An overview of eczema, including its potential triggers and symptoms.
How the three main pillars of eczema - skin barrier, trigger control, and immune control - can affect your eczema and what you can do about it.
Eczema can refer to several chronic skin conditions that affect millions of people worldwide.
The most common type of eczema is atopic dermatitis. When people use the term eczema without defining the type of eczema they are referring to, they are generally referring to atopic dermatitis. Please check out our article on the types of eczema to learn about all the types and how they differ.
Atopic dermatitis is characterized by periodic acute flares, marked by red, itchy, and inflamed skin. The severity and duration of an acute eczema flare are influenced by three main factors:
The key to managing atopic dermatitis involves understanding the condition, identifying personal triggers, and implementing lifestyle changes and treatment.
Here we are going to cover what eczema is in general (all types). We do that by first explaining how the skin is structured, then how skin function (including how it malfunctions in eczema), and finally covering the three-pillars of eczema management.
Eczema is a complex condition that manifests as a group of symptoms, which can vary in terms of which symptoms arise, the area coverage and severity. There are also various potential triggers for eczema, which can also vary in sensitivity, leading to significant variability in the condition.
An individual can have an issue with any, or a combination of, skin barrier strength, triggers, or their immune system. And the weight of those factors can change over the course of time. As a result, there is no single definitive treatment for eczema, and a variety of potential treatments exist.
To manage eczema effectively, it is important to understand the specific symptoms present, which can indicate what triggers might exist, and what treatments might work.
The human skin is an intricate, multitasking organ that can be divided into three primary layers: the epidermis (skin barrier), dermis, and subcutaneous (or hypodermis) layer.
The subcutaneous consists of fat and connective tissue, providing insulation and cushioning for the body. The dermis is made up of connective tissue, hair follicles, blood vessels, lymphatic vessels, and sweat glands, forming a strong, flexible foundation.
The epidermis, akin to the outermost wall, is a waterproof layer responsible for protecting the body from external threats. The epidermis itself is composed of multiple layers, starting with the basal layer at the bottom, moving through the spinous layer, and culminating in the stratum corneum at the surface.(LOP 2022)
New cells are born in the basal layer and migrate upward as they mature, ultimately hardening and connecting with ceramides to form what most people think of as the “skin barrier”: the stratum corneum.(CAR 2017)
Healthy skin serves a variety of crucial functions, from protection to sensation.
Like a fortress against external threats, the skin acts as a physical barrier, defending against harmful substances, UV radiation, and pathogens. In eczematous skin, the skin barrier is compromised, similar to a castle wall with structural damage. The skin is therefore not able to offer full protection.
The skin barrier maintains hydration by preventing water loss, similar to a castle wall that keeps out unwanted elements while preserving valuable resources within.
In eczematous skin, a lack of ceramides, lipids, and structure in the skin barrier causes dryness, increasing transepidermal water loss (TEWL) and allowing triggers to pass through the barrier.
The skin is a first-line player in the immune system. A strong skin barrier acts as a physical blocker, but beyond that, the skin is equipped with an adaptive immune system specialized to protect against specific pathogens and other harmful substances.
The microbiome on the skin’s surface often works symbiotically with the adaptive immune system of the skin to signal and modulate the overall immune response.
Often in eczematous skin the relationship with the microbiome is poor and the body has an overactive innate immune response. With this, and in combination with a weaker skin barrier, the skin has a harder time modulating the immune reaction to triggers.
With sensory receptors detecting touch, pressure, temperature, and pain, the skin allows us to perceive our environment and respond to stimuli.
Individuals with eczema experience itchy sensations, pain, and discomfort, affecting their interaction to the world.
The skin regulates body temperature by controlling heat loss through sweat production and blood flow.
During an acute eczema flare, the blood vessels dilate allowing the blood to deliver immune cells to the affected areas. This process can disrupt the natural thermal regulation, resulting in warm patches of skin at times when the body might need to conserve that heat and making the body more sensitive to temperature changes in the environment.
Healthy skin contributes to our aesthetic appearance, affecting self-esteem and quality of life.
Eczema can lead to skin discoloration, dryness, cracking, and bleeding, diminishing one's aesthetic appearance.
The skin contains a precursor to vitamin D that is converted to its active form when exposed to UV radiation. Vitamin D is essential for bone health, immune function, and other physiological processes.
Eczema sufferers are more likely to have a vitamin D deficiency.
There are three pillars to healthy skin: skin barrier, trigger control and immune control.
If any one of these pillar has a problem, then eczema symptoms will flare. An individual may have problems with one or more of the pillars and these can vary over time. The different types of eczema treatment can be split into categories corresponding to the pillars of eczema management.
