How Are Antibiotics Used to Treat Atopic Dermatitis?

Reviewed by: HU Medical Review Board | Reviewed February 2022

Antibiotics may be used in the treatment of atopic dermatitis (AD), as people with AD are at a higher risk of developing infections. AD damages the skin barrier, allowing bacteria and other microorganisms an opportunity to cause infection. In addition, the itching caused by AD motivates scratching, which can further damage the skin and introduce bacteria. Dysfunction in the immune system of the skin may also contribute to greater risk of infection in AD.

What type of antibiotics are used for people with eczema?

Antibiotics may be topical or systemic. Topical preparations are applied directly to the skin, while systemic antibiotics are taken orally and treat the entire body. The American Association of Dermatology recommends systemic antibiotics for people with AD who show signs of bacterial infection, in addition to other appropriate treatments for the AD itself.

Side effects and drug interactions

Antibiotics can cause side effects, and some antibiotics may interfere with other medications, including other medications used to treat AD. People who are prescribed antibiotics should talk to their doctor about all medications they are taking to avoid any negative drug interactions.1,2

Staphylococcus aureus and atopic dermatitis

Staphylococcus aureus, commonly known as “Staph,” is a bacterium commonly found on the skin of people with AD. Over 90% of AD skin lesions are found to carry 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.

Skin lesions and staph infections

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. A large number of Staph produces toxins that stimulate the immune system and worsen AD.3,4

Staph infections and antibiotics

Localized Staph infections in AD are sometimes treated with topical antibiotics, but more severe involvement may require oral antibiotics. Your physician may also recommend bleach baths to decrease the amount of Staph on the skin and prevent infection.

Other infections

Viruses or fungi may also cause infections experienced by people with AD. Common viral infections include herpes simplex, warts, and molluscum contagiosum (a poxvirus infection). Common fungal infections include Malassezia furfur, Trichophyton, Epidermophyton, Candida, and Pityrosporum ovale. These microorganisms are treated with antiviral and antifungal medications.3,4

Skin infection symptoms

Infection can make AD worse, exacerbating symptoms of blisters, redness, and itching. Skin infections can also cause weeping of the skin, where the skin oozes clear or yellow fluid. Infected skin may have red or yellow spots or bumps. Some people experience a fever or swollen lymph glands in the armpit, neck, or groin. Anyone with AD who experiences symptoms that may be related to infection should visit their doctor for evaluation and proper treatment.5

Antibiotics and proper skin care

In addition to antibiotics, 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 skin care and avoiding other triggers, like irritants, food allergies, or emotional stress.4

Bleach baths and skin infections

Bleach baths may also be helpful for people with moderate to severe AD who have frequent skin infections. Adding bleach to the bath can reduce the number of bacteria on the skin. Bleach baths involve adding 2 teaspoons of bleach per gallon of water. (A typical bathtub holds between 25-40 gallons of water.) For a full bathtub, use ½ cup of bleach. For a half-full tub, use ¼ cup of bleach. Regular strength bleach (6%) should be used – not concentrated bleach.2,6 Check with your physician to see if this is a good option for you.

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