What Is Weeping Eczema?

Eczema is a non-contagious skin condition involving dry, itchy, sore and inflamed skin. Weeping eczema or oozing eczema may be painful and uncomfortable and occurs when the affected skin becomes infected and oozes fluid.¹ 

Possible infections

Staph infection

Commonly, the infection is due to the bacteria Staphylococcus aureus, which is a bacteria often found on our skin. The infection causes symptoms such as fluid oozing from the sore skin, yellow spots or yellow crustiness on the skin, along with feeling unwell. One study discovered that 90% of children with eczema were found to have high populations of Staph on their skin. Another study revealed that 97% of pediatric-infected eczema was caused by Staphylococcus aureus.^{2, 3}

Viral infection: Herpes.

Alternatively, eczema can be caused by a virus. Herpes is a simplex virus, which causes common cold sores, and leads to a potentially serious condition called eczema herpeticum if open eczema is infected. This condition causes painful blisters, which may be red, purple or black, and ooze pus. Eczema herpeticum may also lead to fever, chills,  swollen lymph glands, and serious complications if not treated with antiviral medication.⁴

Why does eczema weep?

Serum

The weeping or oozing occurs due to infection in the eczema rash. The fluid is likely to be a transparent and watery serum, also known as serous fluid, leaking from the wound in the eczema rash. A small amount of serous fluid shows normal healing to injury, but large amounts of weeping indicate there is an active infection. More and more serous fluid accumulates as your immune system increases its attempt to fight the infection.¹

Serosanguinous (pink fluid)

If the clear fluid is pink-tinged, it is ‘serosanguinous’ and leaking from the blood. This may indicate there are broken capillaries, so plasma and red blood cells are leaking with the serum.

Pus

When the fluid weeping from the skin is thick and creamy, this is pus or ‘purulent drainage’ - it may appear yellow, white, grey or brown. This colour is due to many dead white blood cells alongside other proteins from the blood, which have been fighting the infection.

What is eczema?

Eczema is a chronic condition, meaning it is long-term with no cure. Although there are several treatments that can minimise symptoms. Let’s summarise the different types of eczema.

Atopic dermatitis

Atopic dermatitis is the most common type of eczema.⁵ ‘Atopic’ means allergic, and ‘dermatitis’ means inflammation of the skin. Therefore eczema is triggered by an allergic response to substances such as pollen, dust, or pet dander. Its onset is usually in infancy, but it can begin at any time, including in adulthood. 

Atopic dermatitis causes patches of dry, itchy, sore skin. On white skin, this tends to look red, whilst on brown or black skin, eczema may appear purple or dark brown. Eczema patches can occur anywhere on the body, but most commonly they appear on the hands, face, the insides of the elbows, and the backs of the knees.

Contact dermatitis

Contact dermatitis is eczema triggered by contact with a substance such as soap or detergent.⁶ It may also be triggered by specific materials such as metals, ingredients in cosmetic products, or simply too much contact with water. The inflamed, itchy, dry skin will occur a few hours after contact with the irritant.

Dyshidrotic eczema

Dyshidrotic eczema or pompholyx is a type of eczema that causes itchy blisters on the hands and feet.⁷ Symptoms tend to be short-lived, lasting two or three weeks at a time. First, you experience an itchy, prickly feeling in the affected area. Then, small fluid-filled blisters appear, and afterwards, dry, cracked skin once the blisters have vanished. This is thought to be caused by irritation triggered by chemicals found in soap, or an allergic reaction to materials such as nickel. Pompholyx may also be caused by frequent exposure to water, stress, or heat (for example, hairdressers may experience this type of eczema).

Nummular eczema

Nummular eczema is also known as discoid eczema or dermatitis.⁸ The name comes from the coin-shaped patches of inflamed, itchy skin. This often becomes infected and therefore weeps and oozes liquid. Nummular eczema often clears up after strong treatments are given, such as corticosteroid creams and antibiotics to remove the Staph infection.

Venous eczema

Venous eczema is also referred to as varicose eczema or stasis dermatitis. This type of itchy, dry skin usually affects people over the age of 50 with varicose veins, especially women. The itchy skin patches may become red or dark and sometimes contain orange-brown speckles. Factors such as high blood pressure, obesity, and kidney failure increase the risk.

Causes and triggers

Genetic predisposition

Allergic conditions are likely to run in families. Identical twins are found to have high concordance rates for eczema, from 72% to 86%, meaning that if one twin has eczema, there is at least a 72% chance that their twin also has the condition. This shows that eczema is strongly associated with genetics but is also influenced by environmental factors.^{9, 10}

Candidate genes

Several genes increase your risk for eczema. Some of these genes affect a protein found in the skin barrier called ‘filaggrin’. Two healthy copies of filaggrin are needed to repair skin damage. In eczema, you may have one faulty copy of the gene and only one healthy copy. This leaves the skin vulnerable to dryness then to irritants entering the skin and causing inflammation. 

Another group of genes implicated as an eczema risk factor are involved in type 2 T helper lymphocyte function (Th2): these are white blood cells involved in the immune response against allergens, toxins or bacteria in the body.¹¹

Allergies

Eczema is commonly linked to allergies. Eczema makes up part of the “atopic march”, a phenomenon where many patients are diagnosed with atopic eczema as a very young child, then a food allergy, followed by allergic rhinitis (runny nose and hay fever), and later allergic asthma.¹² This common sequence of diagnoses indicates that these allergic issues are closely related. Allergens causing eczema include allergies to dust mites, pet dander, and pollen.

