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Complications of atopic dermatitis

Authors: Dr Amy Stanway, Department of Dermatology, Waikato Hospital, February 2004; Updated: Dr Aysha Rashid, Medical Registrar, Auckland City Hospital, Auckland, New Zealand; Associate Professor Paul Jarrett, Dermatologist, Middlemore Hospital and Department of Medicine, The University of Auckland, Auckland, New Zealand. Copy edited by Gus Mitchell. August 2021

Infective complications of atopic dermatitis

Skin infection is very common in atopic dermatitis due to an inherently abnormal skin barrier, cutaneous and systemic immune system abnormalities, and scratching the itch. Cutaneous colonisation by Staphylococcus aureus forms a bacterial biofilm and worsens the dermatitis by promoting the Th2 allergic inflammatory response. Infants are particularly at risk of severe skin infections.

Bacterial skin infections in atopic dermatitis

Staphylococcal skin infection
- Staph aureus causes impetiginisation of atopic dermatitis
Streptococcal skin infection
- Strep pyogenes may cause impetigo, pustules, or punched out erosions with a scalloped border

Bacterial infection and atopic dermatitis

Viral skin infections in atopic dermatitis

Molluscum contagiosum
Eczema herpeticum
Eczema coxsackium
Eczema vaccinatum
- Rare complication of smallpox vaccination
- Vesicular, pustular, or nodular rash after contact with vaccinia virus

Molluscum contagiosum infection and atopic dermatitis

Eczema herpeticum

Fungal skin infections in atopic dermatitis

Dermatophyte
- Trichophyton rubrum and Epidermophyton skin infection of the head and neck [see Tinea capitis, Tinea faciei]
Yeast
- Malassezia furfur [see Skin conditions associated with Malassezia]

Fungal infection and atopic dermatitis

Complications of skin infections in atopic dermatitis

Cutaneous abscess
Septicaema/septic shock
Osteomyelitis
Septic arthritis/bursitis
Bacterial endocarditis
Herpes virus encephalitis

Contact dermatitis and atopic dermatitis

Contact dermatitis should be considered in the atopic patient with an otherwise unexplained dermatitis flare, particularly if in a patterned distribution.

Irritant contact dermatitis and atopic dermatitis

Irritant contact dermatitis is particularly common with atopic dermatitis due to the abnormal skin barrier function. Atopic hand dermatitis and occupational skin disease are frequent manifestations.

Allergic contact dermatitis and atopic dermatitis

The frequent use of multiple topical treatments for atopic dermatitis increases the risk of allergic contact dermatitis due to exposure to potential allergens. Aeroallergens also commonly aggravate other manifestations of atopy such as hay fever and asthma.

Contact dermatitis and atopic dermatitis

Complications of atopic dermatitis in skin of colour

Postinflammatory hyperpigmentation
Postinflammatory hypopigmentation and leukoderma
Vitamin D deficiency due to covering involved skin especially if extensive

Dyspigmentation due to atopic dermatitis in skin of colour

Other complications of atopic dermatitis

Erythroderma and its complications in atopic dermatitis
Psychological effects of atopic dermatitis
Ophthalmological complications of atopic dermatitis
- Vernal keratoconjunctivitis in children
  - Blepharitis, infectious keratitis, keratoconus
- Atopic keratoconjunctivitis in adults
  - Corneal scarring, loss of vision
- Herpes keratoconjunctivitis in eczema herpeticum
- Cataracts
  - Bilateral with characteristic appearance on eye examination
  - Associated with severe atopic dermatitis
  - Onset around age 15–25 years
Growth
- Severe dermatitis may slow the growth rate of children
- Growth retardation can be due to the dermatitis itself and/or treatment such as systemic corticosteroids
- Dietary restrictions may affect growth and, in extreme cases, cause protein-energy malnutrition

Other complications of atopic dermatitis

Bibliography

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On DermNet NZ

Other websites

AltogetherEczema: The Global Network for Eczema & Atopic Dermatitis
Atopic dermatitis — Medscape
Complications: atopic eczema — National Health Service UK

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