What Is Weeping Eczema?
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Medically reviewed by Brendan Camp, MD
Weeping eczema is a complication of eczema (atopic dermatitis) that occurs when fluid oozes (or "weeps") out of your skin. Eczema is a group of inflammatory skin conditions that cause dry, scaly, and intensely itchy patches of skin. Because of how itchy the patches can be, many people scratch their patches to relieve the itch. But, scratching can often cause the skin to weep fluid and worsen symptoms.
In some cases, scratching breaks open the skin, allowing microorganisms like bacteria and viruses to enter the body and cause a skin infection. But, it's worth noting that edema (or, the accumulation of fluid under the skin) can also cause weeping even if you're not scratching your eczema patches. Fluid-filled blisters that weep fluid and eventually crust over can develop in response to the infection.
There are several types of eczema—and the condition affects over 200 million people worldwide. All types of eczema can weep, and people with eczema have a higher risk of developing skin infections. But treatment is available, as oral medications and topical creams can help soothe irritated skin and clear infections.
Symptoms of Weeping Eczema
Weeping eczema is most common during flare-ups, or when symptoms of eczema are active. If you develop weeping eczema, it's common to experience the following symptoms:
Clear or yellowish fluid oozing out of the skin
Discolored, inflamed, and scaly patches on the skin
Blisters or open sores
Honey-colored crusting around the blisters
When an infection causes weeping eczema, symptoms may include:
Swollen and warm skin
Pus-filled blisters on top of eczema patches
Pain and tenderness
Chills
Redness or discoloration around the affected skin
Causes
Normally, healthy skin acts as a barrier by preventing excess water loss and protecting your body from threats like infectious microorganisms (e.g., bacteria), harmful chemicals, and allergens. People with eczema have weakened skin barriers, causing the skin to lose moisture and increasing the risk of infections. As a result, you may be at an increased risk of developing weeping eczema due to inflammation or infections.
Inflammation
Chronic (long-term) skin inflammation causes skin cells to shrink. When this happens, fluid accumulates around the cells, leading to skin discoloration, swelling, and intense itchiness. Scratching itchy eczema patches can cause the skin to weep or ooze out clear or yellow-colored fluid that crusts over.
Infections
In many cases, weeping eczema develops due to skin infections. Because people with eczema have weakened skin barriers, they are more likely to develop skin infections. Scratching can cause breaks and tears in the skin, allowing bacteria and viruses to enter and cause symptoms of an infection. Skin infections can cause worsened discoloration or redness, skin that is warm to the touch, and pus-filled blisters. Common infections associated with weeping eczema include:
Staphylococcus aureus (staph): Staph infections develop when Staphylococcus aureus bacteria enter the skin. These bacteria live on the skin of nearly 80% of people with eczema. They can easily enter broken or cracked skin, leading to an infection that causes pus-filled blisters that weep a honey-colored fluid that crusts on top of your existing eczema patches.
Herpes simplex virus (HSV-1): The virus responsible for cold sores can also infect eczema-affected skin, causing an infection known as eczema herpeticum. This infection causes clusters of small, painful blisters that look purple, red, or black. These blisters can also weep clear fluid or pus when they break open. If eczema herpeticum affects your eyes, it can also be a medical emergency.
Diagnosis
If you have symptoms of weeping eczema, it's important to see your primary care provider and dermatologist (a doctor who specializes in the skin) for proper diagnosis and treatment. During your appointment, your provider will ask about your medical history, perform a physical exam, and order tests to confirm a diagnosis.
You can expect your provider to ask the following:
If you have a personal or family history of allergies
When your symptoms first developed
What triggers or worsens your symptoms
If you were recently exposed to irritants, such as cigarette smoke
Any changes you've made in your personal care products (e.g., cosmetics, soaps, laundry detergents)
During the physical exam, your healthcare provider will closely examine your skin to confirm the presence of eczema. They'll also check for signs of weeping, including blisters and honey-colored crusting on top of eczema patches.
If your healthcare provider suspects an infection is causing weeping eczema, they may order diagnostic tests, such as:
A skin swab to collect a sample of cells from a blister or sore to determine which bacteria or virus are causing your symptoms
A skin biopsy, which uses a scalpel (small medical knife) to remove a sample of your skin to identify the presence of an infection
Your healthcare provider may recommend allergy testing if certain substances or allergens seem to trigger your eczema flare-ups and contribute to weeping eczema. An allergy prick test or patch test involves scratching or puncturing the skin's surface and applying small amounts of suspected allergens to the skin. Your healthcare provider will observe the area for 15 minutes to see if an allergic reaction develops in response to the allergens they've injected into your skin.
How To Treat Weeping Eczema
At this time, there is no cure for eczema, so treatment focuses on reducing skin inflammation, hydrating dry skin, relieving symptoms, and preventing infections and flares. Your healthcare provider may recommend a combination of different treatments, depending on the cause and severity of your symptoms.
Medications
Medications help control inflammation, soothe irritated skin, and clear infections. Depending on the location and cause of weeping eczema, your healthcare provider may prescribe the following:
Corticosteroids: Topical corticosteroids are the first line of treatment for most types of eczema. You can apply these creams directly to the affected skin to help reduce inflammation, swelling, and itching.