As discussed earlier in this article, the skin barrier plays a crucial role in protecting the body from external irritants and maintaining moisture levels.
The skin barrier can be considered the walls, bricks and mortar, of a castle. People with eczema have a weakened skin barrier, which make their skin more susceptible to irritants and allergens.
The skin barrier must heal before the eczema symptoms stop.
Eczema is often caused by the so called "triggers". Environmental factors such as irritants, allergens, and changes in temperature and humidity serve as triggers.
Identifying and avoiding triggers is an essential part of managing eczema. Some common forms of triggers include harsh soaps and detergents, wool and synthetic fabrics, dust mites, pet dander, and certain foods. Learn more about triggers in the triggers section.
By minimizing exposure to these triggers, individuals with eczema can reduce the severity and frequency of their symptoms. If these triggers are not managed properly, the skin barrier will continue to sustain damage and resulting immune response will continue.
The immune system plays a critical role in eczema, as it is responsible for the inflammation that leads to the characteristic red, itchy, and inflamed skin associated with the condition.
The immune system's response to triggers is complex and involves several types of immune cells and chemical messengers, such as cytokines, chemokines, and antibodies.
In people with eczema, the immune system is often overactive, which leads to excessive inflammation and a further weakening of the skin barrier.
There are also lifestyle changes such as diet, mental health tools and exercise that can be beneficial for immune function, as well as various systemic and targeted medications which can be very successful at calming the immune response and enable the individual to heal.
Now that you have a foundational understanding of what eczema is and how it impacts the skin's functionality, we encourage you to visit the referenced pages to dive deeper into your eczema journey. By exploring eczema's symptoms, types, stages and tracking, along with triggers and treatments, you will gain valuable insights to help you navigate and manage this condition. Equip yourself with knowledge and strategies and take control of your eczema journey today.
Ceramides in the skin influence the strength and suppleness of the skin barrier.
People with eczema often have insufficient long chain ceramides and poorly organized ceramide structure in their skin barrier.
Eczema is a chronic skin condition characterized by periodic flare-ups, with symptoms such as red, itchy, and inflamed skin. Three main factors influence the severity and duration of an eczema flare-up:
Skin barrier strength and the volume of triggers that are able to penetrate the skin barrier are largely controlled by the ceramide composition and organization in the skin.
Ceramides are essential lipids making up 50% of the outermost layer of the skin and providing the “suppleness” of the skin while also providing a barrier to the outside world.(MEC 2014) This barrier plays a vital role in keeping irritants, allergens, and pathogens out, while retaining moisture within the skin.
People with eczema often have a genetic predisposition which prevents their bodies from forming sufficient long chain ceramides and/or organizing those ceramides in their skin barrier.
In the following sections, we will explore the role of ceramides in skin health, their importance in eczema, and how ceramide-based treatments can help manage eczema symptoms.
Ceramides are a class of bioactive waxy-fats, or lipids, involved in various molecular mechanisms in the body. Ceramides are constructed in your skin and are also produced by the microbiome on your skin.(ZEL 2023)
Long chain ceramides help form the “glue” between skin cells, bolstering your skin barrier’s strength, suppleness, and smoothness.
The skin barrier in healthy people tends to be made up of more long chain ceramides.
Ceramides play a crucial role in the development and management of eczema due to their involvement in maintaining skin barrier function, affecting the skin's lipid content, and influencing the microbial life on the skin.(KOH 2022)
One of the primary causes of eczema is a dysfunctional skin barrier, primarily through the lack of long chain ceramides, which allows for increased moisture loss and exposure to allergens and irritants.(COD 2003)
A weakened skin barrier in eczema patients is often associated with imbalances in ceramide composition, specifically:
Decreased abundance of long chain ceramides
Increased quantity of short chain ceramides
Decreased organization of the ceramides in the barrier
Even the “normal” skin of people with eczema tends to have fewer long chain ceramides than that of a person without eczema, and those ceramides are often poorly organized.(BER 2018) This makes the skin susceptible to triggers and it also makes it harder for the skin to heal during a flare. The immune reaction further disrupts the formation and organization of ceramides, often leading to the flare spreading across the skin.
The ceramide composition and pH of the skin have a significant impact on the types of microbial life that can inhibit it. In atopic eczema, lipid composition correlates with the presence of S. aureus, among others, which have the potential to exacerbate eczema symptoms and delay healing from flares.(KIM 2018)
As the skin is symbiotic with a healthy microbiome, when ceramides are disorganized and not enough long chain ceramides are present, the microbiome is disrupted, further challenging the skin and potentially sustaining a flare.(COD 2003)
Long chain ceramides, compared to their short-chain counterparts, are crucial in reducing eczema symptoms. Their absence can lead to various skin problems related to eczema. A reduction in the chain length of ceramides has a stronger association with the severity of eczema than the total level of ceramides or ceramide subclasses.
