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Infective Dermatitis: Origin, Causes, and Treatment

When we talk about dermatitis, we’re usually speaking about skin inflammation associated with atopic dermatitis (eczema) or contact dermatitis. We’re quick to point out that these conditions are not contagious at all, and when we discuss causes, we’re usually talking about genetic predisposition and environmental irritants or triggers–not infection. 



But can dermatitis lesions become infected? And what about infective dermatitis? “Infect” is in its name! Is it contagious? Is it treated the same as atopic dermatitis? Let’s take a look!



Infected Dermatitis: What It Is, Who Gets It, and How to Treat It



Let’s start with infected dermatitis, or infection secondary to chronic dermatitis flare. Because skin barrier damage is a prominent feature of eczema, people with the condition tend to be more prone to different kinds of skin infections. 



Bacterial infection is by far the most common type of infection for eczema sufferers. Our skin is teeming with bacteria at all times. During an eczema flare, dry, cracked skin gives these bacteria an entry point where they can cause infection. Staphylococcus aureus (s. aureus), AKA staph, is the usual suspect. Streptococcus (strep) is another. 



Symptoms to Watch For:


  • Unusually itchy, red patches of skin  A strep or staph infection often starts with intense itching and redness, or skin that is darker than your usual skin tone. 
  • Oozing yellowish pus
  • Yellow, orange, or amber-colored crusts Scaling is a common eczema symptom, but the crusts produced by staph are more likely to have a yellowish or orange appearance (the “aureus” part of the bacterium’s name means golden).
  • Red blisters with pain and warmth  Blisters or bumps that are redder than the surrounding lesions should be watched carefully. Blisters that are warm or painful to the touch should be reported ASAP to your doctor.
  • Red streaks Red streaks emanating from a blister are sometimes seen with a staph infection and call for immediate evaluation by a doctor. 



Bacterial infections won’t resolve without antibiotics, and trust me, you don’t want the complications they can cause. As soon as you notice any symptoms that suggest infection, take it to your doctor. It is important to take medicines exactly as your doctor prescribes them; misusing antibiotics contributes to the rise of resistant strains of bacteria.



Go back to the doctor if the infection doesn’t seem to respond to antibiotics. You could be infected with a strain of staph called methicillin-resistant Staphylococcus aureus (MRSA for short). This strain of staph does not respond to first-choice antibiotics; other antibiotics will be required to treat it. 



reading up on eczema cream can help understand


Preventing Bacterial Infection 

  • Moisturize, moisturize, moisturize! It might sound strange to bring up skincare when we’re talking about infection, but moisturizing is an important part of maintaining the skin’s barrier function (which is our first defense against disease). It’s even more important when you have an eczema flare. Moisturized skin is less likely to crack or itch. Speaking of…
  • Don’t scratch! You’re probably sick of this advice, but it’s important! Scratching transfers bacteria from your hands to your skin, and during an eczema flare, it damages skin that’s already suffering. It’s like rolling out a welcome mat for staph or strep infection. 
  • Wash your hands! Wash your hands without fail after using the restroom, going outdoors, visiting a hospital, or wiping little noses (parents and teachers, looking at you here!). Wash your hands before you apply your all-important moisturizer (ahem!). Use hand sanitizer if you’re in a situation where you can’t immediately wash. Moisturize your hands every time you wash them! 
  • Sanitize surfaces used by multiple people. This pertains to school desks, door handles, sink faucets, wrestling mats, showers, and other areas shared by multiple people. 
  • Don’t swap bed linens or towels with others. 
  • Avoid skin-to-skin contact with infected people. 



If you have a staph or strep infection, all home care, including over-the-counter creams, has to be discussed with your doctor. In some cases, hydrocortisone cream can be used to counteract the itching caused by these infections.(It cannot cure the infection itself. once again, ask your doctor). 



SmartLotionⓇ is a hydrocortisone cream that’s available without a prescription. It was formulated by board-certified dermatologist Steve Harlan, MD to safely address the discomfort caused by chronic skin disorders. Because its probiotic ingredients promote the skin’s healing, it can effectively use a much smaller amount of hydrocortisone than most creams (0.75%). 



Under your doctor’s supervision, SmartLotionⓇ can be safely added to most staph and strep treatment plans. It won’t cure the infection, but it can help you cope with the symptoms while you heal from both your eczema flare and the secondary infection. 



