If you have eczema, you know how frustrating it can be. The itching, the dry patches, the constant worry about what might make it worse. But one of the most common-and often overlooked-problems people with eczema face isn’t just the rash itself. It’s skin infections. And the link between the two isn’t just coincidence. It’s biology.
Why Eczema Makes Skin More Vulnerable
Eczema, especially atopic dermatitis, isn’t just dry skin. It’s a broken skin barrier. Healthy skin acts like a wall-tight, strong, keeping out germs and holding in moisture. In eczema, that wall has cracks. Tiny gaps form between skin cells. The natural oils that protect the surface are missing. And the skin’s immune system goes into overdrive, causing inflammation.
This isn’t just uncomfortable. It’s dangerous. Bacteria, viruses, and fungi that normally live harmlessly on the skin’s surface can now slip through those gaps. The most common offender? Staphylococcus aureus, or staph. Up to 90% of people with moderate to severe eczema carry this bacteria on their skin, compared to only 5% of people without eczema.
It’s not that staph causes eczema. It’s the other way around. The damaged skin lets staph in. Once inside, it feeds on the broken tissue, releases toxins, and triggers even more inflammation. That’s why flare-ups often come with oozing, crusting, or yellowish scales-signs of infection.
What a Skin Infection Looks Like With Eczema
It’s easy to confuse an infected eczema flare-up with a regular flare-up. Both involve redness, itching, and swelling. But infection adds specific warning signs:
- Wet, weepy patches that don’t dry up
- Golden-yellow crusts on top of the rash
- Sudden worsening of itching or pain
- Fever or swollen lymph nodes near the rash
- Rash spreading quickly, even with treatment
If you see any of these, don’t wait. A simple eczema cream won’t fix an infection. You need medical attention. Left untreated, bacterial infections can spread deeper into the skin, leading to cellulitis-a serious condition that can require hospitalization.
Viruses are less common but just as dangerous. Herpes simplex virus (the cold sore virus) can cause a rare but severe infection called eczema herpeticum. It looks like clusters of painful blisters, often on top of eczema patches. It can spread fast and needs urgent antiviral treatment.
How Infections Make Eczema Worse
It’s a cycle. Eczema leads to infection. Infection makes eczema worse. And worse eczema means more infection risk.
When staph bacteria colonize the skin, they release substances called superantigens. These don’t just cause local irritation-they trick the immune system into going haywire. The body attacks its own skin cells, increasing inflammation and making the skin even more fragile. That’s why some people with eczema seem to get one flare-up after another, even when they’re doing everything right.
Studies show that people with eczema who have high levels of staph on their skin are more likely to have persistent, hard-to-control symptoms. Treating the infection doesn’t just clear up the sores-it helps calm the underlying eczema too.
What Doctors Do to Treat Infected Eczema
There’s no one-size-fits-all fix, but treatment usually follows a few clear steps.
First, your doctor will look at the rash. In many cases, they can tell if it’s infected just by sight. If it’s unclear, they might take a swab to test for bacteria or viruses.
If it’s bacterial, topical antibiotics like mupirocin are often the first step. For widespread infections, oral antibiotics like flucloxacillin or erythromycin are prescribed. Treatment usually lasts 7 to 14 days. It’s important to finish the full course-even if the rash looks better after a few days.
If it’s viral, antiviral pills like acyclovir are used. For eczema herpeticum, treatment often starts in hospital.
Once the infection is under control, managing the eczema becomes the focus again. Moisturizers, topical steroids, and newer medications like crisaborole or calcineurin inhibitors help repair the skin barrier. In severe cases, doctors may recommend bleach baths-diluted household bleach in bathwater-to reduce staph bacteria on the skin.
Preventing Infections Before They Start
The best treatment is prevention. Here’s what actually works:
- Moisturize daily. Thick creams or ointments (not lotions) help seal the skin barrier. Apply right after bathing while skin is still damp.
