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Eczema Herpeticum: Why Cold Sores Are Risky If You Have Atopic Dermatitis
Eczema herpeticum is a painful, blistery rash that occurs when eczema-damaged skin is infected with herpes simplex virus type 1 (HSV-1) , or "oral herpes," through skin-to-skin contact.[2]
The most common symptom of HSV-1 is a cold sore on the lip or around the mouth that takes a week or two to heal. Occasionally, HSV-1 can cause genital herpes, often through oral-genital contact.[4]
Although not typical, another herpes simplex virus, HSV-2, which causes most cases of genital herpes, can also trigger eczema herpeticum.
"Patients with eczema have a compromised skin barrier that puts them at a higher risk of skin infections in general, including eczema herpeticum," says Nika Finelt, MD, the director of pediatric dermatology at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in New Hyde Park, New York. Eczema causes breaks in the skin, which allows the herpes virus in.
In kids and young adults with eczema, wrestling and other contact sports can increase the risk of coming into direct contact with the herpes simplex virus and developing eczema herpeticum. Another common scenario can happen among babies with eczema — an adult with a cold sore who gives the baby a kiss raises the baby's risk of developing eczema herpeticum.
People who have other conditions that cause cracking in the skin's surface, such as contact dermatitis or seborrheic dermatitis, can also develop eczema herpeticum.[2]
Once the herpes virus gains a foothold, the infection can spread rapidly over the body, affect vital organs, and even become life-threatening, says Carol Cheng, MD, a pediatric dermatologist at UCLA Health in Santa Monica. Because of this, eczema herpeticum is considered a medical emergency.
RELATED: Atopic Dermatitis Complications: What You Need to Know
What To Know About Eczema And Inflammation
Certain things set off inflammation flare-ups in people with eczema. These causes may include diet, smoking, or allergies. Since eczema is an autoimmune disorder, it's usually treated with steroids or other immunosuppressants.
Eczema, also called atopic dermatitis, is a disease of inflammation. In fact, the "-itis" in its name refers to inflammation. When you have eczema, your skin becomes inflamed, red, and itchy.
Inflammation isn't always a bad thing. When it's your immune system's response to an injury or infection, it includes the release of antibodies and proteins, as well as increased blood flow to the damaged area. This response helps the body fight germs and heal from cuts and other injuries.
But with eczema, your immune system overreacts to typically harmless substances in your environment. What results is a state of constant, or chronic inflammation. Over time, the inflammation damages your skin, leaving it red and itchy.
Here are some common triggers of inflammation flare-ups in people with eczema.
Certain foods increase inflammation in the body, including:
Eliminating these foods may help clear your skin. But before you make any drastic dietary changes, speak with a healthcare professional. Your doctor or a dietitian can help guide you through an elimination diet to try to clear your skin without taking away the nutrients your body needs.
After your skin clears, you may be able to add foods back into your diet, one at a time.
Tobacco is linked to a number of serious health problems, including cancer and health disease. Eczema is another health issue affected by tobacco use.
In addition to irritating the skin, cigarette smoke has a harmful effect on the immune system. It produces chronic inflammation in the body. Smokers have higher levels of inflammatory markers like C-reactive protein (CRP) in their blood.
A study in the Journal of the American Academy of Dermatology found that people who either smoke or are exposed to secondhand smoke are more likely to get eczema than those who aren't exposed.
Quitting smoking can take time, though. More than half of smokers say they've tried to quit, and not everyone is successful.
Tools like nicotine replacement products and medications can help you manage the urge to smoke. If you need help creating a cessation plan, talk with your doctor.
Eczema is an allergic disease. This means your immune system reacts to normally harmless substances in your environment by producing inflammation.
Some of the allergens most likely to trigger eczema are:
One way to avoid a skin reaction is to do your best to avoid your triggers. Consider keeping a diary to help you identify which substances make you itch.
Allergy shots might help, too. This form of treatment gives you very small doses of your trigger substance, giving your body a chance to build up a tolerance to the trigger and keep you from reacting.
