Papules (Skin Lesions) in Atopic Dermatitis

One of the symptoms of atopic dermatitis (eczema) is papules: which are small, raised bumps on the skin that may look like pimples without pus. In some people with darker pigmented skin, papules may be the only sign of atopic dermatitis. Other people have papules in addition to other symptoms.^1,2

Are eczema papules a sign of a viral infection?

Papules can also be a sign of a viral infection. Due to the damaged skin barrier, as well as the dysfunction in the immune system, people with atopic dermatitis are at a greater risk of infection. Serious viral infections of the skin that may be a complication of atopic dermatitis include herpes simplex, warts, and molluscum contagiosum (a poxvirus infection).^3,4

What causes them?

Papules are caused by inflammation, and in atopic dermatitis, there is an increase in inflammation in the skin. In conditions like atopic dermatitis, the immune response is abnormally over-activated, causing a chronic inflammatory state. In addition, many people produce elevated levels of immunoglobulin E (IgE) when exposed to an environmental allergen. Immunoglobulin is a type of protein that is part of the immune system and that acts as an antibody to attach and destroy foreign substances. There are five different types of immunoglobulin, and the IgE protein is found in increased levels in people with allergies. IgE causes the body to release histamine when it comes into contact with an allergen.^5,6

How are they treated?

Treatment for atopic dermatitis involves a combination of good skin care, avoiding triggers, and medications. Moisturizers are one of the basic necessities for people with atopic dermatitis, regardless of the severity of their disease. Some of the anti-inflammatory medications available for treating atopic dermatitis also come in moisturizer formulations, which can help provide additional barrier repair and control itchiness.⁷

Medications

Medications used in the treatment of atopic dermatitis include:

• Topical corticosteroids, to reduce redness, inflammation, and itching
• Topical calcineurin inhibitors, to stop the dysfunctional immune response and reduce redness and itching
• Immunomodulators, which also target the dysfunctional immune response to reduce symptoms7
• If the papules are caused by a viral infection, 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.^3,4

Phototherapy

Phototherapy, which uses light waves directed at the skin, is a second-line treatment strategy. That is, it is only recommended for use after other treatments and lifestyle approaches have failed to improve symptoms of atopic dermatitis. Phototherapy is sometimes used as maintenance therapy in people with chronic atopic dermatitis.⁸

Other symptoms of atopic dermatitis

In addition to papules, atopic dermatitis can cause a rash, scaly patches, weepy sores, itching, blisters, and a change in skin color. Some people also experience eye symptoms or cracks behind the ears. Over time, the areas of skin affected by atopic dermatitis may become thickened.