Calcineurin inhibitors: Topical medications such as Elidel (pimecrolimus) cream and Protopic (tacrolimus) ointment reduce inflammation, itching, and the presence of S. aureus bacteria on the skin. You'll likely receive this treatment if your skin doesn't respond well to standard corticosteroid treatments.
Phosphodiesterase-4 (PDE4) inhibitors: These medicines, such as Eucrisa (crisaborole), control inflammation by blocking a specific inflammatory enzyme. These topical medications offer an alternative option for treating mild to moderate eczema when other treatments are ineffective.
Antibiotics: When a bacterial infection is causing weeping eczema, your healthcare provider may prescribe topical or oral antibiotics (or both) depending on the severity of your infection.
Antivirals: Medications like Zovirax (aciclovir) can help treat viral infections like eczema herpeticum.
Wet Wrap Therapy
Severe or widespread weeping eczema may benefit from wet wrap therapy. Wet wraps hydrate dry, irritated skin and help the skin absorb topical medications (e.g., corticosteroids). This therapy also covers and protects the skin to discourage you from scratching it.
Wet wrap therapy works by soaking clean cotton clothing, cotton wrap dressing, or gauze in warm water to get them damp and applying the wet dressing to the affected areas of the skin. Before putting the wet wrap on your skin, you'll usually need to apply a topical ointment. Once the damp dressings are on your skin, you will leave them on for a few hours or overnight. Most people wear a dry layer of clothing over the wet layer for comfort.
Phototherapy
Phototherapy (also known as light therapy) uses different waves of ultraviolet (UV) light to improve eczema symptoms for people with widespread eczema when other treatments are ineffective. This therapy involves applying a moisturizing oil to your skin and standing in front of a light-emitting machine that treats your eczema patches. Most phototherapy sessions last only seconds to minutes. But it can take one to two months of regular treatments to see improvements.
Prevention
While there is no definitive way to prevent eczema, there are lifestyle modifications you can make to reduce the frequency and severity of flares and protect against infections that can cause weeping eczema. These include:
Maintain a consistent skincare routine: Establish and stick with a skincare routine that includes daily bathing or showering in lukewarm water, using gentle soaps with no added fragrances, applying topical medications as directed, and hydrating the skin with fragrance-free and emollient-rich moisturizing creams.
Manage stress: Stress can worsen eczema symptoms and trigger flares, so practicing stress-management techniques like breathing exercises, meditation, engaging in hobbies, or spending time in nature can help reduce stress and manage eczema symptoms.
Identify and avoid triggers: Knowing what worsens your eczema symptoms or leads to flares (such as pollen or harsh soaps) can help you avoid these triggers and reduce your risk of flares.
Consider bleach baths: Diluted bleach baths a few times a week can help kill bacteria on the skin to control inflammation and reduce eczema symptoms. Use only ½ cup of bleach for a full bathtub of water or ¼ cup for a half-full bathtub. Ensure undiluted bleach does not come into direct contact with your eczema patches.
Prioritize sleep: Eczema symptoms can keep you up at night, and poor sleep quality can worsen eczema symptoms. Maintaining a good bedtime routine that includes applying moisturizer and medications an hour before bed, keeping your room cool, and listening to soothing music can help you get good quality sleep.
Related Conditions
If you have eczema, you're more likely to have or develop several related conditions, including:
Bacterial and viral skin infections
Hay fever
Food allergies
Anxiety or depression
Living With Weeping Eczema
Living with a chronic skin condition like eczema can be emotionally and physically demanding. Maintaining a skincare routine and wearing loose, comfortable clothing made of breathable fabrics (e.g., cotton) can help maintain healthy skin and prevent flare-ups. Research suggests that some clothing made with newer synthetic materials (e.g., silver-coated, chitosan-coated, and cellulose-based fabrics) may help reduce the severity of symptoms and lower your risk of bacterial infections.
Working with a healthcare provider (such as a dermatologist) can ensure you have an effective treatment plan and offer guidance on effectively managing eczema. Connecting with others who understand the challenges of living with eczema in online or in-person support groups can also give you emotional support and valuable insights into how to cope with this condition.
Frequently Asked Questions
Should I go to the ER for weeping eczema?
See a healthcare provider if you have weeping eczema and signs of infection, including fever, flu-like symptoms, pain, and swollen lymph nodes (glands). Eczema herpeticum is a medical emergency that requires immediate treatment. Go to the ER or see a healthcare provider immediately if you develop clusters of small, itchy, painful blisters that ooze pus and have a high fever and chills.
Can I put hydrocortisone on weeping eczema?
Over-the-counter (OTC) hydrocortisone is a low-dose steroid that helps reduce inflammation, itching, and irritation associated with weeping eczema. You can use OTC creams on a short-term basis (no longer than seven days) for temporary symptom relief. See a healthcare provider to discuss other treatment options if your symptoms worsen or persist.
Should you cover eczema or let it breathe?
Covering the affected area can help minimize scratching and promote healing when you have weeping eczema. Your healthcare provider may recommend covering the weeping area with wet wraps to hydrate the skin and reduce inflammation. Avoid tight clothing and use light, breathable fabrics like cotton to prevent overheating and skin irritation.
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