Contents << Previous Chapter Next Chapter >> Search


Microorganisms or their products that clear when the organisms are eradicated may cause microbial eczema. This should be distinguished from infected eczema, in which eczema is complicated by secondary bacterial or viral invasion of the broken skin. The skin becomes sensitized to bacterial products or chemicals present in the exudates. Infectious eczematoid dermatitis is considered as an example of autosensitisation.

The mechanism by which microorganisms can cause eczema is not understood. Bacterial antigens can promote a cytotoxic reaction in the skin.

Clinical Features

The distinction between infective and infected eczema is difficult.

Infected eczema shows erythema with exudation and crusting. The exudation may be profuse with crusting, or slight, with the accumulation of layers of somewhat greasy moist scale, below the surface is raw and red.

The margin is characteristically sharply defined. There may be small pustules and fissures in the advancing edge .

Infective eczema usually presents as an area of advancing erythema, sometimes with micro vesicles. It is seen predominantly around discharging wounds or ulcers, or moist skin lesions of other types.

Infective dermatitis is relatively common in patients with venous leg ulcers, but care must be taken to distinguish it from contact dermatitis due to topical preparations .

Staphylococci or streptococci can be cultured and the lesions respond to antiseptic and antibiotic therapy .

This condition seems to occur particularly in patients with poor standards of hygiene. Hyperhidrosis and heavy footwear may be an important predisposing factor . Infective dermatitis may also complicate chronic threadworm infestation, pediculosis, scabies and excoriations of the skin due to repeated scratching .

Differential Diagnoses

Plantar eczema in children ,this must be distinguished from juvenile plantar dermatosis.

Tinea pedis may also become eczematous due to the overgrowth of Gram-negative organisms .

Fig. 209. Infective dermatitis

Fig. 210. Infective dermatitis


  • Correction and treatment of the predisposing factors .

  • opical antibacterial agents are effective in mild forms of infective eczema due to bacteria.

  • Systemic antibiotics . The important line of treatment is the treatment of infection by an appropriate antibiotic.

  • In acute exudative lesions, Potassium permanganate soaks are helpful for the first 2 or 3 days, in combination with topical and systemic antibiotic. Antihistamines oral preparations may be required to relieve itching which is an important factor in causing excoriations and traumatization of skin, predisposing for seeding of bacteria into the skin.


(Discoid Eczema)

Nummular dermatitis is a chronic eczematous lesion that is caused by different known and unknown factors. The condition may be preceded by atopic dermatitis. The lesion may appear as a separate entity as annular, coin-like or discoid lesions on the extensor surface of the extremities, trunk and the buttocks .

This type of eczema appears mainly in older age groups .

Predisposing Factors

Insect bites : the papular and urticarial lesions may become chronic in neglected untreated cases or by the repeated severe itching and excoriation.

Late manifestation of atopic dermatitis :Discoid eczema may appear at the end stage of chronic atopic eczema

Irritating agents : irritants whether external such as topical sensitizing creams, detergents, metal or internal allergens may cause nummular dermatitis.

Dryness of the skin: dryness of skin due to different factors such as excessive bathing , using harsh and medicated strong alkaline soaps. In older age groups the skin usually tends to be drier.

Psychosomatic disorders may be considered an important predisposing factor.


Drug reaction. Drug reaction due to different drugs such as sulfonamides and methyldopa, where the fixed drug lesion may appear on the previous eczematized site .

Clinical Features

Acute type

Skin lesions are annular or coin-shaped papulo vesicular patches or plaques on an erythematous base. Oozing surface of the lesion may occur with excessive excoriation due to itching or rubbing followed by secondary bacterial infection.

One of the characteristic features of nummular dermatitis is that the patches that seem to be dormant may become active again, particularly if treatment is discontinued.

Chronic type

Atopic dermatitis in childhood is liable to become discoid eczema later on. Cases of chronic discoid eczema have usually an atopic history.

In the chronic stage ,  the lesions are dry and excoriated coin shaped. These are single or multiple lesions and may be accompanied by severe itching which  usually increases with different irritating factors such as emotional stress. Secondary lesions may follow later on involving the limbs or the trunk.


                                                                                                              Fig.211a. Discoid eczema

The course of this type of eczema is very chronic and has the characteristic of relapse and remission, where after healing of the lesions, new recurrent eruption occurs at the same older site .

Fig. 211. Discoid eczema

Fig. 212. Chronic eczema


Elimination of the irritating factor if possible .

Mild topical steroid alone or combined with an antibiotic or salicylic acid (Locosalene, diprosalic, salidecoderm) in an ointment base especially in dry lesions .

Antihistamine preparation such as Citrizine is given for few days preferably at bedtime, where itching is more severe at night and to combat the possibility of sedation especially with old sedating antihistamines.

Corticosteroids orally or parentally are rarely indicated in nummular eczema.



Dyshidrotic eczema is a deep vesicular skin reaction involving the fingers, the interdigital spaces and the feet. The vesicles have a characteristic morphological appearance as that of sago grains. The condition is rare in young age groups and more common in adults .

Predisposing Factors

  • Excessive sweating .

  • Hormonal imbalance .

  • Psychosomatic factors.

  • Occlusion of the areas for a long time as by keeping the feet non-aerated by the socks and shoes most of the day such as in athletes

  • Drugs such as Penicillin, Aspirin.

  • Primary irritants due to nickel , dichromate , perfumes and strong detergents can be considered among the precipitating factors .

  • Bacterial or fungal infection is blamed as a triggering factor also. Meanwhile, bacterial and fungal infections, usually secondarily infect the dyshidrotic areas.

Clinical Features

The lesions are vesicular and usually symmetrical accompanied with mild or severe itching. Excoriation of the lesions is not uncommon.

