Infection and AD Flares

This chapter summarizes the infectious diseases that often occur in patients with atopic dermatitis, their treatments, and prevention options. Infections occur in atopic dermatitis because the skin barrier is compromised and the production of antimicrobial peptides is decreased. The infection rate in atopic dermatitis is high and not only causes physical discomfort to the patient but also creates increased financial obligations for patients that require frequent and prolonged treatment. Cutaneous staphylococcal infections are common in atopic dermatitis patients, as they are more likely to be colonized by Staphylococcus aureus compared to the general population. This can manifest as impetigo, non-purulent skin and soft tissue infections, and purulent skin and soft tissue infections. There are different treatments for staphylococcal infections, ranging from topical to intravenous antibiotics, often based on severity of infection. Eczema herpeticum, eczema coxsackium, and molluscum contagiosum are common viral infections that occur in atopic dermatitis, with specific diagnostics and treatments expanded upon in this chapter. The efficacy of bleach baths to alleviate atopic dermatitis symptoms as well as reduce risk of infection is also discussed, with current research showing conflicting amounts of support for the therapy option. Decolonization is a different method to attempt to eradicate Staphylococcus aureus from the body, most often through treating the nares with mupirocin; there is evidence for its efficacy but also risks of recolonization and resistance after treatment. Infection in atopic dermatitis is frequent and can even prove fatal. Understanding the common infections that occur and their management are highlighted in this chapter.