Eczema is a chronic inflammatory condition characterized by persistent itching, dryness, and inflamed patches of skin. Eczema does not cause true acne, which arises from clogged pores, excess oil, and specific bacteria. However, skin damage resulting from eczema flares frequently leads to secondary skin conditions that produce bumps looking nearly identical to pimples.
Distinguishing Eczema Rashes from True Acne
True acne lesions, such as blackheads, whiteheads, and cysts, form when a hair follicle becomes blocked with sebum and dead skin cells. This typically occurs on the face, chest, and back, where sebaceous glands are highly concentrated. Acne lesions are usually not intensely itchy, though they can be tender or painful.
In contrast, the primary lesions of eczema include red or discolored patches, plaques, and small, raised papules that are intensely itchy. Eczema often appears in flexural areas, such as the inner elbows and behind the knees, driven by an immune system overreaction. While eczema produces small bumps (papules), these result from inflammation, not follicular blockage. The surrounding skin in an eczema flare is typically dry, scaly, and rough, unlike the skin found between acne lesions.
How Eczema Compromises the Skin Barrier
Eczema patients are vulnerable to pimple-like bumps because of a compromised skin barrier. This barrier is often weakened due to genetic factors, such as a deficiency of proteins like filaggrin, which is necessary for maintaining skin structure and hydration. Its absence creates microscopic gaps, allowing moisture to escape and enabling external irritants and microorganisms to penetrate the skin.
Constant scratching further damages this fragile barrier, creating open breaks in the skin’s surface. These openings serve as entry points for pathogens, leading to localized inflammation and infection that manifests as bumps. A common consequence is the increased colonization of the skin by the bacterium Staphylococcus aureus.
Identifying Pimple-Like Eczema Complications
The bumps that mimic acne are usually secondary infections or viral eruptions facilitated by the impaired skin barrier.
Folliculitis
Folliculitis is a frequent occurrence, presenting as small, pus-filled bumps or pustules centered around a hair follicle. This is commonly caused by an overgrowth of Staphylococcus aureus. These bumps are typically red or discolored, can be itchy or tender, and cluster on areas where scratching has occurred, such as the arms, legs, or torso.
Eczema Herpeticum
Eczema Herpeticum is a serious viral infection, usually caused by the Herpes Simplex Virus (HSV-1). It presents as a sudden, widespread outbreak of painful blisters that quickly evolve into characteristic “punched-out erosions.” This condition often involves fever and malaise, and its rapid progression requires immediate medical intervention with antiviral medication.
Molluscum Contagiosum
Molluscum Contagiosum can also be mistaken for persistent pimples. These lesions are firm, dome-shaped papules that are flesh-colored or pink, possessing a distinctive central dimple known as umbilication.
Treatment Approaches for Infected Eczema Skin
Managing pimple-like complications requires treating both the infection and the underlying eczema inflammation. For bacterial complications like folliculitis, a healthcare provider may prescribe topical antibiotics applied directly to the localized area. If the infection is widespread or severe, oral antibiotics may be necessary to clear the bacteria.
If the complication is viral, such as eczema herpeticum, treatment with antiviral drugs like acyclovir must be started quickly to prevent serious complications. Regardless of the pathogen, continue moisturizing and using prescribed topical steroids to address the underlying eczema and restore the skin barrier’s function. Avoiding scratching is paramount, as this prevents the spread of infection and stops the cycle of barrier damage.