Recognising and managing infection

Eczema herpeticum Severe bacterial infection of facial eczema

New Zealand Dermatalogical Society Incorporated. Published online at: http://www.dermnetnz.org

People with atopic eczema are more liable to skin infections as a result of damage from inflammation and scratching which allows bacteria and viruses to penetrate the epidermal skin barrier.6

Bacterial infections3

Bacterial infections are typically caused by staphylococcus and/or streptococcus and can usually be cleared up quickly by antibiotics.

What will skin look like?

  • Weepy
  • Scabby
  • Spots containing or discharging pus

How will eczema be affected?

Unlikely to respond to current treatment

May be getting rapidly worse

Will the patient feel unwell?

Yes, they may feel:

  • Feverish
  • Generally unwell

How should they be managed?

Systemic antibiotic treatment should be initiated

Eczema herpeticum (infection with Herpes virus)3

Children with eczema are susceptible to infection from the herpes virus (responsible for cold sores). Eczema herpeticum can spread very quickly, become systemic and is potentially life threatening so needs to be treated straight away.

What will skin look like?

  • Clusters of blisters like early cold sores
  • Circular ulcers (1-3mm across)
  • Ulcers may join together to make a larger crusty ulcer

How will eczema be affected?

Will be rapidly getting worse

Painful

Will the patient feel unwell?

Yes, they will feel:

  • Feverish
  • Lethargic
  • Generally very unwell

How should they be managed?

Systemic anti-virals should be initiated immediately

Same-day referral to dermatology specialist

Patients should be educated about eczema herpeticum and provided with information to help them recognise the signs and symptoms of infection.

References:
  1. 3.NICE (2007) Atopic eczema in children. Management of atopic eczema in children from birth up to the age of 12 years. Clinical Guideline 57, London, December 2007
  2. 6.National Collaborating Centre for Women’s and Children's Health. Atopic eczema in children: management of atopic eczema in children from birth up to the age of 12 years. Clinical Guideline December 2007 (NICE Eczema Full Guideline) www.nice.org.uk

Code: 12/13 DERM-1018018-0001
Date of preparation: December 2011