Irritants

Irritants for eczema vary depending on the person. You might find that specific soaps and shampoos irritate your skin. Pay attention to which products work well and which products worsen any irritation. Detergents and washing up liquids might also be irritants, resulting in itching or dryness. Environmental factors such as extreme temperatures or very dry air can also irritate sensitive skin.

In addition, sweat can act as an irritant, explaining why many people have eczema in areas such as the insides of the elbows and the backs of the knees. Research has also suggested sweat may affect people with eczema differently, which may cause more irritation or dryness than typical sweat.¹³

Low vitamin D?

Eczema is more prevalent in areas of high latitude, further from the equator. Because of this, the ‘Vitamin D Hypothesis’ has been suggested, linking low vitamin D to allergic conditions such as eczema.¹⁴ Research findings are inconsistent, with some studies saying that low vitamin D increases eczema risk and severity, while others contradict this. Vitamin D plays a role in immune responses, as well as in controlling proteins in the skin such as filaggrin. Further studies are needed to clarify this, but some scientists and doctors suggest that increasing vitamin D levels through supplements or sun exposure could help reduce eczema severity.¹⁴

What are the treatments for weeping eczema?

Moisturisers/emollients

A key treatment for eczema is to regularly apply emollients and un-fragranced moisturisers to prevent dryness and reduce itchiness. The moisturizer mustn’t contain fragrance, as this is likely to irritate and inflame the skin. If the skin is very dry, the emollient should be thick. Thin, watery emollients can increase dryness when applied to inflamed eczema.^1,15

Antibiotics

As the weeping indicates there is an infection in the skin, you may be prescribed antibiotics to kill the bacterial infection. Antibiotics can be administered directly into the skin via cream or may be taken as an oral tablet. However, if the infection is found to be viral, antiviral medication should be given instead.

Steroid treatment

Steroids can be applied directly to the skin (topical treatments) or taken in the form of pills or injections. These help by reducing inflammation. Usually, eczema patients are given topical corticosteroids such as cream, gel, mousse, ointment or solution.

Patients are likely to start with a mild corticosteroid cream such as hydrocortisone, which can be bought over the counter in most countries. If a mild steroid is insufficient, stronger, more potent corticosteroid treatments can be attempted. These can provide a stronger anti-inflammatory effect but are also more likely to cause side effects such as thinned skin or changes in skin colour.

Allergy treatment

Antihistamines

Antihistamines are useful at reducing the feeling of itchiness caused by histamine release in the skin. As many eczema patients have allergies, antihistamine tablets reduce their reaction to allergen exposure and help reduce the urge to scratch the skin.

Targeting allergies with immune shots

Specific allergen immunotherapy may be offered to reduce the allergic reaction in a patient with atopic dermatitis. This involves regular low-level exposure to the allergen - as an injection or a drop under the tongue. However, research results on the efficacy of this for reducing eczema symptoms are inconclusive.¹⁶

UV therapy

Some patients may be recommended ultraviolet (UV) therapy to reduce their eczema symptoms. This is also known as ‘phototherapy’ or ‘light therapy’.¹⁷ UV light is naturally antiseptic and can reduce the number of T lymphocytes (white blood cells) in the skin, which are involved in inflammation. However, this treatment option is usually only recommended as a last resort when steroids and creams are not helping.

New treatments: monoclonal antibodies

Modern treatments are being explored that specifically target part of the biological process of eczema. Monoclonal antibodies are drugs that act like antibodies, binding to a specific target in the body. For example, rocatinlimab binds to a molecule linked to T lymphocytes, reducing the inflammation process in eczema, and this has been found to effectively reduce symptoms of moderate and severe eczema.¹⁸ Research into these types of drugs is still ongoing.

Coping strategies

Eczema is a chronic condition patients may need to learn to live with and manage. Several strategies can help improve the quality of life when dealing with eczema.

• If eczema is very painful, try applying a warm, wet compress to soothe this
• Avoid using soaps - take warm baths containing moisturising oils, and moisturise well after washing
• Gently pat yourself dry after washing, and avoid rubbing yourself with a towel to prevent any accidental scratching
• Keep fingernails clean and trimmed to reduce potential damage by scratching
• Use cotton clothing and cotton gloves to protect the skin
• Avoid irritants such as extreme temperatures or exposure to dry air
• Avoid exposure to chemicals such as chlorine in swimming pools or cleaning liquids, or take extra care to protect your skin and clean and moisturise it after potential exposure
• Practice self-care and stress reduction techniques such as mindfulness, yoga, or any exercise you enjoy
• Use social support by talking to friends and family about what you are dealing with

Summary

Weeping eczema is a very uncomfortable condition caused by infection to an area of inflamed skin. There are several possible causes for eczema, including allergies or irritation by a particular substance. Eczema can be an ongoing struggle but some treatments reduce symptoms by minimising inflammation or reducing the allergic reaction, alongside taking special care of your skin and regularly moisturising. When weeping is severe, you may need antibiotics to stop the infection.