Treatment of Eczema Flare with Secondary Infection

Identifying Secondary Infection

The presence of crusting or weeping of eczematous lesions suggests bacterial infection, according to the British Medical Journal 2, 3
Grouped, punched-out erosions or vesiculation indicate herpes simplex infection (eczema herpeticum), not bacterial infection, as noted by the British Medical Journal 2, 3
Bacteriological swabs are not routinely needed but may be necessary if patients fail to respond to treatment, as stated by the British Medical Journal 2, 3

The British Medical Journal recommends using topical corticosteroids as the primary therapy for eczema flares with secondary bacterial infection, combined with oral flucloxacillin (or erythromycin if penicillin-allergic) 1
Topical corticosteroids remain the cornerstone of treatment even when infection is present, according to the British Medical Journal 2, 3, 4
The British Medical Journal suggests using the least potent preparation required to control the eczema, applying no more than twice daily, and stopping corticosteroids for short periods when possible to minimize side effects 2, 3, 4
Very potent and potent preparations should be used with caution for limited periods only, as recommended by the British Medical Journal 2, 3
Oral antibiotics, such as flucloxacillin, are important for treating overt secondary bacterial infection, according to the British Medical Journal 3, 4
Flucloxacillin is the first choice for Staphylococcus aureus, the most common pathogen, as noted by the British Medical Journal 1, 4
Erythromycin may be used when there is resistance to flucloxacillin or in patients with penicillin allergy, as recommended by the British Medical Journal 1, 4

If herpes simplex infection is suspected, oral acyclovir should be given early in the disease course, according to the British Medical Journal 1, 4
In ill, feverish patients, acyclovir should be administered intravenously, as recommended by the British Medical Journal 1

The British Medical Journal suggests continuing regular bathing for cleansing and hydrating the skin, and applying emollients after bathing to provide a surface lipid film that retards water loss 2, 3, 4
Sedating antihistamines may be useful as short-term adjuvants during severe pruritic episodes, primarily at night while asleep, as noted by the British Medical Journal 2, 3, 4
Non-sedating antihistamines have little to no value in atopic eczema, according to the British Medical Journal 2, 3, 4

The British Medical Journal recommends not delaying or withholding topical corticosteroids when infection is present, as they remain the primary treatment 2, 3, 4
The concern about using steroids during infection is unfounded when appropriate systemic antibiotics are given concurrently, as stated by the British Medical Journal 1