Atopic Dermatitis Complications: What You Need to Know

The most common form of eczema, atopic dermatitis affects about 12 percent of children and 7.2 to 10.2 percent of adults in the United States. (1,2)

Some children may grow out of atopic dermatitis, but the inflammatory skin condition is a chronic (long-lasting) affliction for adults. (3)

One common misconception about atopic dermatitis is that "it is only a skin problem," says Kanwaljit K. Brar, MD, a pediatric allergist and immunologist at NYU Langone in New York City. But this is far from the truth. "Atopic dermatitis is a systemic disease and very bothersome to those who suffer from it," she explains.

What's more, both children and adults with atopic dermatitis can experience complications from the disorder. These are most typically bacterial infections, viral infections, and psychosocial complications.

If you or your child has atopic dermatitis, it's important to know the telltale signs and symptoms of the skin condition, as well as what kinds of complications and conditions are associated with it.

Atopic dermatitis is thought to be caused by a malfunction in the immune system and problems with the skin barrier. When a substance from inside or outside the body triggers the immune system, it overreacts and produces inflammation. This causes the skin to develop an itchy rash. (1,3)

Symptoms of atopic dermatitis include:

• Dry, scaly, very itchy skin
• Inflamed skin
• Cracks behind the ears
• A rash on the cheeks, arms, or legs
• Open, crusted or “weepy” sores (usually during flares) (3)
• Hives
• Dry, pale patches on the face and upper arms
• Small bumps on the upper arms and thighs
• Hyperlinearity (an increase in lines) on the palms of the hands and feet
• A double skinfold underneath the lower eyelid (4)
• Raw, swollen skin
• Skin color changes
• Thickened or leathery skin
• Ear discharge or bleeding (if eczema occurs in the ear) (5)
  

People with atopic dermatitis may fall into the "itch-scratch" cycle. That is, the itching associated with eczema can lead to scratching and rubbing that further irritates the skin. This can, in turn, cause increased itching and scratching that worsens eczema symptoms. (6)

And if the scratching is severe enough to break the skin and leave open sores, it can lead to a common atopic dermatitis complication: a bacterial infection, particularly from staphylococcus and streptococcus bacteria.

In fact, 60 to 90 percent of people with atopic dermatitis probably have staph bacteria on their skin, which can potentially cause infection, according to the National Association of Allergy and Infectious Diseases.

Signs of a bacterial skin infection include:

• Fluid oozing from pustules (blisters)
• Patches of yellow, crusty skin
• Fever and general malaise (7,8,9)
• Swollen, painful skin

People with atopic dermatitis may have a reduced ability to fight these infections, and therefore may further suffer from boils, folliculitis (inflammation of the hair follicles), and impetigo (a highly contagious skin infection).

The infection can also worsen eczema symptoms and make the condition temporarily more resistant to treatments. The bacterial infection often has to be treated with antibiotics before the eczema can be brought under control.

In rare cases, the bacterial skin infection can infect the bloodstream, causing septicemia. (10)

People with atopic dermatitis are at risk for a type of infection from the herpes simplex virus, the virus behind cold sores. This infection is called eczema herpeticum.

RELATED: Eczema (Atopic Dermatitis): A Glossary of Formal and Informal Terms 

Eczema herpeticum starts as a cluster of itchy, painful blisters filled with fluid or pus. The infection also causes fever and swollen lymph nodes around the affected skin areas.

Over time, the blisters will weep or ooze, then break open, creating lesions with a hole-punched look. The lesions usually heal within six weeks.

In severe cases, the infection may affect multiple organs, including the eyes, brain, lung, and liver. (9,11,12)

If a person with atopic dermatitis receives the live-virus smallpox vaccine, a potentially serious infection called eczema vaccinatum may develop. It causes similar symptoms to eczema herpeticum and may be indistinguishable from it in some cases. Usually, however, the blisters and pustules are more pronounced. (13)

Children with atopic dermatitis are also at higher risk of developing a common viral skin infection called Molluscum contagiosum. Caused by a poxvirus, Molluscum contagiosum causes localized clusters of papules (small raised bumps on the skin) with navel-like depressions. The papules contain white, cheesy material (pus).

Doctors typically treat Molluscum contagiosum by removing the contents of the papules and applying antiseptics. (13,14)

Some research suggests that people with atopic dermatitis are susceptible to fungal infections, particularly chronic dermatophyte infections — fungal infections that affect keratinized tissue, such as the skin, hair, and nails. In particular, atopic dermatitis increases an individual's risk of superficial and persistent infections by the fungus Trichophyton rubrum, predominantly on the hands, feet, and nails.

Infections by yeasts in the genera Malassezia and Candida are also common among people with atopic dermatitis. Malassezia yeast are thought to be behind another type of eczema called seborrheic dermatitis, and Candida yeast are the culprits behind various types of yeast infections (including vaginal yeast infections).

Fungal infections aggravate the symptoms of atopic dermatitis and are treated with antifungal medication. (13,15)

Atopic dermatitis can psychologically affect both children and adults.

Preschool children with the condition are more likely to have hyperactivity and other behavioral problems, as well as dependency issues, than those who don't have it.

Children with atopic dermatitis may also experience teasing or bullying, which can be traumatic and cause lasting psychosocial problems. They may develop self-confidence issues that may further affect their ability to develop social skills.

What's more, children and adolescents with the disorder are 2 to 6 times more likely to have depression, anxiety, or conduct disorder than children without it, according to the National Eczema Association.

Adults with atopic dermatitis, on the other hand, have a two-and-a-half- to threefold higher risk of anxiety or depression than those without it. That risk increases with disease severity.

"Patients and caregivers with eczema can also have significant sleep disturbance, [and] this often correlates with the severity of the eczema," Dr. Brar says. Sleep disturbances can affect mood and cause daytime sleepiness and fatigue.

Atopic dermatitis can also result in lifestyle limitations and avoidance of social interactions. (1,9)

People with atopic dermatitis may suffer from comorbid chronic conditions — conditions that are present at the same time.

"Children with eczema can undergo the atopic or allergic march," Brar says. The "atopic march" is a genetic tendency to develop allergic diseases like food allergies, allergic rhinitis, and asthma.

"Food allergies can be life-threatening, and parents of babies with moderate to severe eczema should consult with a doctor before introducing their babies to allergenic foods, such as eggs and peanuts," Brar advises.

Adults often have other serious chronic conditions, including diabetes, obesity, autoimmune disease, high blood pressure, and heart disease. The risk for these conditions increases with atopic dermatitis disease severity.

They also have an increased risk for eye-related conditions, including conjunctivitis (inflammation of the outer membrane of the eyeball and inner eyelid), keratitis (inflammation of the cornea), and keratoconus (progressive disease of the cornea), which increase with disease severity. (1)