You may have read that many eczema patients have a mutation which prevents proper production of filaggrin, a protein which plays a role in the organization of ceramides in the skin barrier. The evidence indicates that long vs short chain ceramide production has a stronger correlation with the presence of eczema and the severity of a flare.(JAN 2012)
Long chain ceramides contribute to the strength of the skin barrier through several mechanisms:
Restoring proper long chain ceramide composition and structure in the skin may block new triggers from increasing the intensity or duration of a flare, will moisturize the skin, and will reduce skin bacterial colonization in patients with atopic dermatitis.(BOR 2016)
Ceramides naturally decrease as we age and during winter months. If you are an adult eczema warrior, then you have doubtless experienced how eczema is worse in the winter and after age 40.
Although we cannot control the passage of time or the changing seasons, there are several strategies to help prevent ceramide loss and maintain healthy skin.
Ceramide-based topical treatments can help replenish the reduced levels of long chain ceramides in the skin, improving the overall skin barrier function and addressing the symptoms of eczema. These products are available in various forms, including creams, lotions, and ointments.
Important considerations when choosing ceramide-based treatments:
A few prescription medications contain ceramides and feature patented formulas that closely mimic the ceramide composition of healthy skin. However, these products may not offer significant advantages over over-the-counter ceramide-based moisturizers - possibly due to their impact on the microbiome.
Some oral supplements on the market claim to support ceramide production in the body. These supplements may include ingredients such as phytoceramides (plant-derived ceramides) or other nutrients that support skin barrier function.
The effectiveness of oral ceramide supplements in treating eczema has not been well-established.
For many eczema sufferers, their bodies naturally lack the enzymes and processes required to build long chain ceramides. As a result, supplements providing the building blocks for ceramides may be less effective than topical ceramides.
Rulo's products are clinically proven to produce long chain ceramides while simultaneously promoting a healthier microbiome. We feed the microbiome health food to induce it to produce long chain ceramides for you. Rulo's products offer the following advantages:
No harmful ingredients - for you or your microbiome
Added protection through a healthier microbiome
No disruption of the skin from foreign ceramides or chemicals
In a 15-week clinical trial, Rulo's products demonstrated the following results:
93% of participants experienced relief from dry, red, itchy skin concerns
95% saw a decreased appearance of skin sensitivity
84% reported a reduction in the appearance of cracking, flaking, and irritation
While eczema presents numerous challenges, understanding the role of ceramides in maintaining skin health can help you better manage its symptoms. It's essential to consider various aspects of eczema when identifying and treating symptoms, and incorporating ceramides into your skincare regimen can improve your overall skin health.
Explore our range of resources and articles to learn more about how ceramides can aid in the treatment and management of eczema.
Share your experiences with us! Tell us what has and hasn’t worked for you. What did we miss in this article that you've found personally impactful? Your insights can help others better understand and manage their eczema.
Eczema is a complex disease influenced by multiple, individual factors, like trigger intensity, skin barrier strength, and immune system sensitivity.
Effective eczema treatment requires an integrated approach and persistence in finding the most effective treatments for your individual factors.
Eczema is a chronic skin condition characterized by periodic acute flares, marked by red, itchy, and inflamed skin. The severity and duration of an acute eczema flare are influenced by three main factors:
Various treatments and lifestyle adjustments can help manage the symptoms and minimize the impact of eczema on your life.
Individual factors play a significant role in determining the most effective treatment plan for eczema. The condition is generally described as a balancing act between skin barrier strength, trigger intensity, and immune intensity. However, those factors can be deeply personal in the way that they represent and work. As a result, your body’s response to treatments will also vary.
In this blog post, we will discuss how available treatments address one or more of the three main factors, differences in treatments for the different types of eczema, and how to tailor your treatment to your personal brand of eczema.
Triggers are factors that can cause or worsen eczema symptoms and vary from person to person. Common triggers include harsh soaps, detergents, fragrances, allergens, climate, stress, and certain foods.
Controlling exposure to triggers can reduce the severity of the condition and allow symptoms to subside.
In our article on trigger avoidance we explore techniques to reduce exposure to different triggers while minimizing the impact on your life.
In our article on washing we explore how best to clean the skin, removing triggers, without causing a flare-up or weakening the skin barrier.
By identifying and minimizing exposure to your personal triggers, you can help reduce the frequency and severity of eczema flare-ups.
To learn more about the triggers themselves, see our article on triggers. See the tracking and allergy tests to learn how to identify triggers.
In people with eczema, skin barrier strength is compromised, more moisture can escape and irritants can penetrate deeper into the skin resulting in dry and damaged skin.
