Managing Infections with Atopic Dermatitis

Reviewed by: HU Medical Review Board | June 2017 | Last updated: September 2023

An infection is caused by the invasion of a microorganism, which may be bacteria, virus, or fungi. Infections can trigger and aggravate atopic dermatitis (eczema). Due to the dysfunction in the immune system and damage to the skin barrier caused by atopic dermatitis, people living with the condition are at a higher risk of developing infections.1

Bacterial infections

Staphylococcus aureus, commonly known as “staph,” is a bacterium commonly found on the skin of people with atopic dermatitis. Over 90% of atopic dermatitis skin lesions are found to have staph, compared to 5% on the skin of healthy people.

Staph infections

In normal skin, the skin barrier and the skin's pH level keep the numbers of staph low. Still, in people with atopic dermatitis, the skin barrier is damaged, the pH level is altered. There may be a reduced immune response to defend against bacteria. This allows the bacteria to multiply. In addition, atopic dermatitis lesions seem to provide a better surface for the attachment of staph due to the inflammation and cracks in the skin. The large number of staph produces toxins that stimulate the immune system and worsen the condition.1,2

Treating bacterial infections

Research has shown that using a combination of topical corticosteroids with an antibiotic is a significantly more effective treatment for reducing the skin inflammation of atopic dermatitis compared to just topical antibiotic or topical corticosteroid alone. Another important part of treatment is proper skin care, as the skin barrier needs to be restored to prevent additional outbreaks of staph bacteria. Due to the increased risk of bacteria becoming resistant that may occur with frequent use of antibiotics, it’s important to combine medical treatment with effective skincare and avoiding other triggers, like irritants, food allergies, or emotional stress.2 In addition to topical treatments, oral antibiotics may also be used to treat staph infections of the skin during flares of atopic dermatitis.

Bleach baths

For people with moderate to severe atopic dermatitis who have repeated skin infections, the addition of bleach to the bath can help decrease the number of bacteria on the skin’s surface and reduce the chance of infections. Bleach baths involve adding 2 teaspoons of bleach per gallon of water. Clinical studies have proven that bleach baths can reduce the bacteria found on the skin's surface and reduce infections.3

Viral infections

Due to the dysfunction in the immune system, people with atopic dermatitis are at an increased risk of serious viral infections of the skin, including herpes simplex, warts, and molluscum contagiosum (a poxvirus infection).

Herpes and smallpox

Herpes simplex virus infection is fairly common, and because it is contagious, direct contact with someone who has active cold sores should be avoided. Vaccination for smallpox can cause severe widespread skin rash, called eczema vaccinatum. People with atopic dermatitis should avoid getting the smallpox vaccination unless there is an imminent danger of smallpox exposure. Because of the skin barrier damage, these viruses have the potential to spread and may become life-threatening.

Treating viral infections

Treatment is customized to the type of virus and may include antiviral medications, cryotherapy (the use of extreme cold to freeze the infected area), or topical treatment.1,2,4

Fungal infections

Two types of fungus are common triggers of atopic dermatitis: yeasts and dermatophytes. The dermatophytes most commonly seen in people with atopic dermatitis are Malassezia furfur, Trichophyton, and Epidermophyton. Malassezia furfur is most often seen in the seborrheic (oily) areas of the skin, including the scalp, face, neck, and upper part of the chest. The yeasts most commonly seen in people with atopic dermatitis include Candida and Pityrosporum ovale. People with fungal infections benefit from treatment with an antifungal therapy targeted to their specific dermatophyte or yeast.1,2

Other infections

Recent research suggests that people with atopic dermatitis may also be at greater risk for developing other infections, including strep throat, pneumonia, and ear infections. It is believed that the dysfunction in the immune system, which is a known contributor to the development of atopic dermatitis, may also increase a person’s risk of other infections.5

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