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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
If you’ve ever experienced the dry, itchy, and often painful red rashes associated with eczema, you know how uncomfortable it can be. And while a flare-up might be distressing, the good news is the skin condition is not contagious.
The exact cause of eczema isn’t fully known, but we do know eczema is a genetic condition—not something you can “catch” or spread to others (NIAMS, 2019). That being said, people with eczema can get skin infections from excess scratching, especially during flares when skin is particularly uncomfortable and itchy. Scratching can cause damage to your skin, harming the barrier your skin is supposed to provide and allowing the bacteria on your skin to cause an infection.
To prevent infection, it’s important to understand what eczema is, how to manage your symptoms, and what your options are when it comes to treatment.
What is eczema and what causes it?
There are different types of eczema, but the most common type is atopic dermatitis, which is an allergic condition that happens when the immune system overreacts, causing skin irritation and sensitivity to allergens (Kim, 2019). Atopic dermatitis typically begins within the first few years of life, and is common in children, but can present at any age (Siegfried, 2015).
While the exact cause of eczema is unclear, it’s likely a combination of genetic and environmental factors. Scientists have found that for many people with eczema, the outermost layer of their skin doesn’t keep moisture in and protect them from allergens, bacteria, and other foreign substances as it should (Barker, 2007). This leaves people more prone to developing reactions to typically non-harmful things.
Environmental factors can increase the likelihood of developing eczema or worsen symptoms (Kantor, 2017). For example, people who live in cities are more likely to develop eczema than those who live in rural areas.
What are the symptoms of eczema?
People with eczema experience a variety of skin-related symptoms, but it can affect different people in different ways. The most common symptoms of eczema include (Eichenfield, 2013):
- Itching and scratching
- Red or inflamed skin rash
- Excessively dry skin with scaly patches
- Oozing and crusting
- Patches of skin that thicken over time with repeated scratching
The symptoms typically show up on the face, knees, elbows, ankles, and hands, but can show up anywhere on the body (Nemeth & Evans, 2020). And if you have eczema, you might be more likely to develop asthma or other allergies (Ferreira, 2017). These three conditions together even have their own name: they’re called the atopic march (Nutten, 2015).
Unfortunately, there’s no cure yet for eczema . For some people, eczema spontaneously goes away before they reach their teenage years. Others may experience periods with minimal symptoms, followed by flares (Kim, 2016).
If you’re experiencing signs and symptoms consistent with eczema, it’s important to talk to a healthcare professional. They can help you understand what might be causing your symptoms, and how to manage them. At your appointment, you may be asked about your family history, whether you have allergies or asthma, and if you’ve ever noticed certain substances or situations that aggravate your symptoms.
How does an infected eczema wound become infected?
When a person has eczema, the outermost layer of their skin doesn’t function as it should (Nutten, 2015).
Usually, the cells that make up this layer are tightly linked to keep moisture in your skin and prevent foreign substances (like allergens, bacteria, viruses, fungi, and debris) from entering. It’s sort of like having just a window screen instead of a solid glass window. Nothing is getting through that glass window, but with eczema, the skin cells are like the window screen, allowing wind, rain, and small bugs to get inside. This is why those with eczema are more vulnerable to infections—especially during flares (Langan, 2015).
Research has also found those with severe itching have higher rates of infection compared to those who don’t (Wang, 2017). Scratching an itch temporarily relieves discomfort, but scratching can tear fragile skin and create small openings for particles to enter that could cause an infection. It’s like opening up the window and removing the screen entirely.
How to tell the difference between eczema and a skin infection
The signs and symptoms of eczema flares can resemble an infection, but there are some important distinctions between the two (Alexander, 2020). Generally, symptoms of a skin infection include:
- Foul-smelling, discolored fluid coming out of the rash
- New-onset pain
- Red streaks that extend out from the affected area
Although redness, swelling, and drainage are also commonly seen with eczema—that doesn’t necessarily mean you have an infection. A honey-colored crust around the area, as well as drainage that appears milky, yellow, or brown, and has a foul odor can indicate an infection (Alexander, 2020).
If you notice any of these changes in your skin, speak with a healthcare professional about how to best treat it.
What can you do to reduce eczema symptoms?
Treatments for eczema focus on maintaining the moisture balance in your skin, reducing itching, and helping your immune system do its job to protect you against germs. Here are some of the main treatments to address symptoms, prevent infection, and reduce discomfort:
- Moisturizers or emollients: Emollients are a type of moisturizer that can be used for the treatment of eczema (Sethi, 2016). They contain different types of oils that help protect the skin and keep it soft. Moisturizers are generally well-tolerated and may reduce the duration and frequency of flares (van Zuuren, 2017).
- Topical corticosteroid cream or ointment: Applying these to affected areas can reduce itching and inflammation (AAD, n.d.). While topical corticosteroids have been available and used for over five decades, there are potential side effects with long-term usage, including making your skin more prone to damage (Siegfried, 2015). Your provider can recommend a safe course of treatment. Another option is pimecrolimus (Elidel), a cream that can suppress immune reactions and reduce bothersome symptoms of eczema, such as itching, redness, and dry skin. Medications like pimecrolimus can increase the risk of infection, and because of how the medication works, it’s important to stay out of the sun when you’re using it (FDA, 2006).
- Oral medications: Pills like dupilumab (Dupixent) can be used to reduce the severity of infections in patients with eczema (Eichenfield, 2019).
Why does treating your eczema symptoms matter?
It’s important to treat eczema symptoms to protect your health and minimize discomfort the condition can cause. As mentioned, people with eczema are at higher risk of infections. Left untreated, skin infections can migrate into the bloodstream and reach your bones, joints, or even your heart and cause more serious problems (Langen, 2017; Narla, 2018).
People with eczema can also incur financial, psychological, and even social costs without proper treatment. In fact, eczema is associated with increased sleep disturbances, such as fatigue, daytime sleepiness, and insomnia (Silverberg, 2015). It can also affect your mental health and your overall quality of life (Drucker, 2017).
When eczema flares happen, you don’t need to worry that you’re contagious to others. If you’re experiencing itching and discomfort, talk to your provider about one of the many available treatments.
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Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.