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Eczema (young people)

When eczema becomes infected, antibiotics and anti-fungal treatments

Infected eczema was something that a lot of young people had experienced. Eczema itself is not infectious or contagious (it cannot be spread to another person), but it can become infected if germs set in. A skin infection can then be contagious for other people, as is the case with impetigo (a common infection which comes in two forms – bullous and non-bullous). Infections can be difficult to avoid because eczema makes the barrier function of the skin less effective (see more in ‘What causes eczema?’). Scratching damages the skin which makes it easier for bacteria, viruses or fungi to take hold. Cutting nails short is one way to limit likely injuries to the skin from scratching.
 
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Georgia talks about scratching itchy eczema as leading to infections.

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Age at interview: 20
Sex: Female
Age at diagnosis: 4
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It’s like you’re trying to dig the itch out of your skin. And that’s why it gets so in-, it’s such a bad thing to scratch. I mean it’s alright if you’re just there sort of mindlessly stroking and scratching your skin with your nails. But if you’re trying to dig that itch out, you’re taking away so much skin and allowing for infection…

Yeah.

…to get in and things like that. I think I’m really bad for that.
Cleanliness was stressed as important for avoiding infections. Anissa says you should have clean hands when applying emollients and steroid creams. She adds that putting make-up on top broken skin risks infection. Katie-Lauren heard that you can limit spreading an infection like folliculitis by moisturising downwards on the skin (rather than upwards, which might more easily block or damage the hair follicles). Shams also talked about clean clothes.

However, it’s not possible or practical to avoid all germs. Laura is very aware of how often she uses her hands and that she picks up germs when using public transport. At the same time, many found washing their hands often and using some kinds of soaps irritated their eczema. Abid says you shouldn’t let worry about infections stop you from doing things you want to and that it’s not helpful to be “overly cautious”. A few had heard about the ‘hygiene hypothesis’ which suggests that a lack of exposure to germs in childhood could be a factor in developing eczema (see also causes).

There are different kinds of infections that can develop with eczema. Not everyone knew the names of the infections they had developed, but some included: impetigo, eczema herpeticum (an infection of the eczema with herpes/cold sore virus) folliculitis (an infection of the hair follicles), cellulitis (an infection of the deeper layers of the skin). Vicky, Hazel and Sarah also had chickenpox when they were younger which combined with their eczema to make it more severe.
 
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Cat makes sure to change her razor every week or so to avoid developing folliculitis on her legs again.

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Age at interview: 24
Sex: Female
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So yeah so I've like on your legs had some sort of infections, sort of folliculitis, I think, yeah.

OK.

So sort of that sort of a couple of times, it was probably cos I wasn’t using a clean razor as well [laughs], but yeah so it's sort of things just like yeah having like, you know making sure you’ve got fresh sort of-, well a razor, or one that’s like, you know, change it every week or something, things like that is probably the worst I’ve sort of had.

And so when you developed folliculitis on your legs did you – what did you do about it; how did you respond?

I went to the GP and got some antibiotics so yeah, which all cleared it up in a couple of days so it's fine.
Symptoms of infected eczema

Some people found it difficult working out if their eczema was infected at first. Jessica’s vulval eczema symptoms were so bad that she says she wouldn’t know if it had become infected. Others had symptoms that were very different to their normal eczema and so they knew there was a problem. Some symptoms and signs of infected eczema include:
  • inflamed skin (swollen, hot, red)
  • blistered skin, ‘boils’ and cysts
  • pus/weepy fluid (often yellow or green) coming out of the skin and crusts or scabs
  • painful skin – “like you’ve got cuts everywhere”
  • high temperature (fever)
  • feeling unwell and tired
  • becoming confused and forgetful
Infections can develop in/on eczema anywhere on the body. Aisha remembers getting infected eczema on her scalp, which was difficult to treat with creams and ointments. The eczema on George’s leg became very cracked and infected.
 

Georgia has eczema above her top lip and finds it often becomes infected.

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Age at interview: 20
Sex: Female
Age at diagnosis: 4
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I’m quite lucky actually, I don’t get ill that much. I don’t get colds or coughs or fevers or things like that. I think my body has decided that eczema is the only thing [laughs] it’s going to let me have. But if I do get something like a, something as simple as a cold or a cough, especially because it’s been there [points to above top lip], I’ve had this part of my skin infected quite a bit. Because obviously like the bacteria in having a cold will infect that bit. And I’ll have to go back, go to the doctor’s and get antibiotics for something as silly as a cold because it’s infected my skin. But I am quite lucky in the sense that I’ve never contracted any kind of serious infection such as, I don’t know, things like MRSA…

Oh yeah.