A solid 7–9 hours of sleep each night is essential for healthy immune function. Sleep helps your immune system learn how to react properly to germs and other threats. That may be why people who don't sleep well tend to get more infections and allergies.
Inflammation rises when the sleep pattern is broken. Disrupted sleep can throw off this cycle and lead to more persistent inflammation.
The constant itching from eczema makes it even harder to sleep, which can throw you into a cycle of not enough sleep, in particular REM sleep, and too much itchiness. Getting your eczema under control with medication, moisturizers, and other treatments can help you sleep more soundly.
Your emotional health and the health of your skin are closely connected. When you're under stress, your body releases hormones like adrenaline and cortisol. In larger-than-normal amounts, cortisol can trigger inflammation in the skin.
Dealing with stress-induced flares can make you even more anxious and upset. Managing stress can help prevent flare-ups.
Here are some ways to help keep stress at bay:
Eczema puts you at higher risk for infections. In part, this is because a problem with your skin barrier lets in more bacteria and other germs. Another reason is that inflammation interferes with your skin's natural immune response against these germs.
To prevent infections:
Treating eczema starts with learning and then avoiding your triggers. Bathing or showering in warm water every day and then using an oil-rich moisturizer afterward will prevent your skin from drying out and getting itchy.
These topical treatments, some available over the counter and others by prescription, bring down inflammation and stop the itch:
For moderate-to-severe eczema, doctors sometimes prescribe immunosuppressants like azathioprine, cyclosporine, or methotrexate. These medications lower the overactive immune response and help to relieve eczema symptoms.
People with mild-to-moderate eczema may be prescribed crisaborole. The steroid-free topical ointment was approved to treat eczema in 2016 by the Food and Drug Administration (FDA).
Biologics are a newer type of injectable medication. These biological products target the immune system response that causes inflammation in eczema.
Dupilumab (Dupixent) is the only biologic FDA-approved to treat eczema. It blocks two key chemicals that contribute to the process of inflammation: interleukin-4 (IL-4) and interleukin-13 (IL-13).
If eczema symptoms are interfering with your daily life, ask your doctor what type of inflammation is causing them, and how to manage them. Keep track of your symptoms and their causes to identify your triggers.
Eczema is often part of a group of conditions that doctors call the "atopic march." People with eczema often have asthma and allergies, too. If you have these conditions, you may also need treatment for them.
Inflammation is a part of eczema that contributes to symptoms like redness and itch. There are many ways to reduce inflammation, including diet adjustments, trigger avoidance, and over-the-counter and prescription medications.
It could take a bit of trial and error to find the eczema treatment that finally relieves the inflammation and itch for you. Be persistent — if the first treatment you try doesn't help, go back to your doctor and discuss other options.
Can You Tell A Harmless Rash From The Fatal Or Contagious? Pharmacist Shares Vital Clues And When To Seek Immediate Help
IF your skin breaks out in lumps or bumps, you'll often be tempted to dismiss it as a harmless rash.
In many cases, it will be just that.
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Changes to your skin can provide vital clues about any underlying health conditionsBut a pharmacist has warned Brits not to overlook changes to their skin, as they could be vital clues to a life-threatening condition.
From a subtle discolouration to a change in texture or feel, skin can serve as a silent messenger of the first signs of an underlying health condition.
George Sandhu, deputy pharmacy superintendent from Well Pharmacy, said: "Whether you're curious about a pimple, dry patch or discolouration, your skin can act as a barometer for your general wellbeing.
"Skin is a major organ, capable of revealing not just cosmetic but also potentially life-threatening conditions – it's not something to take lightly.
Read more on skin conditions"Through observation, we can identify changes that may signify deeper health issues."
From shingles to eczema or sepsis - below are ten well-known conditions that affect the skin.
1. ShinglesHow to spot it: Red blotchy skin, which turns into itchy blisters, that ooze fluid.
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Shingles can cause red and itchy patches of skin which turn into blistersCredit: NHS14
The rash can be red, but this can be harder to see on brown and black skinCredit: NHSShingles is an infection that causes a painful rash.
