Introduction

Eczema can often be unbearably itchy, and it can be very tempting to scratch the affected areas of skin. However, chronic scratching can damage the skin, which can cause more eczema, increasing the risk of your skin becoming infected or scarred. So, what started as a more manageable skin condition may turn into something more serious—Impetigo, a contagious bacterial infection. These two skin issues, though different, are more connected than you might realise. In this essay, we’ll explore how eczema and Impetigo can interact, why one might lead to the other, and what this means for those looking to keep their skin healthy.

What is Eczema?

The most prevalent type of eczema is atopic dermatitis (atopic eczema). It is a long-term skin disorder that produces dryness, itching, redness, and inflammation. Although it can affect people of any age, children are particularly susceptible (and it often develops before they turn 1). People who have eczema typically have more sensitive and reactive skin, which frequently reacts to a variety of triggers such as allergens, irritants, stress, or weather changes.¹

Eczema typically appears as patches of dry, scaly skin that may become red and inflamed. However, it can present quite differently in people of colour as darker skin tones may mask the redness so it may appear more dark brown, purple or ashen grey. As a result, misdiagnosis or delayed diagnosis may happen.²

The afflicted areas may be quite irritating, and rubbing the area may aggravate it even more. Though it can arise anywhere on the body, eczema typically affects the face, hands, inside the elbows, and behind the knees.¹

The exact cause of eczema isn't fully understood, but it's believed to involve a combination of genetic and environmental factors. People with a family history of eczema, allergies, or asthma are more likely to develop the condition. Eczema is often managed with moisturisers, topical steroids, and by avoiding known triggers. While it can be persistent and uncomfortable, many people find ways to manage their symptoms and keep flare-ups under control.¹

What is Impetigo?

Impetigo is a highly contagious bacterial skin infection that affects people of all ages, but it usually affects young children. It is caused by two types of bacteria: Staphylococcus aureus and Streptococcus pyogenes. The infection typically develops when bacteria enter the skin through a cut, scrape, or insect bite.³

It normally starts with red sores or blisters, but the redness may be harder to see on brown and black skin. These typically appear on the face, particularly around the nose and mouth, but it can also affect other areas like the hands and legs. When the sores burst, it can form crusty, golden-brown patches which are itchy and uncomfortable, although scratching it can spread the bacteria to other parts of the body or other people.³

There are two main types of impetigo:⁴

1. Non-bullous impetigo: The more common form, characterised by small red sores that quickly rupture, ooze, and form a crust
2. Bullous impetigo: Less common, marked by larger blisters filled with fluid that stay intact longer before bursting

Impetigo is usually treated with topical or oral antibiotics, depending on the severity of the infection. Doctors often prescribe hydrogen peroxide cream if it's in 1 area, an antibiotic cream or tablets if it's more widespread and antibiotic tablets if you have bullous impetigo.³

Good hygiene practices, such as regular hand washing and keeping wounds clean, are essential in preventing the spread of the bacteria. With proper treatment, impetigo typically clears up within a week or two, but it can be recurring, especially in environments where close contact is common, like schools or daycare centres.³

The Link Between Impetigo and Eczema

Those with eczema tend to have a higher risk of developing impetigo because they have a compromised skin barrier. The inflammation and dryness and, therefore, itching associated with eczema often leads to small ‘open wounds’ in the skin, allowing bacteria to enter (such as Staphylococcus aureus and Streptococcus pyogenes, which are responsible for Impetigo), meaning that people with eczema are more prone to skin infections.¹

When impetigo develops on skin already affected by eczema, it can lead to a secondary bacterial infection. Eczema patients already have inflamed and damaged skin, so the presence of bacteria can cause the infection to spread more rapidly, which can worsen the condition. This secondary infection can result in more severe symptoms, making eczema harder to manage and treat as patients may not respond to their regular treatments. If the infection triggers an inflammatory response, causing the eczema to flare up more severely than before, it can create a cycle where the worsening eczema and itching provide more opportunities for bacterial growth, further complicating the condition and prolonging the healing process.¹

Prevention and Management of Co-occurrence

Practising good skin hygiene is important for patients with eczema to prevent impetigo. That involves regular handwashing, especially after scratching or touching eczema-affected areas, as it can help reduce the risk of introducing harmful bacteria into the skin. It's also important to keep the skin clean and dry, particularly in areas prone to eczema, to prevent bacterial growth. Also, using mild antibacterial cleansers and avoiding known irritants that can further trigger and irritate the skin can be effective in maintaining hygiene without worsening eczema symptoms.^1,5

Treating eczema flares quickly and effectively can also reduce the risk of developing impetigo. Early intervention with moisturisers, topical steroids, or other prescribed treatments can help control inflammation and prevent the skin from becoming so compromised that it becomes vulnerable to bacterial infection. It's also important to manage itching to minimise scratching, which can break the skin, causing open wounds and increasing the likelihood of impetigo.¹

When eczema and impetigo co-occur, a combined treatment approach is often necessary. This might involve using topical or oral antibiotics to treat the impetigo while continuing to manage the eczema with appropriate moisturisers, anti-inflammatory medications, and other eczema-specific treatments. The goal is to address both conditions simultaneously to prevent them from exacerbating each other so that patients can heal more quickly.

Lifestyle modifications, such as dietary changes and stress management, can also play a role in preventing eczema flares and, by extension, impetigo. Some eczema patients find that certain foods trigger their symptoms, so identifying and avoiding these triggers can help maintain skin health. Stress is also a known trigger for eczema flare-ups, so incorporating stress management techniques can be beneficial in reducing the frequency and severity of eczema flares.¹

Using gentle, hypoallergenic skin care products can help protect the skin’s barrier and reduce the risk of irritation and infection. Products free from fragrances, dyes, and harsh chemicals are less likely to aggravate eczema and can help maintain skin health. Regular use of emollients and moisturisers can keep the skin hydrated and resilient, reducing the risk of cracks and breaks that could lead to impetigo.⁶

Conclusion

Eczema and impetigo are distinct skin conditions, but they are closely linked, with eczema increasing the risk of developing impetigo due to the compromised skin barrier. Impetigo, in turn, can complicate and worsen eczema symptoms, creating a cycle that is challenging to manage. Understanding the symptoms, causes, and interactions between these two conditions is crucial for effective prevention and treatment.

FAQs

What is the difference between Impetigo and Eczema?

Eczema is a type of dermatitis, while impetigo is a type of skin infection. Eczema can appear anywhere on the body and can cause intense itching that comes and goes, whereas Impetigo is a highly contagious infection that can be a result of the open wounds caused by Eczema. It usually appears as crusty, honey-coloured sores and blisters around the mouth and nose. Impetigo can mimic eczema, especially if it occurs in open, weepy, eczema-affected skin. However, the hallmark feature of impetigo is the honey-coloured crust on the surface.

How can I prevent impetigo if I have eczema?

Maintaining good skin hygiene, promptly treating eczema flare-ups, and using gentle, non-irritating skin care products can help prevent impetigo. Avoiding scratching and keeping the skin well-moisturised are also crucial steps.

Is it possible to treat both eczema and impetigo at the same time?

Yes, both conditions can be treated simultaneously. Treatment usually involves using antibiotics for impetigo while continuing to manage eczema with moisturisers, topical steroids, or other prescribed treatments. Medical guidance is crucial to ensure both conditions are treated effectively.