Eczema (atopic dermatitis) is a skin condition that is primarily inflammatory and is not caused by bacteria. As a result, antibiotics are rarely used as a first-line treatment for eczema. In most cases, the mainstay of eczema treatment involves moisturizers (emollients) to keep the skin hydrated, topical corticosteroids to reduce inflammation during flare-ups, and other non-steroidal anti-inflammatory medications like topical calcineurin inhibitors.
However, in certain situations, antibiotics may be prescribed for individuals with eczema. These situations include:
- Secondary Infections: When eczema causes breaks in the skin, bacteria can enter and cause secondary infections. If an infection is suspected or confirmed, topical or oral antibiotics may be prescribed to treat the infection.
- Eczema Herpeticum: Eczema herpeticum is a severe complication of eczema caused by the herpes simplex virus. It leads to widespread and painful blisters that can quickly spread. In this case, antiviral medications (not antibiotics) are used to treat the herpes infection.
- Superinfection: In some cases, eczema may become superinfected with bacteria due to constant scratching and open wounds. In such situations, antibiotics may be used to address the bacterial infection.
Antibiotics
If your eczema becomes infected, you may also be prescribed an antibiotic.
Oral antibiotics
If you have an extensive area of infected eczema, you may be prescribed an antibiotic to take by mouth. This is most commonly flucloxacillin, which is usually taken for 1 week.
If you’re allergic to penicillin, you might be given an alternative such as clarithromycin.
Topical antibiotics
If you have a small amount of infected eczema, you’ll usually be prescribed a topical antibiotic, such as fusidic acid. These medicines come as a cream or ointment you apply directly to the affected area of skin.
Some topical antibiotics also contain topical corticosteroids.
Topical antibiotics should usually be used for up to 2 weeks as necessary.
Antihistamines
Antihistamines are a type of medicine that stop the effects of a substance in the blood called histamine. Your body often releases histamine when it comes into contact with an irritant. Histamine can cause a wide range of symptoms, including sneezing, watery eyes and itching.
Antihistamines may be prescribed during flare-ups of discoid eczema to cope with the symptom of itching, particularly if it’s interfering with your sleep. However, they will not treat the damaged skin.
Many older types of antihistamines can make you feel sleepy (drowsy), which can be useful if your symptoms affect the quality of your sleep. Otherwise, ask a pharmacist or GP to recommend a “non-sedating” antihistamine.
Complementary therapies
Some people may find complementary therapies, such as herbal remedies, helpful in treating eczema, but there’s little evidence to show these remedies are effective.
If you’re thinking about using a complementary therapy, speak to a GP first to ensure the therapy is safe for you to use. Make sure you continue to use other treatments a GP has prescribed.
Further treatments
If the treatments prescribed by a GP are not successfully controlling your symptoms, they may refer you for assessment and treatment by a doctor who specialises in skin conditions (dermatologist).
Further treatments that may be available from a dermatologist include:
- phototherapy – where the affected area of skin is exposed to ultraviolet (UV) light to help reduce inflammation
- bandaging – where medicated dressings are applied to your skin
- immunosuppressant therapy – medicines that reduce inflammation by suppressing your immune system
It is essential to use antibiotics judiciously and only when prescribed by a healthcare professional. Overuse or inappropriate use of antibiotics can lead to antibiotic resistance, where bacteria become resistant to the drugs, making them less effective in treating bacterial infections.
If you have concerns about eczema management or suspect an infection, it’s essential to consult a healthcare professional, such as a dermatologist, who can provide a proper evaluation and prescribe the appropriate treatment based on your specific condition and needs.