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The 7 stages of Alzheimer's - from changes to forgetfulness and fading awayThe first signs of shingles can be:
The rash will usually appear within a few days of these first symptoms - usually on the chest and belly, but it can appear anywhere on your body including on your face, eyes and genitals.
You can tell if it's a shingles rash if it appears on one side of your body only - if both sides are affected, it's unlikely to be shingles.
Sun Health Explainer: Skin cancer and molesBlotches will pop up on your skin, becoming itchy blisters that ooze fluid. They should dry and out scab within a few days.
In rare cases shingles can cause pain without a rash.
You can't spread shingles to others, but people could catch chickenpox from you if they have not had chickenpox before or have not had the chickenpox vaccine, as both illnesses are caused by the chickenpox virus.
The NHS suggests avoiding pregnant mothers who have not had chickenpox before and people with a weakened immune system – like someone having chemotherapy and new-born babies.
If you have shingles symptoms, you can pop into a pharmacy for diagnosis and treatment under the new Pharmacy First service.
The shingles vaccine helps reduce your risk of the illness and is available on the NHS for:
How to spot it: It starts as itchy, red sores or blisters. Once healed a crusty, yellow or "honey-coloured" scab forms over the sore.
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Impetigo causes sores or blisters that can look like cornflakes stuck to your skinCredit: NHSImpetigo is a very contagious skin infection, but not usually serious. It often gets better in seven to 10 days if you get treatment.
Conditions start with red sores or blisters, which quickly burst and leave crusty golden-brown patches.
The NHS says the patches can look like cornflakes stuck to the skin and can be painful.
Impetigo can easily spread to other parts of your body or to other people until it stops being contagious - this is generally 48 hours after the infected person starts using prescribed hydrogen peroxide cream or antibiotics or when the patches dry out and crust over.
Pharmacy First allows pharmacists in England to provide advice and treatments for impetigo, though you can also see a GP about the condition.
3. Atopic eczemaHow to spot it: Patches of itchy, dry, cracked and sore skin that is red, weepy, crusty, itchy or flaky.
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Eczema can cause the skin to become itchy, dry and crackedCredit: © DermNet New ZealandAtopic eczema - sometime called atopic dermatitis - is one of the most common forms of eczema, a condition that causes the skin to become itchy, dry and cracked.
The skin condition leaves a sufferer scratching, sometimes feeling like they cannot stop.
Some only have small patches of dry skin - this'll often be on the hands for adults or inside of the elbows, backs of the knees and the face and scalp in children.
But others may experience have inflamed skin all over their body.
4. SepsisHow to spot it: Blue, grey, pale or blotchy skin, which can also appear on lips or tongue – on brown or black skin, this may be easier to see on the palms of the hands or soles of the feet.
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Sepsis can cause your skin to look mottle and blueishSepsis is a life-threatening reaction to an infection, where the immune system overreacts and starts to damage the body's tissues and organs.
If you're displaying signs of sepsis, you need to get hospital treatment right away, as it could turn into septic shock if not treated early, resulting in organ failure and even death.
Aside from blue, grey, pale or mottled skin, a rash that doesn't fade when you roll a glass over it - the same as meningitis - can signify sepsis.
Other symptoms can include a fast heart rate, low blood pressure, fever, nausea and vomiting, clammy skin, confusion and diarrhoea.
Go to A&E if you or your child are exhibiting these symptoms.
5. Staph infectionsHow to spot it: A painful red lump or bump on the skin.
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Staph infections can result in boils or abscessesCredit: NHS/SuppliedStaph infections are caused by bacteria called staphylococcus.
Symptoms include:
The infection tends to go away on its own but can sometimes need antibiotics.
The bacteria that cause staph infections live harmlessly on many people's skin, often in the nose, armpits, groin and buttocks.
They usually only cause an infection if they get into the skin – for example, through a bite or cut.
The NHS says the bacteria can spread through close skin contact, sharing towels and toothbrushes and less common, through droplets in coughs and sneezes.
