What Complications Are Related to Atopic Dermatitis?

Some people with atopic dermatitis (AD) develop complications or comorbid conditions, which may include a number of different physical or psychological problems.

Infectious complications of atopic dermatitis

Because AD causes cracks and breaks in the skin, there is a greater potential for infection. Common microorganisms that cause infections in people with AD include:

• Bacteria - such as Staphylococcus aureus (commonly called “staph”) or
  Streptococcus
• Fungi - such as Malassezia (a dermatophyte) or Candida (a yeast)
• Viruses - such as warts, herpes simplex, and molluscum contagiosum (a poxvirus infection)^1-3

Treatment for infections from bacteria involves using topical and/or systemic antibiotics. Sometimes, topical corticosteroids may be discontinued for a short period of time on actively infected skin, until the infection is adequately treated. Bleach baths (a small amount of bleach diluted in a water bath) are also often used as a preventative measure to decrease the amount of bacteria on the skin. Treatment for fungal infections is an antifungal therapy targeted to the specific dermatophyte or yeast, and treatment for viral infections may include using antiviral medications, cryotherapy (the use of liquid nitrogen to freeze the infected area), or topical treatments. Proper skin care is also important to prevent future infections.^2,3

Eczema herpeticum

Herpes simplex virus (HSV) may cause a serious complication called eczema herpeticum. Herpes simplex virus is highly contagious, and direct contact with people who have active cold sores should be avoided. Eczema herpeticum can be severe, progressing to a widespread infection or even death, if left untreated. Eczema herpeticum can cause red, dome-shaped bumps or blisters that may rupture to form open sores. Affected areas often include the face, neck, and upper trunk. Eczema herpeticum may also cause fever, enlarged lymph nodes, and general malaise. Early diagnosis and treatment is important to minimize complications.^1-4

Contact dermatitis

Some people with AD also develop contact dermatitis, which can cause mild swelling of the skin, dry or cracking skin, blisters that ooze, painful ulcers, reddening, and itching. Contact dermatitis encompasses both irritant contact dermatitis and allergic contact dermatitis. Irritant contact dermatitis is a reaction that occurs when the skin comes in contact with a substance that is irritating, such as detergents, soaps, cleaners, or other chemicals.

Allergic contact dermatitis is when the skin develops an allergy to a substance that comes into contact with it. Common causes of allergic contact dermatitis include cosmetics, adhesives, or metals. A frequent contributor to contact dermatitis is nickel. Many people have an allergic reaction to nickel, which is commonly used in earrings, clothing zippers, or eyeglass frames. Allergic contact dermatitis causes reddening, blisters that ooze, itching, and swelling.^5,6

Hand dermatitis

Hand dermatitis, or hand eczema, is another skin condition that may affect people with AD. Hand dermatitis appears on the hands as redness, itching, pain, dryness, blisters, and cracks in the skin. It frequently occurs in people whose work exposes their hands to repeated exposure to water, harsh soaps, or other chemicals.^7,8

Eye problems

Eye complications that may occur in people with AD include itching around the eyelids, eye watering, inflammation of the eyelid (blepharitis), and infection (conjunctivitis).⁸

Sleep problems

The intense itch associated with AD is frequently a cause of interrupted sleep in people with AD. The repeated waking and loss of sleep is one of the most distressing impacts of AD on people living with the condition, as well as their family members.^1,8

Emotional and behavioral impact

Along with the physical effects of AD, many people living with the skin condition also experience psychological effects. Some children with AD experience teasing or bullying, with a resulting impact on their self-esteem. Children with AD may be more likely to have behavioral problems, such as inattention and hyperactivity, or poor school performance, which may be linked to the disrupted sleep caused by the itch-scratch cycle.^1,8,9