Severity of eczema is variable, ranging from localised mild scaling to generalised involvement with redness, oozing and secondary infection. Itching and scratching are the predominant symptoms. The distribution of the rash typically varies with age. The entire body may be affected but the nappy area is usually spared. Bacterial infection is usually recognised by crusting of the eczematous lesions.
Pustules are generally less common except with infections of the palms and soles.
A subgroup of patients with infected eczema who may be clinically distinct are those with diffuse erythema of a characteristic beefy red colour. These features are very suggestive of streptococcal infection. Patients with eczema complicated by streptococcal infection are at risk for developing acute glomerulonephritis. A high index of suspicion is needed for the diagnosis of herpes simplex infection in patients with atopic eczema. Typical herpetic lesions are vesicular, but in patients with eczema the blisters have often ruptured, leaving discreet characteristic punched out ulcers.