In our section on moisturizing we cover how to build the skin barrier back up which is necessary to resolve a flare and how to keep it strong to prevent new flares.
In our section on managing symptoms we reviewed the tools and techniques that can be used to calm the eczema symptoms and reduce the damage to the skin barrier caused by an active flare.
The skin is made of proteins, ceramides, dead skin cells and other lipids. There are multiple processes the body uses to produce and organize the skin barrier and any one of which can go awry.
In our article on ceramides, we cover how they work to block triggers and provide smooth, moisturized skin naturally. We also cover how to supplement them.
The skin works symbiotically with the microbiome, the collection of microorganisms in the environment. The microbiome can help protect the skin and tune the immune system (which also protects the microbiome). There are a number of ways the microbiome can become disorganized.
In our article on the microbiome we cover signs that your microbiome is out of balance and how to cultivate a healthy skin microbiome.
The immune system is a complex network of organs and cells that protect the body from invasive pathogens. The third pillar of eczema treatment, the immune control, involves managing immune-influencing factors through lifestyle changes and treatment options that target parts of the immune system to restore normal activity.
Our section on understanding immune control provides a deep-dive into the role of the immune system in eczema.
Most people start their eczema treatment journey by going to the doctor. This typically means that they are in mid-flare and the symptoms are at their worst.
Because of the limitations on time and the patient’s focus on the symptoms, doctors’ go-to treatments usually revolve around immune modulation as it often provides the most direct symptom relief in a limited amount of time.
Triggers can take time to identify. The skin barrier takes time to heal and strengthen. Both processes involve more effort on the patient’s part and do not require a doctor. So expect your physician to focus on the medical immune modulation techniques below.
However, an approach to trigger avoidance/removal, skin barrier strengthening, and general immune control will provide the maximum long-term benefit of reducing flare intensity, duration, and occurrence.
The immune modulation treatments below have been grouped into self care, which can be done on your own, and medical treatments, which require a physician.
Self care treatments are things which you can do on your own. To boost immune health holistically, please check out the following:
Our Diet and Nutrition page details how food can be used to reduce inflammation and support a healthy immune system.
Our Mental Health page details how mental well-being techniques can be used to boost immune health.
Our Exercise page details how physical activity can be used to improve immune health and;
Our Infections page learn how to identify and combat infections.
Some medications that use immune control can be bought over the counter with no prescription.
Our Antihistamines page will show you when and how to use antihistamines including which varieties work best to reduce itchiness and inflammation with oral or topical treatment.
Our Topical Steroids page covers how they can work to reduce inflammation and control eczema flares.
In some moderate or severe cases of eczema, it may be necessary to escalate the treatment by involving prescription medication. It is necessary to talk to your doctor about the following medical treatments:
Our Topical Steroids page also covers higher potency topical steroids can be used to reduce inflammation in more severe acute flares
Our Topical Calcineurin Inhibitors page covers TCIs and how they work to calm the immune response.
Our Phototherapy covers how light or UV therapy can be used to calm the immune response and boost vitamin D.
Our Immunosuppressant page covers how oral systemic immunosuppressives calm an overactive immune response and the risks associated with them.
Our JAK Inhibitors page covers how JAK Inhibitors interrupt a part of the inflammatory pathways.
Our Monoclonal Antibodies page covers how they work to reduce the inflammatory response.
In many cases, an overactive immune system response leads to inflammation and irritation of the skin. However, the immune system is incredibly complex and understanding the root cause of the intensity of your immune reaction can be challenging.
The above treatments work in targeted ways to modify your immune response.
Working with a healthcare professional can help you identify the underlying factors contributing to your immune system's response enabling you to tailor your treatment plan accordingly.
To ensure the best chances of recovery, it is important to know what support is available, who to talk to, and what you can expect from each option.
Our Doctors page covers how can a doctor help you with and how to work with them to optimize your treatment.
Our Allergy Tests page covers what tests are available, how they work, and how to apply them to your eczema.
Ultimately, the most effective eczema treatment plan will be as unique as your individual manifestation of the condition. By collaborating with healthcare professionals and utilizing self-care strategies, you can better manage your eczema symptoms and flare-ups and it will lead to an improved quality of life.
Eczema is a complex skin condition influenced by trigger intensity, skin barrier strength, and immune system sensitivity. It is essential to understand that an effective eczema treatment plan will vary from person to person as each individual experience with eczema is unique. As you embark on your journey to manage your eczema symptoms and flare-ups, remember that trial and error may be necessary to find the most effective treatments for you.
By remaining patient and persistent in finding the best combination of strategies, you can significantly improve your quality of life and gain better control of your eczema. Share your experiences with us! Tell us what has and hasn’t worked for you. What did we miss in this article that you've found personally impactful? Your insights can help others better understand and manage their eczema.
