Weepy Sores (Wet Eczema) in Atopic Dermatitis

Atopic dermatitis (eczema) is caused by a combination of genetic, immunologic, and environmental factors.

Filaggrin gene (FLG) mutation in atopic dermatitis

In people with atopic dermatitis, there sometimes a decrease or lack of filaggrin in the skin. Filaggrin is a protein that plays a key role in the structure and formation of the outermost corneal layer of the skin. The lack of filaggrin has been traced back to genetic mutations in the FLG gene. Not having enough filaggrin in the skin layers creates a damaged skin barrier, leading to a reduced ability to maintain the skin’s natural amount of water, as well as sores and rashes. The damaged skin barrier may also allow for airborne allergens' to enter the skin, which could lead to an inflammatory response by the immune system.

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Filaggrin mutation and the pH of the skin barrier

Another theory suggests that the skin barrier's normal pH may be affected by filaggrin defects, which could lead to the overgrowth of bacteria. This could then trigger the immune system to create inflammatory skin lesions. There is also emerging evidence that the dysfunction in the immune system in patients with atopic dermatitis not only causes disease but also decreases the amount of functional filaggrin. Immune system dysfunction also creates an increase in inflammation.3,4

Bacterial infections and atopic dermatitis

Staphylococcus aureus, commonly known as “staph,” is a bacterium that is commonly found on the skin of people with atopic dermatitis. Over 90% of atopic dermatitis-related skin lesions are found to have staph, compared to 5% on the skin of those without the condition. In skin not affected by the condition, the skin barrier and the pH level keep the numbers of staph low, but in people with atopic dermatitis, 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 atopic dermatitis 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 flares.5,6

Viral infections and atopic dermatitis

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 simplex virus infection is fairly common, and because it is contagious, direct contact with someone who has active cold sores should be avoided. Because of the skin barrier damage in people with atopic dermatitis, 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.2,6

What is wet eczema?

Atopic dermatitis can cause blisters that ooze, or weepy sores. Weepy areas leak fluid, which is usually clear. Atopic dermatitis is the most common type of eczema, and when it presents with weepy sores, it may also be called wet eczema, weepy eczema, or weeping eczema. Weepy sores can also be a sign of infection. Infection is a common complication as bacteria or other microorganisms due to the damage to the skin barrier.1,2

How is wet eczema treated?

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.

Medications

Medications used in the treatment of atopic dermatitis include:

Wet wrap therapy

With or without a topical corticosteroid, wet-wrap therapy is another technique that can help weepy sores from atopic dermatitis. Wet-wrap therapy involves applying the medication (if using) and wrapping the affected area in a layer of wetted gauze, cotton, or bandages, followed by a layer of dry bandages. Wet-wrap therapy helps improve the moisture of the affected skin, improves the penetration of the topical medicine, and provides a physical barrier against scratching.7

Phototherapy

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

Other symptoms of atopic dermatitis

In addition to the weepy sores, atopic dermatitis can cause a rash, scaly patches, itch, bumps or papules, 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.

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Emily Downward | June 2017