Is that eczema or an infection on my child's skin?

Many kids with eczema get frequent skin infections. The very dry skin has cracks that allow bacteria, viruses, and other germs to get inside the body.

When a child has a skin infection, parents often notice that eczema treatment fails to work. Even when following the child’s treatment plan, they may notice that the eczema:

• Remains as is

• Worsens

Honey-colored crusts

These crusts often are a sign of a staph infection.

Blisters

The blisters on this patient's arm are a sign of a staph infection

Crusts and open sore

A staph infection can also look like this.

Small, crusted bumps

This child has an infection caused by the herpes simplex virus, which often causes painful skin and a fever. If your child has these signs, seek immediate medical attention.

How can I tell my child has a skin infection?

A skin infection can look a lot like eczema. Both cause swollen, itchy skin that can ooze fluid and form crusts. By looking closely at your child’s skin, you can find signs of a skin infection.

You’ll want to look for:

• Yellowish-orange or honey-colored crusts, often on top of eczema.

• Pus-filled blisters, especially on top of eczema.

• Sores that look like cold sores or fever blisters.

• Reddish, swollen bumps on skin.

• Streaks or redness spreading on skin.

You’ll also want to check your child for:

• A fever

• Flu-like symptoms

• Pain

• Swollen tonsils and other lymph nodes (commonly called lymph glands)

Infection or eczema?

A skin infection can look a lot like eczema. Looking for some common signs can help you spot a skin infection.

What should I do if my child seems to have a skin infection?

Flu-like symptoms or a fever (thermometer reads 100.4° F or higher): Get immediate medical care.

Signs of infection without fever: If you see signs but your child seems the same as usual, contact your child’s dermatologist.

If you are using wet-wrap therapy, occlusion (covering the eczema with plastic), or soak and smear, stop. These can worsen the infection. Before using one of these treatments again, ask your child’s dermatologist when it’s safe to start.

How is a skin infection treated?

Medicine is required to clear the infection. The type of medicine will vary with the type of germ causing the infection. An antibiotic is necessary to treat an infection caused by bacteria, such as a staph or strep infection. Some antibiotics you apply to the skin. Others come in pill form.

A virus often requires an anti-viral medicine like acyclovir.

A fungal infection may be treated with an anti-fungal cream. Sometimes stronger medicine is necessary to treat an infection caused by a fungus.

Can I prevent new skin infections?

If your child gets frequent skin infections, the following can be helpful:

1. Bathe your child as often your child’s dermatologist recommends. Bathing helps remove bacteria, viruses, and other germs from the skin. It also helps the skin heal.
2. Moisturize your child’s skin as often as necessary to reduce dry skin and cracking. Germs enter the body through cracks in the skin.
3. Avoid dipping your fingers into your child’s moisturizer. Dipping your fingers into your child’s moisturizer can spread bacteria and other germs from your child’s skin to the moisturizer. If you’ve been dipping your fingers into your child’s moisturizer and your child develops a skin infection, you’ll need to throw away the moisturizer.

You can avoid spreading bacteria and other germs by:

• Using a pump applicator
• Scooping out the moisturizer with a spoon

4. Ask your child’s dermatologist about bleach bath therapy. For children who get frequent skin infections, this therapy may be helpful.
5. If your child continues to have just as many skin infections and you’re doing everything to prevent these, tell your child’s dermatologist.

A bit of detective work may be necessary to find out what’s causing the infections.

Why do children with eczema get frequent skin infections?

The skin has many important jobs. One is to keep out germs and other harmful substances. Eczema makes the skin less effective at doing this job, so it’s easier for bacteria, viruses, and other germs to get inside the body.

Following the dermatologist’s treatment plan helps to build up the skin so that it can do a better job of keeping out germs and other substances.

Related AAD resources

• Cold sores: Should I keep a child with eczema away?

• Does eczema put my child at risk for infections?

• How to bathe a child who has eczema

Images

• Blisters, crusts and open sores: Photos used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

• Honey-colored crusts: Photo used with permission of Moise L. Levy, MD, FAAD.

• Small, crusted bumps: Dermatology DDx Deck, Photo reprinted with permission of Elsevier-Moby. 

References
Arkwright PD, Motala C, et al. “Management of difficult-to-treat atopic dermatitis.” J Allergy Clin Immunol Pract. 2013 Mar;1(2):142-51. 

Eichenfield LF. “Perspectives in atopic dermatitis: Optimizing outcomes (introduction)” Semin Cutan Med Surg. 2012 Sep;31(3 Suppl):S1-2. 

Pride HB, Tollefson M, et al. “What new in pediatric dermatology?” Part I. Diagnosis and pathogenesis. J Am Acad Dermatol 2013 Jun; 68(6):885.e1–885.e12.

Pride HB, Tollefson M, et al. “What new in pediatric dermatology?” Part II. Treatment. J Am Acad Dermatol 2013 Jun; 68(6):899.e1–899.e11.

Silverberg J Garg N et al. “New developments in comorbidities of atopic dermatitis.” Cutis 2014 May;93(5).222-4.