The skin barrier function is compromised in eczema, allowing for increased water loss and trigger permeability.
Selecting the right moisturizer can reduce eczema flare-ups, the need for prescription medicine, and improve skin barrier strength.
Eczema, affecting millions of individuals globally, is a recurring skin condition typified by red, itchy, and inflamed skin outbreaks. The degree and length of these flare-ups are influenced by three key factors:
So why is moisturizing an essential part of eczema treatment? Let's dive deeper into the science of our skin to answer that question.
Our skin is not just a passive barrier; it is a dynamic organ with a fundamental role in our body's overall health. One of its primary functions is to act as a protective barrier, shielding us from external environmental factors, like irritants, allergens, and infectious agents. In individuals with eczema, this skin barrier function is compromised.
Even the healthy, non-flaring skin of those with eczema will show signs of having greater permeability and water loss (and therefore trigger pass-through).
Eczema moisturizers can support the skin in various ways:
Reduce dryness, irritation, and subsequent itching and trigger pass-through.(SET 2016)
Provide necessary hydration for skin healing (dry skin will struggle to produce the proteins needed to repair itself)
Create a physical barrier against triggers
Reduce inflammation (CAS 2006)
Nourish the microbiome, which in turn reduces inflammation and pathogens
Selecting the right moisturizer can reduce the number of flares, the amount of prescription medicine required to halt or relieve a flare, and promote barrier strength. (ZUU 2017)(GIR 2022)
When it comes to managing eczema, not all moisturizers are created equal. Various types of moisturizers are available on the market, each with its own unique formulation, texture, and benefits. Each has different properties that can make them more suitable for specific symptoms and situations.
In this section, we'll break down the differences between eczema creams, lotions, gels, and ointments, to help you make an informed choice about which product is right for your skin.
Lotions have the lightest feel, spread easily, and dry quickly. There is no official definition of a “lotion” but, in general, they will have a lower oil content than creams and ointments - this will become important in our section on choosing the right product for you. Lotions are generally non-occlusive, meaning they do not form a water-tight barrier on the skin's surface.
Again, there is no official definition of creams, including aqueous creams, but they are generally made from a 50:50 oil to water ratio and are thicker than lotions. Although they may feel slightly greasy upon application, creams are generally non-greasy after absorption. Like lotions, creams are also non-occlusive.
Ointments are the thickest moisturizers, often consisting of an oil to water ratio of something like 80:20. They create an occlusive layer on the skin, which can feel greasy, which may not be suitable for daytime use or for those with oily or acne-prone skin. However they can provide a longer-lasting barrier of oil to keep moisture in.
Gels contain no oils, making them non-greasy and easily absorbed, and a suitable option for those who are prone to acne. While eczema lotions, creams, and ointments all contain an oil as a primary tool for eczema relief, eczema gels often serve as a medium for delivering other ingredients to the skin.
When it comes to managing eczema, the active ingredients in your chosen moisturizer can make a significant difference. Many lotions, creams, and ointments rely solely on the oil to provide lasting moisture and relief, but there are other “active” ingredients that can help as well. These ingredients may or may not provide a therapeutic effect for your version of eczema. In this section, we'll delve into some of the most common active ingredients found in eczema moisturizers and their benefits.
Ceramides are lipids (fats) that naturally occur in the skin and play a critical role in maintaining the skin's barrier function. Ceramides have a direct connection to the long-term nature and severity of eczema.
People with atopic dermatitis often have lower levels of long chain ceramides in their skin overall (even their healthy skin), than someone who does not have eczema. Not all ceramides are made equal though and they are often expensive. Learn more in our page about ceramides.
Hyaluronic acid is a powerful humectant, meaning it draws moisture from the environment. This ingredient can hold up to 1,000 times its weight in water. Hyaluronic acid can help to alleviate the dryness associated with atopic dermatitis and enhance the skin's overall health and appearance.
Like hyaluronic acid, glycerin is a humectant that attracts water to the skin. It's commonly used in skincare products due to its ability to hydrate the skin and lock in moisture.
Colloidal oatmeal has been used for centuries to soothe itchy, irritated skin. It contains antioxidants and anti-inflammatory compounds that can help to reduce inflammation and itchiness in eczema-prone skin. Colloidal oatmeal also forms a protective barrier on the skin's surface, helping to retain moisture and protect against irritants.
Petrolatum (also known as petroleum jelly) is a highly effective occlusive ingredient. This means it forms a physical barrier on the skin to prevent water loss. While it doesn't provide moisture itself, it locks moisture in, making it a valuable ingredient for eczema sufferers with extremely dry skin.