…or something like that. I have read people’s blogs that have picked up those kind of infections because their skin is so open and inflamed and things like that.
 
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Lizzie talks about the different body parts where she’s had infections.

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Age at interview: 19
Sex: Female
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I've had quite a few infections in my eczema, like round my eyes and my finger; like my thumb at the moment’s swollen and it's been swollen for maybe four months now and like nothing's worked on it. But with infections it can be a lot nastier than general eczema. So, and they, that can be more painful than usual, like especially round the eyes you can't – sometimes I can't open my eyes well enough because like the eczema's kind of come round, or the whole eyelid and it just makes it very painful. But that usually can clear up within a week when you're giving a particular like, maybe sometimes an antibiotic and a lot of cream as well.
Getting medical help and treating infected eczema

Because it’s not always obvious if eczema is infected, it’s important to get help from medical professionals. Some infections, such as eczema herpeticum (a viral infection), are serious and need medical attention right away. Naomi says she doesn’t like going to the GPs but accepts that she must for infections. Anissa feels like doctors only take her eczema seriously when it becomes infected. Diagnosing an infection is not always straightforward.
 

Himesh learnt that he had eczema when he was admitted to hospital for an infection at age 10/11.

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Age at interview: 17
Sex: Male
Age at diagnosis: 10
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I think I had an infection first so I ended up in the hospital and one of the doctors said, I think they said “This is due to your eczema” and I was, obviously I, I didn’t know I had eczema at that time until the doctor said, so yeh I think that’s when it started.

Hmm. How did you feel when the doctor said that?

I didn’t know how to feel because I think at that point I didn’t know what eczema was, if that makes sense, so yeh.

And what happened next, did the doctor explain a little bit about it?

Yeh explained like you have a skin condition for it, you’ll have to put creams and stuff, which I didn’t mind at the time because I thought that’s alright, if that makes sense, but as you, you know, get used to, to the routine and stuff it gets kind of annoying I guess ‘cos it take up a lot of time, so yeh.

Hmm. Hmm. So what did you think the symptoms might have been because you said you had an infection, was that a skin infection?

Yeh it was I think because I probably scratched myself that’s why something probably went into my immune system and then it triggered an infection which was really bad because I had to stay overnight in the hospital. I think that infection I had to have medicine through my veins I think it was, so yeh it was pretty bad as I’d never experienced anything like that, I used to be a really healthy kid really so yeh.
 

Anissa goes to her GP to confirm whether she has infected eczema and, if it is, to get treatment (such as antibiotic tablets).

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Age at interview: 20
Sex: Female
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So I got an infection which, like I went to them when I first got it and they were like, “Oh, it’s just your eczema. Like, just put your creams on.” And by the time that they did something, it had spread to the whole lower back and started coming to my sides.

Because like, it happens really quickly. And then at that stage, she was quite understanding and really nice and like there was no waiting for the tablets, because they’re like blue things to cure infection or something, and she, she, even though I’d just started on the tablets, she was like, “Look, if it doesn’t cure it, like go in a week, we’re going to give you an injection.” And then explain the injection and the process of having the injection and everything like that. But like to get to that stage, and I’d never even knew that you could have an injection beforehand. So, but that was nice because it made me feel like, ‘Oh God, if these tablets don’t work then I’m doomed. It’s just going to keep going.’ 
Eczema can become so infected that the person has to go to hospital and stay over for treatment, as was the case for Himesh, Vicky and Georgia. This can be very upsetting, especially for young children, and mean missing weeks of school. Himesh says getting an infection can feel like a “waste” of all the effort put into controlling eczema.
 
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Georgia was in hospital for infected eczema when she was little.

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Age at interview: 20
Sex: Female
Age at diagnosis: 4
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When I was about 3 or 4 I was admitted into hospital because it was infected, because I’d been scratching so much. I remember being there for two or three weeks. I don’t really remember it that much. I’m not too sure if it’s because I was so young or if I’ve just blocked it out because it was such a, like a traumatic experience. I know from my mum it was quite traumatic cos obviously I was so young and I didn’t understand it. And I didn’t understand why people would tell me to stop doing something that was so natural to me. When I was there I remember I was given wet wraps. I was put into isolation for a while because they thought my infection was so severe that I might’ve caught it of other people or I might give it to other, other people. I remember being given loads of prescriptions, having a bath I think two or three times a day to keep it moisturised because it was so dry and it was so infected. Ugh, it was horrible [laughs].

