Does infected eczema always need antibiotics?

Not always. Mild localised infection may be managed with prescription topical therapy alone. Spreading infection, significant crusting, systemic symptoms, or cellulitis usually need medical review and often oral antibiotics. The decision turns on extent, depth, your medical history and how rapidly the picture is changing.

Should I stop steroid cream if eczema looks infected?

Not always. Inflammation often still needs treatment while infection is treated — but it depends on severity and the type of infection. The right approach is treating the infection AND continuing to settle the underlying inflammation, not pausing both. If you are unsure, book a review rather than stopping your prescribed cream.

Can I use bleach soaks for severe hand eczema?

Yes, in selected infection-prone cases. Bleach soaks are often more practical than a full bath for hand-only or foot-only eczema. Use the dilution approach in our eczema bath recipe, make a smaller volume scaled proportionally, soak for about 10 minutes in lukewarm water, pat dry and moisturise immediately afterwards.

What does eczema herpeticum look like and how urgent is it?

Eczema herpeticum is herpes simplex virus (HSV) spreading into eczema-affected skin. It looks like clusters of small painful blisters or punched-out erosions — often with sudden severe pain in an eczema patch that previously was not painful, fever or feeling unwell, and rapid spread. It can become severe quickly and needs same-day or next-day medical assessment and antiviral treatment. If you suspect it, book an urgent appointment or go to an emergency department, particularly if there is eye involvement.

Are bleach baths safe?

At correct dilution (similar concentration to a chlorinated swimming pool) and frequency, dilute bleach baths are safe and well-tolerated. The dilution must be precise — too strong is irritating, too weak does nothing. Always moisturise immediately afterwards. Do not use bleach baths on rapidly spreading infection, fever, suspected eczema herpeticum, or deep open wounds — seek review first in those cases.

How is infected eczema different from a normal flare?

A normal flare is dry, itchy, inflamed skin that responds to your usual moisturiser + anti-inflammatory cream plan within days. Infected eczema looks different — weeping or oozing patches, yellow honey-coloured crusts, increased tenderness or pain (worse than usual itch), pustules or pus bumps, rapid worsening rather than gradual flare, and sometimes systemic symptoms like fever or feeling unwell. Pain is one of the most useful early clues — eczema itches, infection hurts.

Can I use Dettol or other antiseptics on infected eczema?

Harsh antiseptics (Dettol, povidone iodine in concentrated form, tea tree oil, alcohol-based products) usually worsen the eczema barrier even while killing some surface bacteria. The result is often more inflammation and more infection over time. Stick to prescription topicals, gentle cleansing, and dilute bleach baths or soaks where appropriate — those are the evidence-based options for infection-prone eczema.

Do I need a referral?

No referral is required. You can book directly via the booking panel in the sidebar. Both clinics — Ivanhoe and Diamond Creek — see adults with eczema. If you have a referral from your GP or dermatologist for our records we welcome it, but it is not required to book or to be seen.

Eczema

Infected Eczema in Adults — Impetigo, Cellulitis, HSV Red Flags and Bleach Soaks

How to recognise infection early in adult eczema, what to do safely at home, and how dilute bleach baths or soaks can help in infection-prone eczema (especially hands). Covers impetigo, cellulitis, eczema herpeticum (HSV) urgent red flags, when not to use bleach, and a practical hand-soak method.

By Dr Christopher Irwin, MBChB, FRACGP, MMed (Skin Cancer), FACAM, MSCCA

Last reviewed 2026-06-06 · 9 min read · Editorial policy

In brief

Honey-coloured crusts suggest impetigo (bacterial).
Rapidly spreading redness, warmth and pain can indicate cellulitis — prompt review.
Painful blisters or sudden severe pain can be eczema herpeticum (HSV) — urgent.
Dilute bleach baths can reduce bacterial load in infection-prone eczema.
Bleach soaks (hands/feet) are a practical adaptation for chronic hand eczema.
Moisturising immediately after a soak is more important than rinsing or not.
Hands are particularly vulnerable — wet work, detergents, sanitiser and friction stack up.
Avoid harsh antiseptics like Dettol or essential oils on eczema — they worsen the barrier.
Frequent infected flares often signal under-treated eczema OR untreated contact dermatitis.
No referral required — book directly via the booking panel in the sidebar.