Unfortunately, it is toxic to your microbiome, which is why it is often used in wound care. See our article on the microbiome to understand the impact that has on eczema.
Niacinamide, or vitamin B3, is an ingredient that's gaining popularity in skincare due to its wide range of benefits. It helps to restore the skin's barrier function, improves skin texture, reduces inflammation, and even helps to reduce itchiness. This makes it a beneficial ingredient for those with eczema.
Aloe Vera is well-known for its soothing and anti-inflammatory properties, making it a common ingredient in skincare products for sensitive or irritated skin. It can help to calm inflammation, soothe itching, and provide lightweight hydration.
Most lotions, creams, and ointments incorporate oils to provide temporary hydration and to form a barrier on the skin. Typically, these skincare products feature petroleum-based oils.
Petroleum-based oils, while effective, can strangle the skin's microbiome, potentially prolonging an eczema flare-up.
Alternative options, like coconut oil, shea butter, or sunflower seed oil, can also be used, although their impact can vary depending on individual skin sensitivities.(VER 2008) Even though they are derived from natural sources, these oils and extracts can sometimes cause allergic reactions, as they may contain plant-based irritants.
Some manufacturers opt to try to extract the critical ingredients from the plant to avoid the irritants and allergens in the plant. However, impurities introduced during the extraction process might be present. Opting for raw, organic, and virgin oils could mitigate the risks of impurities, but individual reactions can still vary widely.
Navigating the world of eczema moisturizers can be overwhelming given the variety of options available. In this section, we will guide you on how to choose the right eczema moisturizer based on several factors, including the severity of your symptoms, your skin type, your sensitivity to ingredients, and your lifestyle.
Selecting the right moisturizer for your eczema treatment requires trial and error to determine what works best for your skin and type of eczema. This may change over time as your symptoms and needs evolve. Consider the following tips when choosing a moisturizer:
Assess your symptoms and the other treatments you are using: If using topical steroids, avoid occlusive moisturizers.
Avoid moisturizers with fragrance and colorings: they can irritate the skin.
Severity of Symptoms: The severity of your eczema should be a significant factor in your choice. For mild eczema, a lotion, gel, or serum targeting skin barrier concerns might suffice. For more severe eczema, a lotion including anti-inflammatory compounds may help.
Skin Type: If you have oily or acne-prone skin, you might want to opt for a gel, serum, or lotion, which is less likely to clog pores.
Lifestyle & Environment: Consider your daily routine and personal preferences. If you dislike the feeling of a heavy product on your skin during the day, you might prefer using a lighter lotion or gel in the morning and a thicker cream or ointment at night.
In developing this article, we scrutinized the existing moisturizers in the market and kept finding concerns. We noticed an abundance of moisturizers that:
Included a myriad of ingredients, which were potential allergens or harmful to the skin's microbiome.
Heavily relied on oil for temporary skin protection, resulting in frequent reapplication.
Leveraged so-called "hero" ingredients to make claims, yet lacked significant scientific backing.
So we put our team to work to develop something that could:
Provide relief for dry, red skin that lasts.
Deliver just the right amount of hydration that the skin needs — not too much, not too little, and without the need for constant reapplication.
Maintain a healthy microbiome, avoid introducing new allergens or triggers, and use natural compounds that were sourced as purely as possible.
Our dedication and commitment to these principles have resulted in a line of products that we are truly proud of. We invite you to explore our product range and experience the Rulo difference for yourself.
Allergies are overreactions by the immune system to otherwise harmless compounds. Unfortunately allergies are all too common for people with eczema.
Moisturizers can come with a number of ingredients both active and inactive, natural and synthetic that could cause an allergic reaction. Look for moisturizers that are fragrance-free and hypoallergenic to minimize potential irritation.(NEM 2022) Be sure to patch test a small area to see if you are sensitive before diving in.
How to conduct a patch test:
Choose a small, discreet area of your skin, like the inside of your wrist or elbow.
Apply a small amount of the product to the selected area.
Wait for at least 24 hours to see if any reaction occurs. If there's no reaction, the product is likely safe for you to use. If you notice redness, irritation, or any other signs of a reaction, stop using the product immediately.
Repeat the process every time you introduce a new product into your routine.
Keep a log of the list of ingredients if you do have a reaction to a product. Try switching to another product and compare the ingredient list to try to identify which ingredient might be the culprit.
The act of moisturizing is simple, but understanding the nuances can make a significant difference in the effectiveness of your eczema treatment. Keep these key points in mind:
The most crucial time to apply your moisturizer is immediately after bathing, while your skin is still damp.
