Infections with bacteria and viruses are common among atopic dermatitis patients. For instance, over 90 percent of patients have the bacteria Staphylococcus aureus on their skin, and the breaks in the skin barrier caused by the rash and by scratching can lead to infection. Proper skin care measures directed at maintaining a healthy skin barrier are a key part of reducing bacterial colonization or infection. In addition, topical anti-inflammatory medications including steroids and calcineurin inhibitors reduce the ability of bacteria to bind to the skin.
For small, localized bacterial infections, a prescription topical antibiotic called mupirocin is often used. This is an ointment usually applied to the affected area three times per day for one to two weeks. The brand name of this drug is Bactroban. Oral antibiotics are used for more extensive or more severe skin infections. A skin culture done with a cotton swab may be helpful to determine if bacteria are sensitive or resistant to different antibiotics. Methicillin-resistant staphylococcus aureus (MRSA) is becoming a more common problem for patients with atopic dermatitis.
Viral infection is another complication of atopic dermatitis. Herpes simplex is a common viral culprit. Anti-infective drugs such as oral acyclovir or valcyclovir may be prescribed for localized outbreaks but intravenous acyclovir may be needed for more wide-spread infection. If there is any possibility of ocular involvement, then evaluation by an eye specialist as soon as possible is necessary.
Good skin hydration is also important in restoring the skin barrier to protect against infectious agents. Cleansers can also decrease skin colonization by bacteria. Some dermatologists have been prescribing dilute bleach baths, especially for patients with recurrent MRSA. However, these may be very irritating for some patients and since the nose is a main reservoir of staph bacteria, patients often get quickly re-colonized.