Complications Infection

Secondary infection of the skin is the most common complication of AD. Infection can be caused by a variety of bacterial, viral and fungal organisms. The most frequent infections occur with bacterial organisms, most commonly Staphylococcus aureus. As previously stated, some investigators have demonstrated an increased colonization of the skin of patients with AD, with more than 90% of lesions showing colonization in some patients. These organisms gain access to the deeper skin layers because a loss of skin integrity in AD permits secondary infection. Although S. aureus is the most common culprit causing impetiginous lesions, p-hemolytic streptococci are also common. Infected skin lesions may be difficult to detect because of the similarity of appearance of chronic AD and secondary infection. Infected lesions may appear more erythematous, pruritic and crusting with areas of open excoriations. Deep pyogenic infections such as furuncles, abscesses and cellulitis are unusual in AD. Systemic antibiotics are the treatment of choice and frequently provide significant relief of symptoms and aid in clearance of skin lesions.

Viral infections are a particularly troublesome complicating factor in some patients with AD. Patients have an unusual susceptibility to certain types of viral infections. The most common organisms found are those of herpes simplex (eczema herpeticum), verruca vulgaris (common warts), molluscum contagiosum and vaccinia (eczema vaccinatum). Kaposi's varicelliform eruption is a particularly severe, explosive infection caused by herpes simplex or vaccinia infection. Viral lesions are typically vesiculopustular in appearance and occur in clusters on both affected and unaffected skin, but with a predilection toward affected skin. The lesions of molluscum contagiosum are papular, centrally umbilicated lesions surrounded by a pale halo. All viral lesions can be seen on any portion of the body. Infection may be localized or result in systemic toxicity (i.e., herpes and vaccinia). Appropriate antiviral therapy may be indicated on a long-term basis to combat these infections, some of which can become latent and recur later (i.e., herpes simplex). In addition to the mentioned viral infections, patients with AD may be at increased risk for developing severe infection following exposure to varicella.

Fungal infections can also complicate the course of AD. Trichophyton rubra and M. furfur or orbiculare are the most commonly implicated organisms. Candida albicans have also been implicated in some reports, but strong evidence for those yeasts being a source of infection does not exist at present. Infection with M. furfur is typically seen in the adolescent or adult patient with AD in whom a typical head and neck distribution of lesions is noted. Topical and systemic antifungal agents may be necessary to control infection.

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Curing Eczema Naturally

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