Atopic Dermatitis Complications: What You Need to Know

Atopic dermatitis, the most common form of eczema, can lead to a range of complications that go beyond skin issues to include those involving eye health and mental health. People with atopic dermatitis are also more likely to experience a number of other chronic health conditions, including asthma and food allergies.

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 Health 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.

It isn’t known why people with eczema more commonly have staph bacteria living on their skin, but it’s believed that differences in the skin barrier play a role, such as defects that can allow allergens and bacteria to enter the body more easily, among other factors.

• Eczema symptoms that don’t respond to treatment
• Honey-, yellow-, or orange-colored crusts that develop on top of eczema
• Pus-filled blisters on top of eczema
• Sores that resemble cold sores
• Red, swollen bumps on the skin that are painful to touch (the red may be obscured in skin of color)
• Red streaks on the skin that seem to be spreading (the red may be obscured in skin of color)
• Fever
• Flu-like symptoms
• Pain
• Swollen lymph nodes, which may occur in your neck, under your chin, in your armpits, or in your groin

If you notice any symptoms of a staph infection, contact your doctor, who may prescribe an antibiotic. While most staph infections are minor, they can trigger an eczema flare, and untreated staph infections  can potentially be fatal.

Eczema herpeticum occurs when the herpes virus infects large areas of the skin. It usually appears on the face and neck, but can also appear on other parts of the body, such as the hands.

Symptoms of eczema herpeticum include:

• A cluster of small, itchy, painful blisters
• Blisters that look red, purple, or black and ooze pus when they are broken open (these may be harder to see on skin of color)
• High fever and chills
• Swollen lymph glands

Complications of eczema herpeticum may include scarring from blisters; infection in the cornea of the eye (herpetic keratitis); and rarely, organ failure and death if the virus spreads to the brain, lungs, and liver. See your doctor right away if you notice symptoms of eczema herpeticum because immediate treatment can reduce your risk of complications.

In children, about half of cases clear up in 12 months, and two-thirds clear up within 18 months, with or without treatment.

Pink Eye (Conjunctivitis) Pink eye is an inflammation of the conjunctiva, or the thin, transparent membrane that covers the white part of the eye and the inner surface of your eyelids. Signs and symptoms of pink eye include a pink or red color in the eye; watery, itchy eyes; sensitivity to light; and wet, sticky or dry, crusty eyes.

Inflamed Cornea (Keratitis) Atopic dermatitis can irritate the cornea (the clear, dome-shaped tissue on the front of the eye), which can lead to inflammation. Signs and symptoms of keratitis include pain or discomfort in the eye; sensitivity to light; and eyes feeling gritty or watery or like you have something in them. See your doctor if you have symptoms of keratitis, as it can usually be cured if caught early.

Keratoconus The cornea is usually round, but rubbing your eyes a lot because of itchy skin from atopic dermatitis can cause the cornea to change shape and bulge, making it cone-shaped. Signs and symptoms of keratoconus include nearsightedness; blurry vision; sensitivity to light, especially when driving at night; and constantly changing your prescription for eyeglasses or contacts. Call your doctor right away if you have any signs of keratoconus, as waiting too long to seek treatment can result in vision loss.

Atopic dermatitis can psychologically affect both children and adults.

What’s more, children and adolescents with the disorder are 2 to 6 times more likely to have depression or anxiety than children who don't have the skin condition. Children who have atopic dermatitis are also more likely to be diagnosed with attention deficit hyperactivity disorder (ADHD) and other conduct disorders.

Adults with atopic dermatitis, on the other hand, have a 2.5 to 3 times higher risk of anxiety or depression than those who don't have the condition.

“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.

People with atopic dermatitis may experience 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 (hay fever), 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.