Quick definition

Infected eczema in adults is what happens when the inflamed, cracked eczema barrier lets bacteria (most commonly Staphylococcus aureus, causing impetigo) or viruses (herpes simplex, causing eczema herpeticum) take hold. Signs: weeping or oozing, honey-coloured crusts, increased pain (eczema usually itches; infection hurts), pustules, rapidly spreading redness, fever or feeling unwell. Eczema herpeticum (clusters of painful blisters or punched-out erosions, often with severe pain and fever) is the most urgent presentation. Cellulitis (deep bacterial infection, rapidly spreading redness, warmth, pain, fever) is the second-most urgent. Less severe infection often responds to prescription topicals; significant infection usually needs oral antibiotics. For infection-prone adults, dilute bleach baths or soaks (especially for hand eczema) reduce bacterial load as part of a broader plan. ^(1–3,4,5)

Adult eczema is a barrier problem. When the barrier is inflamed and cracked, bacteria (especially Staphylococcus aureus) can overgrow, and viruses can enter through broken skin. ^(1–3) Hands are particularly vulnerable because they are exposed to wet work, detergents, sanitiser, friction and repeated micro-trauma.

This article focuses on the recognition and management of infection in adult eczema. For the full condition overview — symptoms, causes, diagnosis and treatment options — see adult eczema (atopic dermatitis).

Bacterial infection — impetigo and infected eczema

What it looks like:

Weeping or oozing patches
Yellow “honey-coloured” crusts
Pustules or small pus bumps
Increased redness and swelling
Tenderness or stinging that is worse than usual
A flare that worsens suddenly rather than gradually ^(1–4)

What usually happens next — mild, localised infection may be treated with prescription topical therapy. More widespread infection often needs oral antibiotics, particularly if there is significant crusting, rapid spread or systemic symptoms. ^(1–3)

Cellulitis (urgent)

Cellulitis is a deeper bacterial infection that can start from cracked eczema — especially on legs or hands.

Seek urgent review if you notice:

Rapidly spreading redness
Warmth and swelling
Increasing pain
Fever, chills or feeling unwell
Red streaking or tender lymph nodes ^(1–3)

Viral infection — eczema herpeticum (HSV) urgent red flags

Eczema herpeticum occurs when herpes simplex virus spreads into eczema-affected skin. It is less common than bacterial infection but is important because it can become severe quickly and needs prompt antiviral treatment. ⁽⁵⁾

Same-day or next-day assessment red flags:

Clusters of painful blisters or punched-out erosions
Eczema suddenly becoming very painful — pain is a key clue
Fever, malaise or feeling unwell
Rapid spread across areas of eczema
Eye involvement (rash near eyes, eye pain, light sensitivity)

If you suspect eczema herpeticum, get reviewed urgently — book the next available appointment, or go to an emergency department if you cannot be seen quickly.

What you can do at home (safely)

If you suspect infection:

Do not wet wrap over oozing, crusting or infected-looking skin unless you have a specific plan from your doctor ^(1–3)
Clean gently — no scrubbing
Keep nails short and avoid picking crusts
Continue moisturising surrounding skin — this protects the unaffected barrier
Continue your flare plan if advised, but if infection looks significant or is worsening, seek review for a clear plan ^(1–3)
Avoid harsh antiseptics (Dettol, concentrated iodine, tea tree oil, alcohol-based products) directly on eczema — these often irritate and worsen the barrier even while killing some surface bacteria

Bleach baths and bleach soaks (hands and feet)

For adults with infection-prone eczema (recurrent crusting, repeated infected flares, or heavy bacterial colonisation), dilute bleach baths can reduce skin bacterial load as part of a broader plan. ^(6,7)

You do not need a separate adult bleach bath page — we use the same RCH-style dilution logic as our eczema bath recipe and apply it appropriately for adult-sized baths or hand/foot soaks.

Full recipe — read first

The detailed bath oil + pool salt recipe and the optional bleach dilution method are on our eczema bath recipe page.

When bleach soaks (instead of a full bath) are especially useful

Bleach soaks are often the most practical option for:

Severe hand eczema that keeps cracking and crusting
Recurrent infected fingertip fissures
Stubborn foot eczema with fissures (selected cases) ^(6,7)

How to do a bleach soak for hands — practical

This is the simplest adult adaptation:

Use a clean bucket or container and make up a dilute bleach bath using the same dilution as the eczema bath recipe (the “per 10 L” method) ⁽⁶⁾
Use lukewarm water
Soak hands for about 10 minutes ^(6,7)
Pat dry — do not rub
Apply your plan — anti-inflammatory to active eczema if prescribed , then moisturiser generously ^(1–3)

Tip: if making 10 L feels too much, you can make a smaller volume and scale the bleach down proportionally — the goal is maintaining the same final dilution. ^(6,7)

When NOT to do bleach soaks

Avoid bleach baths or soaks and seek review first if you have:

Rapidly spreading redness, significant warmth or pain
Fever or systemic symptoms
Suspected HSV or eczema herpeticum (blisters, severe pain)
Deep open wounds where the soak causes significant burning ^(1–3,5)

Should you rinse afterwards?

