Systemic antibiotics are usually necessary to treat overtly infected eczema.
First- or second-generation cephalosporins (e.g. cephalexin 25-50 mg/kg divided twice daily) given for seven to 10 days are usually effective. A semi-synthetic penicillin can also be used. Long-term maintenance antibiotic therapy should be avoided, as it may predispose to colonization by methicillin-resistant organisms.
A topical antibiotic such as mupirocin (Bactroban) can be applied three times daily to affected areas for seven to 10 days to treat localized areas of involvement. In addition, twice-daily intranasal application of mupirocin for five days can reduce nasal carriage of S. aureus, which in turn can result in improvement of atopic dermatitis. Use of topical neomycin is discouraged, as neomycin is one of the most common allergens causing contact dermatitis.
Patients with eczema herpeticum, also referred to as Kaposi’s varicelliform eruption, usually require treatment with systemic acyclovir in a hospital setting. Superficial dermatophytosis and P. ovale can be treated with topical or rarely systemic antifungal drugs. A subset of patients with atopic dermatitis may respond to treatment with antifungal agents.