- Keep nails short. Scratching is the biggest cause of skin breaks. Even small scratches let germs in.
- Use gentle cleansers. Avoid soaps with fragrances or alcohol. Soap-free washes like Cetaphil or E45 are better.
- Wear soft fabrics. Cotton is best. Wool and synthetics can irritate and trap sweat.
- Consider bleach baths. Twice a week, add half a cup of bleach to a full bathtub. Soak for 10 minutes, then rinse with clean water. This reduces bacteria without killing good skin microbes.
- Watch for early signs. If your eczema suddenly feels hotter, more painful, or starts oozing, act fast.
Some people benefit from long-term, low-dose antibiotics during high-risk seasons-like winter, when skin gets drier. But this isn’t for everyone. Talk to your doctor if you’re getting infections often.
What Doesn’t Work
There’s a lot of misinformation out there. Avoid these myths:
- Apple cider vinegar soaks. They can burn already damaged skin and make things worse.
- Essential oils. Many are skin irritants. Tea tree oil, for example, can trigger allergic reactions in eczema-prone skin.
- Over-washing. Showering too often, especially with hot water, strips natural oils and dries skin further.
- Ignoring signs of infection. Waiting to see if it gets better often leads to bigger problems.
Just because something is "natural" doesn’t mean it’s safe for eczema. Your skin is already compromised. Stick to evidence-based care.
When to See a Doctor
You don’t need to panic every time your eczema flares. But call your doctor if:
- The rash doesn’t improve after 3-5 days of regular treatment
- You see yellow crusts, pus, or weeping
- You develop a fever or feel unwell
- The rash spreads rapidly or appears in new areas
- You’ve had multiple infections in the past year
Early treatment stops small problems from becoming serious ones. And the sooner you treat an infection, the faster your eczema will calm down.
The Bigger Picture
Understanding the link between skin infections and eczema changes how you manage your condition. It’s not just about calming inflammation. It’s about protecting your skin like you would protect a wound.
Think of your skin as a fence. Eczema leaves gaps. Infections are the animals that walk through. You can’t just chase the animals away-you need to fix the fence.
That means consistent care: moisturizing, avoiding triggers, watching for infection signs, and acting fast when something looks off. It’s not glamorous. But it works.
People with eczema who follow these steps don’t just get fewer infections. They also have fewer flare-ups, better sleep, and less stress. The skin barrier heals. The cycle breaks. And life gets easier.
Can eczema turn into a skin infection?
Yes. Eczema damages the skin barrier, making it easier for bacteria like staph to enter and cause infection. Signs include oozing, crusting, sudden worsening, or fever. It’s not eczema turning into infection-it’s eczema creating the conditions for infection to happen.
Is eczema caused by poor hygiene?
No. Eczema is a genetic condition linked to immune system overactivity and skin barrier defects. Poor hygiene doesn’t cause it. In fact, over-washing or using harsh soaps can make it worse. People with eczema often have clean skin but still get flare-ups because of their biology, not cleanliness.
Can I use over-the-counter antibiotic creams on my eczema?
Only if your doctor says so. Many OTC antibiotic creams, like Neosporin, contain ingredients that can cause allergic reactions in people with eczema. Even if it seems to help at first, it can lead to worse rashes later. Always check with a healthcare provider before using them.
Do bleach baths really help with eczema?
Yes, for many people. Diluted bleach baths (half a cup in a full tub) reduce staph bacteria on the skin, which helps prevent infections and calm inflammation. Do them twice a week for 10 minutes, then rinse with clean water. Don’t use undiluted bleach-it’s dangerous. This method is backed by multiple clinical studies and recommended by dermatology groups.
How long does it take for infected eczema to heal?
With proper treatment, most bacterial infections clear up in 7 to 14 days. But the eczema underneath may take longer to fully calm down-sometimes weeks. Healing isn’t just about the infection going away. It’s about repairing the skin barrier, which requires consistent moisturizing and avoiding triggers. Don’t stop care just because the rash looks better.