Some of the active ingredients work to “lock moisture” to the skin. On drier skin, this process can release energy and cause a stinging sensation. By using moisturizer while the skin is wet you:
Retain some of the moisture from the water already on the skin
Spread the moisturizer a little easier
Alleviate some of the stinging sensation.
Here's a step-by-step guide on how to apply your eczema moisturizer:
Apply to damp skin: As mentioned earlier, the best time to moisturize is after a bath or shower while your skin is still damp. Pat your skin dry with a towel instead of rubbing it, then apply your moisturizer.
Apply your moisturizer by gently smoothing it onto your skin in the direction of hair growth to avoid folliculitis (inflammation of the hair follicle). Don't rub it in as this can potentially irritate your skin and trigger a flare-up.
Use enough product: Be generous with your moisturizer. It should be applied in a thick layer, covering all areas of dry or affected skin.
Let it absorb: Give your skin time to absorb the moisturizer before getting dressed or applying any other skincare products. This usually takes a few minutes.
Wet wraps can be applied immediately after moisturizing.
Here are some common mistakes to avoid when moisturizing your skin:
Not moisturizing often enough: If you have eczema, moisturizing once a day may not be enough. Listen to your skin, and if it feels dry or itchy, it is probably time to reapply your moisturizer.
Using the wrong type of moisturizer: As we have discussed, the type of moisturizer you use matters. Make sure you are using a moisturizer that's designed for eczema-prone skin and suits your skin type and severity of symptoms.
Applying moisturizer to dry skin: Always apply your moisturizer to damp skin to help lock in moisture. This is most effective immediately after a bath or shower.
Ignoring your triggers: Eczema is often triggered by specific factors, such as certain fabrics, fragrances, or allergens. Even the best moisturizing routine won't be fully effective if you do not also take steps to avoid your triggers.
In hot and humid weather, avoid using excessive ointment, as it can cause heat rash or discomfort due to skin overheating and reduced sweat effectiveness.
Avoid applying moisturizer to scratches, cuts, or scabs, as it may interfere with the healing process or increase the risk of infection.
Here are some insider tips to enhance your skincare routine and boost your skin's health:
Keep Moisturizer Handy: Whether you're at work, in the park, or traveling, always carry a small bottle or tube of your trusted moisturizer. Having it readily available allows for quick application whenever your skin feels dry or irritated.
Apply Moisturizer Proactively: Do not wait for your skin to show signs of dryness. Use moisturizers preemptively to protect your skin, especially before exposing it to harsh conditions. For instance, before swimming, apply a protective layer of ointment to any dry areas to shield them from the chlorine and other chemicals in pool water.
Use Moisturizers for Cleansing: This might sound unconventional, but moisturizers can be excellent gentle cleansers. Check out our washing page for more details on how to incorporate moisturizers into your cleansing routine.
Keep your moisturizer clean: opt for a squeezable moisturizer. Those in a jar can induce bacteria growth from touching it
Avoid Sodium Lauryl Sulfate: Sodium Lauryl Sulfate (SLS) is a common ingredient in many skincare products but it's a known skin irritant. Make it a habit to read the ingredients list of any new product and avoid those containing SLS.(TSA 2010)
Moisturizing is a critical component of eczema treatment, but there are other methods and treatments that can help improve your symptoms. Explore additional treatment options such as dietary changes, stress reduction, and prescription medications to further enhance your eczema management.
By understanding your skin's unique needs and following a proper moisturizing routine, you can take control of your eczema and improve your quality of life.
Triggers are internal or external factors that can worsen eczema symptoms.
Managing eczema involves understanding and addressing triggers.
Eczema is a chronic skin condition characterized by periodic acute flares, marked by red, itchy, and inflamed skin. The severity and duration of an acute eczema flare are influenced by three main factors:
Trigger intensity
Triggers play a critical role in the severity and duration of an acute flare. You can think of them as an invading army outside the city gates.
There are various types of eczema, such as atopic dermatitis, contact dermatitis, dyshidrotic eczema, nummular eczema, seborrheic dermatitis, and stasis dermatitis. Some of the types have the same triggers while others have unique.
This section explores the different sources of eczema triggers, how they can be identified and what can be understood about the resultant eczema. This page introduces each of the types of triggers with reference to the detailed pages.
Triggers are external or internal factors that initiate or worsen the symptoms of an acute flare - the tell-tale inflammation and irritation of a patch of skin.
Triggering substances can be present in the environment or enter the body through food and drink.
Triggers can vary significantly among individuals, and what causes a flare-up in one person might not affect another. Factors such as genetics, lifestyle, and environment can influence how a person reacts to specific triggers. It's essential for individuals with eczema to identify and understand their triggers.
