Eczema, Skin Infections, and STDs

Eczema, also known as atopic dermatitis, is a common chronic relapsing inflammatory skin condition that can affect any part of the body. This skin-itching disease is caused by a complex interaction between genetics and environmental factors. Patients with eczema tend to develop symptoms during early childhood. 

Eczema symptoms predominantly relapse and recur; in some, the symptoms may continue into adulthood. Patients with eczema are associated with an inherent genetically impaired skin barrier, leading to increased susceptibility to environmental insults such as stress, allergies, soap and detergent, and infectious pathogens.

In this article, we want to understand the correlation between skin, the presence of eczema, and skin infections; in particular, are patients with eczema more prone to acquiring STDs?

Correlations of eczema and skin infections

The skin is the biggest organ in our body. Its primary function is to provide a physical barrier to protect the internal organs and body against the external environment. Unfortunately, in eczema, inborn cracks and defects in the skin’s epidermis layer result in weaker or ineffective skin protection against noxious environmental agents. Additionally, clinical studies have shown that patients with eczema have a significantly higher risk of contracting skin infections from bacteria, viruses, and fungi [1].

Staphylococcus aureus is one of the most common bacterial infections associated with eczema [2]. This bacteria can be found even on a normal skin surface and is usually harmless. However, in the case of eczema, the bacteria invade the fragile and defective epidermis of the skin, triggering an immune response and leading to a vicious cycle of eczema flare-ups and skin infections.

Fungus and mould are other common microbes that can be detected on healthy skin. They are generally environmental colonies that' do no harm’ to the human body. When a person has an eczema flare-up, the affected skin can be inflamed, broken, weepy, red, and raw. This can be a thriving ground for fungus and mould. The fungus has the potential to invade the eczematous skin, leading to skin infection.

Correlations of eczema and STDs

Generalised (whole-body) eczema

You might be at risk of:

• Herpes Simplex Virus (HSV) presents with eczema herpeticum.
• Human Papillomavirus (HPV) presents with clinical warts.
• Molluscum Contagiosum presents with mollusca bumps.
• Scabies presents with intense, itchy burrows.

In severe eczema with generalised involvement, the skin surface appears dry, chappy, cracking, excoriated, oozing, and possibly bleeding. At this stage, the skin cannot fully function as a physical barrier against external bacteria and viruses.

HSV is an STD known to be associated with localised cold sores affecting the mouth or the genital region. In generalised eczema, one can develop a condition known as eczema herpeticum [3]. It is a medically serious condition, as one can be gravely ill with generalised extensive sores and blistering and flaring of eczema; some may even warrant hospitalisation to stabilise the condition. See your doctor to diagnose this condition early and receive antiviral medication and proper eczema care.

Viruses and mites, such as HPV, pox virus, and scabies mites, can inoculate the impaired skin layer in patients with eczema. This leads to the clinical presentation of warts and molluscum bumps. Although these skin infections are not generally life-threatening, they can be annoying. They can cause chronic itch and discomfort and are easily spread throughout the body and to other sexual partners if not treated.

Localised eczema affecting the genitals – Vulva or scrotal/penile eczema

You can be at risk of:

• Herpes Simplex Virus (HSV) presents with genital cold sores.
• Human Papillomavirus (HPV) presents with genital warts.
• Molluscum Contagiosum presents with mollusca bumps.
• Scabies and pubic lice present with intense, itchy burrows over the genitals.
• Syphilis (less common).

It is imperative to note that the skin and mucous membrane around the vulva in females and the scrotal/penile region in males are generally thinner and less robust than the skin over our soles or hands. Hence, with the chronic breakdown and inflammation of the skin over the genitals secondary to eczema, one is invariably predisposed to infections, including STDs.

Symptoms of STDs acquired via skin-to-skin contact tend to be more localised to the genitalia region. Nonetheless, as the viruses and the mites can spread, it is possible that the sores, warts, bumps, and scabies rash can be transmissible to other parts of the body. There is a theoretical risk (low risk) of syphilis if there is an open eczematous wound over the genital, though this is less common.

What can I do if I have eczema and would like to reduce my risk of contracting STDs?

There are two main domains here in reducing the risk of contracting STDs.

Manage eczema

Firstly, it is important to ensure the skin can function effectively as a barrier layer against external noxious agents, including STDs. This will help ensure good, effective, and consistent long-term management of underlying eczema. Manage your eczema in the following ways:

• Moisturise the skin repeatedly and adequately. This will ensure the buildup and maintenance of a good skin barrier.
• Topical medications, such as topical steroids or calcineurin inhibitors, help resolve active skin surface inflammation.
• Anti-itch medications can break the itch-scratch cycle, allowing the skin barrier to grow, heal, and be well-maintained.
• Lifestyle management may be required to reduce further eczema flare-ups by eliminating possible irritants or allergens in the form of wash, fabrics, dust mites, or even food substances.
• Second-line systemic treatment may be required to manage the condition in recalcitrant eczema cases.

Risk management of STDs

Secondly, to reduce the risk of contracting STDs, you should:

• Safe sex is always advisable. Barrier contraception can reduce the risk of STDs, though it is not foolproof either.
• Consider proactive, regular STD screening with your partner(s). This can reduce the risk of transmission of STDs.
• Seek and receive early treatment for any STD infections.
• Consider vaccinations such as HPV vaccinations if one is suitable and age-eligible.
• Understand the mode of STD transmission and abstain until the infection is cleared or controlled before resuming a sexual relationship with your partner(s).

What have I learnt today?

• Eczema is a chronic skin inflammatory condition associated with an impaired skin barrier.
• Without a good physical skin barrier, people with eczema are more susceptible to developing skin infections from environmental bacteria, viruses, and fungi.
• One who is sexually active and has poorly controlled eczema has a higher risk of contracting STDs.
• A good skin barrier is achievable with proper eczema skin care and management.
• STD infection risks can be mitigated by ensuring a good skin barrier, regular STD screening, and early STD treatment.

References

1. Singh, M., & Pawar, M. (2020). Skin Infections in Eczema: A Comprehensive Review. Journal of Clinical Medicine, 9(7), 2312. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7317931/
2. National Eczema Society. (n.d.). Skin infections and eczema. https://eczema.org/information-and-advice/living-with-eczema/skin-infections-and-eczema/
3. Haddad, A., & Sander, M. (2020). Atopic Dermatitis. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK560781/