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Over-the-Counter Topical Antibiotic Ointments: Are They Safe and Effective for Eczema?

Posted on May 03, 2022
Medically reviewed by
Kevin Berman, M.D., Ph.D.
Article written by
Elizabeth Wartella, M.P.H.

Over-the-counter topical antibiotic ointments are used to treat skin infections and injuries like scrapes and burns. These medicated ointments are not typically recommended for treating eczema symptoms, and they can actually cause a type of eczema called contact dermatitis. The National Eczema Association lists over-the-counter (OTC) topical antibiotic ointments as a main source of contact dermatitis among topical medications.

Contact dermatitis results from an irritant or allergen that touches the skin. Symptoms include inflammation, redness, and itchiness in the area where the substance touched the skin. Not everyone will develop contact dermatitis from OTC topical antibiotics, but for people who already have eczema, it is a risk.

While OTC topical antibiotic ointments are not intended (nor usually suggested) to treat eczema, they may be recommended when someone with eczema also has a skin infection (sometimes called infected eczema). Antibiotic ingredients will help kill the bacteria causing the skin infection, but likely won’t resolve any eczema symptoms. Furthermore, some research studies have found that OTC topical antibiotics might not be the most effective treatment option for a skin infection in people with eczema. Bottom line: It’s important to weigh the pros and cons before using topical antibiotics.

Members of MyEczemaTeam have commented about their difficulties treating eczema symptoms and skin infections. One member wrote, “I just found out a few days ago that using an antibiotic ointment when my skin is raw only helps to heal the damaged skin but flares up my eczema … I definitely won’t keep making that mistake!”

Talk to a doctor or dermatologist if you have eczema and believe you also have a skin infection. They will help provide an accurate diagnosis of your skin condition(s) and make a plan for treating your symptoms.

Over-the-Counter Topical Antibiotic Ointments

Over-the-counter topical antibiotic ointments are ointments applied directly to the skin to treat minor injuries, scrapes, and burns. The term “over-the-counter” means that they can be bought without a prescription, and they are available for purchase at most drug and grocery stores. These ointments work to kill bacteria, so they are used to treat and prevent bacterial skin infections.

Common antibiotic ingredients in OTC topical antibiotic ointments include:

  • Bacitracin
  • Neomycin
  • Polymyxin B

Some OTC antibiotic ointments include a combination of these ingredients. Depending on their specific use, some products contain other ingredients, like an anesthetic (for numbing) or petrolatum. (Scientists dissolve an ointment’s ingredients in petroleum jelly so you can apply it.) It is important to review the potential side effects and drug interactions before trying any new medication, including those available over the counter.

OTC Topical Antibiotics and Eczema

Because eczema is not a bacterial infection, OTC topical antibiotic ointments are not recommended for treating eczema itself. Topical treatments for eczema (both OTC and prescription) include ointments, lotions, and moisturizers that usually include ingredients like hydrocortisone and others that regulate the immune system in the skin. For severe eczema, injected or oral medications may be prescribed.

Eczema-Related Skin Infections

There are situations when it is possible to have both eczema and a bacterial infection. The National Eczema Society notes that skin infections happen often in people with eczema. Eczema often damages the outermost layer of the skin, making it more prone to bacterial, fungal, and viral infections.

Intense scratching from eczema symptoms also makes the skin more prone to infection. Open skin scratches and wounds can become infected with bacteria, including staphylococcus, the bacteria that causes staph infection. If an infection develops, a doctor may recommend topical antibiotics.

“I’m back on antibiotics as my eczema has become infected! So frustrated and so, so itchy,” posted a MyEczemaTeam member.

It may be difficult to distinguish the symptoms of eczema from a skin infection. But there’s a simple rule of thumb that helps in certain cases: Never apply OTC ointments to deep punctures or lesions. And while OTC antibiotic ointments can help heal skin infections, it is still advised to visit a dermatologist before you test a new ointment on your skin. Its ingredients might be known to aggravate existing eczema symptoms or cause contact dermatitis.

Risk of Contact Dermatitis

Using OTC topical antibiotic ointments can result in a type of eczema called allergic contact dermatitis, sometimes called a contact allergy. Allergic contact dermatitis results from an irritant or allergen that touches the skin. Symptoms like redness and a rash develop one to two days after skin contact. Other symptoms include inflammation, itching, and possibly burning or blistering of the affected areas.

Aside from OTC topical antibiotic ointments, a range of substances may cause contact dermatitis. Some of these include:

  • Shampoo
  • Perfume
  • Metal (jewelry)
  • Laundry detergent
  • Soap
  • Makeup
  • Paint

A research study on 100 people found that among different topical medications, topical antibiotic ointments like bacitracin and neomycin were the greatest contributors to contact dermatitis. A different study published in the Journal of the American Academy of Dermatology named bacitracin and neomycin as common allergens in people with contact dermatitis on their hands.

While OTC topical antibiotic ointments may cause contact dermatitis in some people, they might not cause any irritation or allergic reaction in other people. If you think you might be allergic to OTC topical antibiotics, ask your dermatologist or allergist about patch testing. Doctors use patch tests to determine your specific allergies.

Effectiveness

Treating eczema-related skin infections with OTC topical antibiotic ointments may also not be the most effective treatment option. There is some research exploring the value of treating infections with OTC topical antibiotics.

One research study examined children with eczema and skin infections who lived in the U.K. Researchers found that using topical antibiotic ointments, in addition to the standard treatment for eczema (emollient cream and topical corticosteroids), did not show additional wound healing benefits.

A member of MyEczemaTeam described how using a topical antibiotic ointment helped their child’s skin infection, but worsened their eczema symptoms. “I’ve started putting the antibiotic cream on my daughter’s face,” the caregiver posted. “It’s clearing up the infection, but the eczema is spreading.”

Topical antibiotic creams have the potential to help eczema-related skin infections, but another general concern with their use is something called antibiotic or antimicrobial resistance.

Antibiotic Resistance

Frequent or inappropriate use of antibiotics, whether they are topical or oral and OTC or prescription, presents the risk of antibiotic resistance. “Inappropriate” can mean not following the medicine’s directions, such as using the ointment for longer or shorter than directed. Antibiotic resistance happens when bacteria grow stronger than the antibiotics designed to kill them. (If antibiotics cannot treat an infection, soaking in a bleach bath — a tub filled with water and a small amount of bleach — might kill the bacteria and help eczema symptoms.)

The Centers for Disease Control reports that 35,000 people in the United States die every year from antibiotic-resistant infections. As a result, most doctors prescribe antibiotics only if necessary, and if they are known to improve specific symptoms.

Using OTC topical antibiotic ointments could contribute to your personal antibiotic resistance. For this reason, topical antibiotics should not be used for longer than 14 days. Consult a health care provider before using OTC topical antibiotics to make sure that it’s the safest and most effective treatment option for your skin condition.

Talk With Others Who Understand

On MyEczemaTeam, the social network for people with eczema and their loved ones, more than 42,000 members come together to ask questions, give advice, and share their experiences with others who understand life with the condition.

Do you deal with eczema and skin infections? Have you used OTC topical antibiotic ointments on them? Share your experiences in the comments below, or start a conversation by posting on MyEczemaTeam.

All updates must be accompanied by text or a picture.
Kevin Berman, M.D., Ph.D. is a dermatologist at the Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Learn more about him here.
Elizabeth Wartella, M.P.H. is an Associate Editor at MyHealthTeam. She holds a Master's in Public Health from Columbia University and is passionate about spreading accurate, evidence-based health information. Learn more about her here.

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