Different reputable sources differ on rinse vs no rinse. The most important step either way is moisturising immediately afterwards. ^(6,7) If your skin feels dry or stingy after a soak, a brief rinse can be reasonable.

Prevention — reducing infected flares

Most adults reduce infection frequency by focusing on:

Daily barrier routine and moisturising
Early flare control
Hand protection — gloves for wet work; moisturise after washing
Trigger reduction and contact allergy assessment when indicated ^(1–3)

If you get frequent infected flares, it is worth reviewing whether:

Eczema is under-treated (leading to scratching and skin breaks), and/or
Contact dermatitis is keeping the skin inflamed and vulnerable (patch testing can help) ^(1–3)

When to seek urgent care (checklist)

Seek urgent review if:

Redness is spreading quickly
Increasing pain, warmth, swelling
Fever or feeling unwell
Pus, significant weeping or extensive crusting
Painful blisters or sudden severe pain (HSV red flag)
Rash involves the eyes or you have eye symptoms ^(1–3,5)

If you have recurrent infected eczema, crusting or weeping flares, severe hand eczema with fissures, or you are unsure what you are seeing, book a review via the panel in the sidebar. Clinics at Ivanhoe and Diamond Creek.

Frequently asked questions

Does infected eczema always need antibiotics?

Not always. Mild localised infection may be managed with prescription topical therapy alone. Spreading infection, significant crusting, systemic symptoms, or cellulitis usually need medical review and often oral antibiotics. The decision turns on extent, depth, your medical history and how rapidly the picture is changing.
Should I stop steroid cream if eczema looks infected?

Not always. Inflammation often still needs treatment while infection is treated — but it depends on severity and the type of infection. The right approach is treating the infection AND continuing to settle the underlying inflammation, not pausing both. If you are unsure, book a review rather than stopping your prescribed cream.
Can I use bleach soaks for severe hand eczema?

Yes, in selected infection-prone cases. Bleach soaks are often more practical than a full bath for hand-only or foot-only eczema. Use the dilution approach in our eczema bath recipe, make a smaller volume scaled proportionally, soak for about 10 minutes in lukewarm water, pat dry and moisturise immediately afterwards.
What does eczema herpeticum look like and how urgent is it?

Eczema herpeticum is herpes simplex virus (HSV) spreading into eczema-affected skin. It looks like clusters of small painful blisters or punched-out erosions — often with sudden severe pain in an eczema patch that previously was not painful, fever or feeling unwell, and rapid spread. It can become severe quickly and needs same-day or next-day medical assessment and antiviral treatment. If you suspect it, book an urgent appointment or go to an emergency department, particularly if there is eye involvement.
Are bleach baths safe?

At correct dilution (similar concentration to a chlorinated swimming pool) and frequency, dilute bleach baths are safe and well-tolerated. The dilution must be precise — too strong is irritating, too weak does nothing. Always moisturise immediately afterwards. Do not use bleach baths on rapidly spreading infection, fever, suspected eczema herpeticum, or deep open wounds — seek review first in those cases.
How is infected eczema different from a normal flare?

A normal flare is dry, itchy, inflamed skin that responds to your usual moisturiser + anti-inflammatory cream plan within days. Infected eczema looks different — weeping or oozing patches, yellow honey-coloured crusts, increased tenderness or pain (worse than usual itch), pustules or pus bumps, rapid worsening rather than gradual flare, and sometimes systemic symptoms like fever or feeling unwell. Pain is one of the most useful early clues — eczema itches, infection hurts.
Can I use Dettol or other antiseptics on infected eczema?

Harsh antiseptics (Dettol, povidone iodine in concentrated form, tea tree oil, alcohol-based products) usually worsen the eczema barrier even while killing some surface bacteria. The result is often more inflammation and more infection over time. Stick to prescription topicals, gentle cleansing, and dilute bleach baths or soaks where appropriate — those are the evidence-based options for infection-prone eczema.
Do I need a referral?

No referral is required. You can book directly via the booking panel in the sidebar. Both clinics — Ivanhoe and Diamond Creek — see adults with eczema. If you have a referral from your GP or dermatologist for our records we welcome it, but it is not required to book or to be seen.

Which clinic?