While most “live” vaccine variants remain off-limits for people with eczema, non-live vaccines can be an important part of reducing infection risk.

Eczema is a collective term for seven inflammatory skin conditions sharing similar symptoms and pathology. Among eczema types, atopic dermatitis is the most common, affecting as many as 30% of children and 10% of adults in the United States.

The severe itching, irritation, and dryness associated with eczema are due to an underlying skin barrier dysfunction. The skin becomes unable to retain proper moisture levels, and skin permeability — how easily substances cross the skin barrier into the body — increases.

The result is a chronic inflammatory response that causes itching and other symptoms.

Some people feel uncertainty when it comes to eczema and vaccinations.

Historically, certain vaccines posed serious risks for people with this skin condition. For example, there was an association between the smallpox vaccine and severe adverse reactions in people with eczema. Plus, growing concern about vaccine safety in general has raised questions about vaccine ingredients as well as risk versus reward.

This article answers frequently asked questions about eczema and vaccinations.

Although rare, some people may experience an eczema flare-up after receiving a vaccine. For example, this could occur due to an allergic reaction from a suppressed immune system or the natural inflammatory response to the vaccine.

Natural inflammatory responses

Any time inflammation compounds in the body, eczema can flare. Higher levels of inflammation mean an increase in inflammatory substances, like cytokines, that cause itching and other symptoms.

In some cases, inflammation from a vaccine may be enough to trigger an eczema reaction.

Immunosuppressant medications

According to a 2021 literature review, vaccines that use live versions of a pathogen are those most commonly associated with eczema flare-ups. These vaccines are known as “live-attenuated” as they use a weakened version of a germ to create an immune response in the same way as if the body naturally developed the infection.

When a person is taking immune-suppressing medications to treat eczema inflammation, live-attenuated vaccines may overwhelm the weakened immune response and develop into full infections, causing systemic inflammation that worsens eczema.

Skin barrier dysfunction

Some live-attenuated vaccines, such as smallpox and monkeypox vaccines, may cause rampant infection even without the use of immunosuppressant drugs.

The traditional smallpox vaccine, now reserved for military use and special circumstances, is a live-attenuated vaccine known to cause a potentially fatal complication called eczema vaccinatum (EV).

EV results from the vaccinia virus that makes up the traditional smallpox vaccines. Skin barrier dysfunction in eczema allows the live-attenuated vaccinia virus to spread rapidly across the surface of the body, causing severe eczema symptoms, swollen lymph nodes, and systemic illness.

EV is also associated with the monkeypox vaccine, another vaccine made using the vaccinia virus. As with the traditional smallpox vaccine, healthcare professionals only use the monkeypox vaccine under special considerations.

People with eczema considered high risk for smallpox or monkeypox can receive modified vaccine alternatives that do not allow virus replication.

Allergic reactions

Allergies and sensitivities to vaccine ingredients can make symptoms of eczema flare. Allergies are a common co-occurring condition with eczema that can worsen inflammation and trigger symptoms.

The link between vaccines and new cases of eczema is an area of current study. According to a 2021 systematic review and meta-analysis, there is no consistent link between vaccine regimen and atopic dermatitis development.

However, while vaccines do not appear to directly cause skin barrier dysfunction that leads to eczema, some may act as environmental triggers in genetically susceptible people.

This means if a person is predisposed to eczema or living with extremely mild eczema, a vaccine reaction could potentially make symptoms clinically significant for the first time.

Some experts also believe complex interactions between the developing immune system in infancy and childhood vaccines may play a role in future eczema development.

For example, a large-scale 2021 cohort study found delaying standard diphtheria, tetanus, pertussis, polio, and Haemophilus Influenza type b (DTaP-IPV-Hib) was associated with a reduced risk for atopic dermatitis after 4 months of age.

However, more research is necessary to understand the correlation between childhood vaccinations and future eczema diagnoses.

As a general rule, people living with eczema should not receive live-attenuated vaccines due to the risk of infection.

Examples of live-attenuated vaccines available in the United States include:

  • traditional smallpox vaccine
  • nasal spray influenza (flu) vaccine
  • yellow fever vaccine
  • measles, mumps, and rubella (MMR) vaccine
  • chickenpox vaccine

For common diseases, such as influenza, non-live options are available. A doctor can recommend which vaccines make sense based on an individual’s age, overall health, and eczema triggers.

According to the International Eczema Council, all novel COVID-19 shots currently available are non-live vaccines. Unlike live-attenuated, non-live vaccines cannot cause infection or spread on the skin surface.

Examples of non-live vaccines safe for use in eczema include:

Eczema does not suppress the immune system in children or adults. It is a chronic inflammatory skin disease that can increase the risk for infection by allowing more infectious pathogens to cross the skin barrier into the body.

More infections are a result of skin barrier dysfunction, not lowered immunity.

Some children and adults may take immunosuppressant medications to help manage eczema. These medically suppress the immune system to help manage inflammation.

Eczema comes with an increased risk for infections. While not all vaccines are appropriate for use in eczema, non-live vaccines can offer an important layer of protection against common and potentially serious illnesses such as the flu.

Most people living with eczema can receive vaccinations without experiencing eczema-related side effects. However, for some individuals, vaccinations can compound inflammatory processes in the body, acting as initial environmental triggers or worsening existing eczema symptoms.

Due to the potential for infection, experts do not generally recommend live-attenuated vaccines for people with eczema.