliculitis:
• Use a lighter, cream-based moisturiser (see Table 2 in
Chapter 4).
• Smooth the moisturiser on to the skin in a wiping action,
following the same direction that the hairs grow (i.e. like
stroking a cat). There is no need to massage or rub cream
into the skin as this just pushes the cream up into the hair
follicle.
• If a topical steroid is being used, it should be in a cream
rather than an ointment base.
• It might be useful to leave bandaging off until the problem
has settled.
If the areas of folliculitis become more widespread, inflamed
and painful, they may have become infected. Seek advice from your
doctor if this happens as oral antibiotics are sometimes needed.