Fungal infections


There are millions of species of fungus. Some of them live on our skin without causing any problems. But just like staph or strep, some of these fungi can cause infection in vulnerable skin. 


Most fungal infections arise from one of two kinds of fungi: Candida is a species of yeast that thrives in warm, moist areas of the body (think underarms, skin folds, feet, and groin). Dermatophytes are mold-like parasites that cause ringworm (these fungi appreciate the same real estate as candida). 


Candidiasis (yeast infection) of the skin causes an intensely itchy, dark red, hive-like rash. It looks remarkably similar to eczema lesions; see a doctor if  your eczema rash is not responding to treatment, especially in areas where candida likes to set up shop (around your nails, for example, or the folds of skin you find at your joints). 


Candidiasis is treated with topical antifungal creams containing clotrimazole, which are available over-the-counter. If the rash doesn’t respond within a week of starting treatment, your doctor can prescribe stronger treatments such as nystatin or ketoconazole. 


Ringworm has nothing to do with worms; it gets its name from the red, circular rashes (rings) it causes. The rashes can be hard to distinguish from those caused by discoid eczema; see a doctor if a circular lesion does not respond to your usual eczema treatments. 


It’s treated with antifungal creams containing miconazole. If it’s located on the scalp or nails, though, oral antifungals (prescription only) might be needed. 


Ringworm spreads easily from skin-to-skin contact or by contact with a pet who has the fungus on its feet or its skin. You can also pick it up from surfaces (especially those in warm, damp places, like a gym shower) and from sharing linens. 


A corticosteroid cream like SmartLotionⓇ can be added to antifungal treatment–it won’t cure the infection, but it will help with the itching (remember not to scratch)!


Viral infections


Eczema herpeticum is a viral skin infection caused by a herpes simplex virus–these viruses normally only cause fever blisters. For people with eczema, an infection with this virus can spread rampantly over the skin. It is a serious condition


Eczema herpeticum lesions rapidly worsen and spread. The virus causes clusters of fluid-filled blisters which can break, leaving open sores on the skin. It is sometimes accompanied by fever and malaise.



These symptoms should be evaluated immediately. If your doctor cannot see you, see an urgent care or emergency department. Eczema herpeticum is highly contagious, so you should be isolated from other patients as you wait. It’s treated with an antiviral drug called acyclovir. 


Eczema herpeticum is spread by skin-to-skin contact, and it can survive for a long time on hard surfaces. Avoid close contact with people who have active fever blisters, especially if you have eczema. 



Do not apply eczema cream to eczema herpeticum sores without your doctor’s guidance!  

Infective Dermatitis

Infective dermatitis is a severe form of eczema associated with the human T cell lymphotropic virus (HTLV-1). HTLV-1 interferes with the immune system, making patients more prone to infection, such as the persistent staph or strep infection that causes infective dermatitis. An infective dermatitis rash resembles a psoriasis flare, with scaly, weeping patches occurring on skin where sebum production is higher (such as the eyelids, scalp, and underarms). 

Infective dermatitis is chronic; the only treatment is long-term systemic antibiotic treatment along with topical corticosteroids. 

Over such a long period, corticosteroid use can lead to skin atrophy and topical steroid withdrawal. This is the kind of case SmartLotionⓇ was formulated for. It won’t cause the skin to thin, and it won’t cause topical steroid withdrawal–even after long-term use. Under a doctor’s care, most people can use it along with their prescription treatments without any adverse effects.

Summing It Up

Infected dermatitis is just what it sounds like–dermatitis flares with an added infection (a rotten cherry on top of the worst sundae ever). It can be bacterial, fungal, or viral in nature.


Infective dermatitis is the result of immune system suppression caused by HTLV-1. Its severe, chronic eruptions of psoriasis-like lesions are caused by a stubborn infection with strep or staph requiring years of oral antibiotic treatments. 

With a doctor’s supervision, SmartLotionⓇ can be used alongside treatments for bacterial and fungal infections (No creams should be applied to eczema herpeticum sores). SmartLotionⓇ is also a great candidate for treating ID symptoms that remain after prescription treatments. 

Bottom line–leave nothing to chance. See a doctor for any suspected skin infection. Don’t forget to ask about adding SmartLotionⓇ to help you through the symptoms!



Steven Harlan MD

Board Certified Dermatologist

Inventor of SmartLotion®

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