I remember coming home. My dad took over most of it. My mum kinda took a step back. I think it was quite painful for her to watch me cry and scratch and not understand it.
 
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Naomi had impetigo when she was younger and had to stay at home.

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Age at interview: 17
Sex: Female
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Yeah, so and I've had…I've had many infections as well. I had impetigo.

OK 

Which…that was only when I was a kid, only had it twice, cos my brother got it and he touched me and then I had it [laughs], that was odd. But yeah that was when it was really bad because, you know it's like an infection, so you have to like stay at home, you can't go out cos if someone touches you; touch their own skin, it will spread. So, yeah that was…that was quite…I remember that being painful and crying a lot when I was a kid.
Some kinds of skin infections can be treated with antibiotics (in the form of tablets, creams, injections or IV drips). Other kinds of skin infections are fungal (such as ring worm) and are treated with antifungal creams or tablets. Most people had been prescribed antibiotic tablets by their GPs which cleared up the infections. Maham says it took about a week for infected eczema on her face to heal with antibiotics.
 
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Himesh talks about one of his eczema infections. He had to stay in hospital for antibiotic treatment.

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Age at interview: 17
Sex: Male
Age at diagnosis: 10
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One of the worst ones were Bullous Impetigo because I got referred to the hospital because obviously I had infection but at that point I didn’t know it was Bullous Impetigo I think they said it was some type of herpes virus. So they were giving me medicine through the veins for the wrong treatment which made my energy levels go down and were thinking why is this happening I should be getting better if that makes sense. And like for a good, I think four or five days they were treating me with this through the veins and it wasn’t helping at all and I think a derma- specialist, a dermatologist nurse, no doctor came in and said “You’re treating the patient with the wrong medicine, he hasn’t got, I think it was herpes virus at that point, he’s got Bullous Impetigo”. And then once I got the right treatment my energy levels you could see was going up, so yeh I spent a good two weeks probably in the hospital. 

It kind of wasted my time I think most of my infections were at school time so I think this was Year 6, 7 something like that, it really affected my school time ‘cos obviously Year 6 last year of primary school and stuff like that but SATS as well I think it was but yeh still it just affected valuable time as well because I could have been out of the hospital much quicker than two weeks if they had treated me with the right medicine, but yeh.
If the infection of the eczema is contagious, the person will usually be kept away from others for a few days to avoid passing it on. This was the case for Himesh who had to stay in a special room on his own whilst he was in hospital for impetigo. 

There were some concerns and downsides to antibiotics taken for skin infections. Katie-Lauren had heard “loads of warnings about using antibiotics” and was worried that they might not work when she really needed them. However, she said that she trusts her doctor to know what’s best and will take antibiotics when prescribed them.
 

Sarah didn’t like some things about the antibiotics she had for her infected eczema, such as the smell/taste and that she couldn’t drink alcohol whilst taking them.

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Age at interview: 23
Sex: Female
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They were like ones where you took one antibiotic a day. The worst things about the, like when you have the, the boils and you take like the three antibiotics a day, like they absolutely stink. This is the kind of thing I think GPs never know about. So when I went back to the GP’s they were like, “Do you want the same antibiotics again?” I asked, “Do you know what these antibiotics smell like? Because if you did I don’t think you’d prescribe them to anybody.” Cos when you open the tub it just smelt like you wouldn’t believe it. And then you had to take them. And then you have that like taste in your mouth of these like disgusting antibiotics. But, yeah, I think that’s just antibiotics, isn’t it? They’re not very nice. You can’t drink on them.
Some people had scars from their eczema having become infected. Vicky, Sarah and Hazel had scars from when they had chickenpox in combination with eczema. For more on scars and lasting marks from eczema, also see the section in Eczema symptoms: what does eczema look and like?.
 
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Chickenpox worsened Vicky’s eczema and has left her with some scars.

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Age at interview: 19
Sex: Female
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I had the chickenpox when I was, that was I think it was before I started the steroids cos I know, I think I must have been four or five I think when I got it cos I know it was when I was sort of like in pre-school and school, I got it and I was covered in it. Like I had it on the balls of my feet, on the palms of my hand, everywhere and you couldn’t distinguish between what was chickenpox and what was eczema and I couldn’t move from it or anything, I was really quite ill.

Cos we lived in a maisonette at the time, on the top floor and there was quite a few steps to get up there, I couldn’t walk up and down them, I couldn’t do anything. I couldn’t bend my legs cos where it was so sore behind there so cracked and everything and I couldn’t bend them. So I had to be carried everywhere then.
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