Fig. 213. Dyshydrotic eczema

Fig. 214. Dyshydrotic eczema 
(with secondary bacterial infection)

The vesicles of dyshidrotic eczema involute spontaneously and do not rupture as in other vesicular skin lesions.


Most cases resolve spontaneously .

Treatment and correction of the predisposing factors such as hyperhidrosis.

Severe eczematized cases need antihistamine and topical steroid cream .

Creams are preferred than ointments in these cases as cream is less occlusive than ointments .

Dusting powder between the toes may help to keep the skin dry.

Fig. 215. Pustular dyshydrotic eczema


(Dermatitis Plantaris Sicca)

Juvenile dermatoses affects mainly children . Both feet may be involved symmetrically and become macerated.

Predisposing Factors

Sweat retention and occlusion of the feet by woolen or polyester socks.

Keeping the foot for a long time without aeration is an important triggering factor.

Walking barefooted on woolen or polyester carpets. This may lead to static electric charges that may also have a role in skin dryness and initiation of such problem .

The synthetic materials or chemicals used in the shoes or socks may have an important role.

Fig. 216. Juvenile plantar dermatoses

Clinical Features

Both soles are involved which become macerated and fissured.

The interdigital spaces and the weight bearing areas are spared .

Fig. 218. Juvenile plantar dermatoses

Fig. 217. Juvenile plantar dermatoses


  1. Avoid walking barefreted.
  2. Avoid occlusim of the areas.
  3. Emollients such as pelroleum jelly.
  4. Mild topical corticosteraid alone or in combination with salicylic acid used for a short time may give good results.
  5. Fluorouracil may be tried in older children.
  6. Retonic acid.
  7. Vitamine A orally for a short period.



Stasis dermatitis is an exogenous type of dermatitis, related to peripheral vascular disturbances with venous incompetence and more common in older age groups.

Fig. 219. Stasis dermatitis

The skin manifestation is characteristically on the inner lower leg above the internal maleolus. The lesion appears as a cyanotic , erythematous and edematous due to local congestion. The condition may be accompanied by mild itching, lichenifecation, ulceration and hyperpigmentation.



  1. Parish WE, Welbourn E, Champion RH. Hypersensitivity to bacteria in eczema. IV: Cytotoxic effect of antibacterial antibody on skin cells acquiring bacterial antigens. Br J Dermatol 1976; 95: 493-506.

  2. Parish WE, Welbourn E, Champion RH. Hypersensitivity to bacteria in eczema. Titre and immunoglobulin class of antibodies to staphylocci and micrococci. Br J Dermatol 1976; 95: 285-93.

  3. Weismann K, Hjorth N. Microbial eczema of the feet. Br J Dermatol 1982; 107: 330-7.

  4. Welbourn E, Champion RH, Parish WE. Hypersensitivity to bacteria in generalized eczema. I: Bacterial culture, skin tests, and immunofluorescent detection of immunoglobulins and bacterial antigens. Br J Dermatol 1976; 94: 619-25.

  5. Bendl BJ. Nummular eczema of stasis origin: a morphological pattern of diverse etiology. Int J Dermatol 1979; 18: 129-35.

  6. Calnan CD, Meara RH. Discoid eczema - dry type. Trans St John‘s Hosp Dermatol Soc 1956; 37: 26-8

  7. Cowan MA. Nummular eczema - a review, follow-up and analysis of 325 cases. Acta Derm Venereol 1961; 41: 453-60.

  8. Rollins TG. From xerosis to nummular dermatitis. J Am Med Assoc 1968; 206: 637.

  9. Ashton RE, Griffiths WA. Juvenile plantar dermatosis - atopy or footwear? Clin Exp Dermatol 1986; 11: 529-34.

  10. Graham RM, Verbov JL, Vickers CFH. Juvenile plantar dermatosis. Clin Exp Dermatol 1987; 12: 468.

  11. Jones SK, English JSC, Forsyth A et al. Juvenile plantar dermatosis - an eight year follow-up of 102 patients. Clin Exp Dermatol 1987; 12: 5-7.

  12. Mackie RM. Juvenile plantar dermatosis. Semin Dermatol 1982; 1: 67-75.
    M"ller H. Atopic winter feet in children. Acta Derm Venereol 1972; 52: 401-5.

  13. Shrank AB. Aetiology of juvenile plantar dermatosis. Br J Dermatol 1979; 100: 641-6.

  14. Stankler L. Juvenile plantar dermatosis in identical twins. Br J Dermatol 1978; 99: 585-6.

  15. Hersle K, Mobacken H. Hyperkeratotic dermatitis of the palms. Br J Dermatol 1982; 107: 195-202.
    de Boer EM, Bruynzeel DP, Van Ketel WG. Dyshidrotic eczema as an occupational dermatitis in metal workers. Contact Derm 1988; 19: 184-8.

  16. Duhra P, Ryatt KS. Haemorrhagic pompholyx in bullous pemphigoid. Clin Exp Dermatol 1988; 13: 342-3.

  17. Burton JL. Venous ‘stasis‘ ulcers, stasis dermatitis and mothers‘ political ambitions for their offspring: Reply. Br J Derm 1990; 122: 715-16.

  18. Fraki JE, Peltonen L, Hopsu-Havu VK. Allergy to various components of topical preparations in stasis dermatitis and leg ulcers. Contact Derm 1979; 5: 97-100.

  19. Breit R. Allergen change in stasis dermatitis. Contact Derm 1977; 3: 309-11.

  20. Ryan TJ. Venous stasis ulcers, stasis dermatitis and mothers‘ political ambitions for their offspring. Br J Dermatol 1990; 122: 715 (letter).


Contents << Previous Chapter Next Chapter >> Search