Managing Infections with Atopic Dermatitis

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

Bacterial infections and atopic dermatitis

Staphylococcus aureus, commonly known as “staph,” is a bacterium that is commonly found on the skin of people with AD. Over 90% of AD skin lesions are found to have staph, compared to 5% on the skin of healthy people. In normal skin, the skin barrier and the pH level of the skin keep the numbers of staph low, but in people with AD, the skin barrier is damaged, the pH level is altered, and there may be a reduced immune response to defend against bacteria. This allows the bacteria to multiply. In addition, the lesions of AD 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 AD.1,2

Treating an infection

Research has shown that using a combination of topical corticosteroids with an antibiotic is significantly more effective treatment for reducing the skin inflammation of AD 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 resistance that may occur with frequent use of antibiotics, it’s important to combine medical treatment with effective skin care 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 AD.

For people with moderate to severe AD who have repeated skin infections, the addition of bleach to the bath can be helpful to decrease the amount 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 surface of the skin and reduce infections.3

Viral infections

Due to the dysfunction in the immune system, people with AD are at an increased risk of serious viral infections of the skin, including herpes simplex, warts, and molluscum contagiosum (a poxvirus infection). 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 a severe widespread skin rash, called eczema vaccinatum, in people with AD, and people with AD should avoid getting the smallpox vaccination unless there is an imminent danger of exposure to smallpox. Because of the skin barrier damage in people with AD, these viruses have the potential to spread and may become life-threatening. 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 AD: yeasts and dermatophytes. The dermatophytes most commonly seen in people with AD 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 AD 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

Non-skin infections

Recent research suggests that people with AD 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 AD, may also increase a person’s risk of other infections.5

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view references
  1. Peterson JD, Chan LS. A comprehensive management guide for atopic dermatitis. Dermatology Nursing. 2006;18(6):531-542. Accessed online on 4/5/17 at http://www.medscape.com/viewarticle/551352_5.
  2. Leung, DYM. Infection in atopic dermatitis. Curr Opin Pediatr. 2003;15:399-404.
  3. Eichenfield LF, Tom, WL, Berger TG, et al. Guidelines of care for the management of atopic dermatitis. J Am Acad Dermatol. 2014;71:116-32.
  4. Leung, DYM, Boguniewicz M, Howell MD, Nomura I, Hamid QA. New insights into atopic dermatitis. J Clin Invest. 2004;113(5):651-657. doi:10.1172/JCI21060.
  5. Langan SM et al. Increased risk of cutaneous and systemic infections in atopic dermatitis-a cohort study. J Invest Dermatol. 2017 Feb 12. pii: S0022-202X(17)30175-6. doi: 10.1016/j.jid.2017.01.030.
View Written By | Review Date
Emily Downward | June 2017
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