You should see a GP if you think you have a staph infection and it's getting worse or spreading quickly, it lasts more than a weak or you have a weakened immune system.
6. MRSAHow to spot: A red and swollen patch of skin, which leaks pus or liquid and is warm to touch.
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MRSA can cause skin to redden, feel warm and leak fluid or pusCredit: NHS/SuppliedMRSA is a type of bacteria that usually lives harmlessly on the skin, but if it gets inside the body, it can cause a serious infection that needs immediate treatment with antibiotics.
If you get an MRSA infection under your skin, you may have an area of skin that:
You should ask for an urgent GP appointment if you have a wound that's painful, red, swollen or warm, as these could be symptoms of an MRSA infection.
The infection can spread to your blood, lungs, or other parts of your body, causing symptoms that include high temperature, difficulty breathing, chills, dizziness and confusion.
Call 999 or go to A&E if you have any of these symptoms.
7. Pityriasis versicolorHow to spot it: Patches of skin that may be darker or lighter than your normal skin colour - discolouration may be red, brown or pink
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Pityriasis versicolor causes patches of skin to change colourCredit: NHS/Supplied14
On brown or black skin, the patches tend to be paler than the surrounding skinCredit: NHS/SuppliedPityriasis versicolor is a common fungal skin infection that causes patches of skin to change colour.
On white skin, the patches are usually pink, red or pale brown. You may notice the patches do not tan in the sun.
On brown or black skin, the patches tend to be paler than the surrounding skin.
The patches usually appear on the chest, upper back, upper arms, neck or tummy.
You should see a GP if patches of your skin have changed colour.
8. MeningitisHow to spot it: A rash which starts with small, red pinpricks before spreading quickly and turning into red or purple blotches.
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Mengitis causes a rash that doesn't fade when you roll a glass over itCredit: Meningitis Research FoundationMeningitis is an infection of the protective membranes that surround the brain and spinal cord - called the meninges - which can be very serious if not treated quickly.
It can affect anyone, but is most common in babies, young children, teenagers and young adults.
With the effects of meningitis developing suddenly it is important to be aware of symptoms.
It can cause a rash that doesn't fade when you roll a glass over it. But the rash does not always appear, so it's important to know other signs of the life-threatening disease.
Other symptoms to be aware of include:
Call 999 for an ambulance or go to your nearest A&E immediately if you think you or someone you look after could have meningitis.
9. CellulitisHow to spot it: Red, hot and painful skin
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Cellulitis can cause swelling in your fingers, the back of your hand or near your toesCredit: NHS/Supplied14
It can also affect your eye, which can be seriousCredit: NHS/SuppliedCellulitis is a skin infection that's treated with antibiotics. It can be serious if it's not treated quickly, with complications including a blood clot or infection of the bone joint.
The condition makes skin feel painful, hot and swollen. Skin may also be blistered, and your glands can also get painful and swollen.
Cellulitis is caused by a number of bacteria. The bacteria gets into the body through a wound, whether it be an ulcer, tattoo or insect bite.
Cellulitis generally affects the legs and feet.
10. Molluscum contagiosumHow to spot it: Raised and dome-shaped spots with a shiny white dimple in the middle.
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Molluscum contagiosum causes dome-shaped spots with a shiny white dimple in the middleCredit: NHS/SuppliedMolluscum contagiosum is an infection that causes spots on the skin, which is usually harmless and rarely needs treatment.
The spots tend to be about 2 to 5mm wide and usually appear together. They are raised and dome-shaped with a shiny white dimple in the middle.
Children with the infection often get spots on their body and in or around folds of skin, while adults may get them in the lower tummy area and groin if it's spread through sexual contact.
The spots should clear up within 18 months without needing treatment.
The condition is usually passed on by direct skin to skin contact, however the chance of passing it on to other people during normal activities is so small that normal day-to- day activities can continue.
When a skin rash requires you to see a doctor or call 999
MOST of the time, rashes in babies and children aren't anything too serious.
But if you little one's rash is accompanied by any of the following symptoms, they need urgent medical help and you must call 999 or take them to A&E immediately:
Source: NHS
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