The skin barrier is the outermost layer of our skin, which plays a crucial role in maintaining our overall skin health. This layer is composed of flattened, dead skin cells (corneocytes) surrounded by a lipid matrix, which consists of ceramides, cholesterol, and fatty acids. It acts as the wall and gates of the city that not only retains moisture but also defends against triggers.
When there are triggers in the external environment, the skin barrier is responsible for the first line of defense of the body against the impact of those triggers. The immune system acts as backup to the skin barrier. The strength of the skin barrier can significantly influence how individuals with eczema react to various triggers in the environment.
In individuals with eczema, the skin barrier is often weakened or compromised leading to increased susceptibility to triggers. This compromised state can be due to genetic factors, reduced production of essential ceramides, or damage caused by scratching or exposure to large amounts of triggers.
The gut plays a significant role in overall health, including the health of the skin. A strong gut helps maintain a balanced immune system which can influence the development and severity of skin conditions like eczema.
When triggers entered the digestive system, the strength of the gut can help modulate the immune system's response to triggers, reducing inflammation and the severity of flare-ups.
A weakened or imbalanced gut can exacerbate the immune system's response to triggers leading to increased inflammation and worsening eczema symptoms.
Sensitivity of the immune system to triggers can significantly influence how an individual with eczema responds to various external and internal factors.
A heightened immune response can exacerbate eczema symptoms, while a well-balanced immune system can help mitigate the impact of triggers and minimize flare-ups.
The individual nature of the immune system, combined with the skin barrier and gut strength help to explain why two people can encounter the same triggers, but have different outcomes.
Understanding common eczema triggers can help individuals manage their condition and reduce flare-ups. Here is a brief summary of some typical triggers.
Common allergens like pollen, pet dander, dust mites, and certain foods can cause an immune reaction leading to inflammation and worsening of eczema.
Dry or cold air, excessive heat, and humidity can trigger eczema flare-ups by causing skin dryness or increased sweating.
Emotional stress can weaken the immune system making the skin more susceptible to triggers and exacerbating eczema symptoms.
Hormonal fluctuations, particularly in women, can trigger eczema flare-ups due to the impact of hormones on the immune system and skin health.
Unlike allergies, food sensitivities are not caused by an immune reaction but can still result in an increased inflammation and exacerbation of eczema. Also, some foods are known to promote inflammation in the body which can contribute to eczema flare-ups. Examples include processed foods, refined sugars, and trans fats.
While the above triggers can affect individuals with various forms of the condition, some triggers are more specific to certain types of eczema. Understanding these triggers can help individuals manage their eczema more effectively.
Atopic dermatitis which is the most common form of eczema, is often linked to a genetic predisposition for skin barrier weakness and malfunctioning immune system. Triggers for atopic dermatitis include:
Allergens: Pollen, pet dander, dust mites, and certain foods can trigger atopic dermatitis flare-ups.
Dry skin: A genetically weak skin barrier, low humidity, cold weather, and harsh soaps can exacerbate skin dryness and lead to an acute atopic dermatitis flare.
Infections: Bacterial, viral, or fungal infections can worsen atopic dermatitis symptoms.
Contact dermatitis occurs when the skin comes into direct contact with an allergen or irritant. Triggers for contact dermatitis include:
Dyshidrotic eczema is characterized by small, itchy blisters on the hands and feet. Triggers for dyshidrotic eczema include:
Stress: Emotional stress can trigger dyshidrotic eczema flare-ups.
Allergens: Nickel, cobalt, and chromium salts can exacerbate dyshidrotic eczema.
Moist conditions: Prolonged exposure to water, excessive sweating, or occlusive footwear can trigger dyshidrotic eczema.
Nummular eczema, also known as discoid eczema, presents as coin-shaped patches of irritated skin. Triggers for nummular eczema include:
Seborrheic dermatitis affects areas of the skin with a high density of oil-producing glands. Triggers for seborrheic dermatitis include:
Stasis dermatitis is caused by poor blood circulation in the lower legs, resulting in inflammation and skin changes. Triggers for stasis dermatitis include:
Effectively managing eczema triggers is a vital part of controlling the condition and reducing flare-ups. By understanding and addressing the factors that contribute to eczema symptoms, individuals can take control of their skin health and improve their quality of life.
Taking steps to identify and manage eczema triggers can significantly reduce the frequency and severity of flare-ups. By avoiding or minimizing exposure to known triggers, individuals can help prevent skin irritation and inflammation, leading to better overall skin health.
Working closely with healthcare providers, such as dermatologists, allergists, and nutritionists, is crucial for effective eczema management. These professionals can help identify personal triggers, develop tailored treatment plans, and provide guidance on how to manage eczema triggers effectively.
Eczema triggers are diverse and can vary among individuals. Irritants, allergens, climate and environmental factors, stress, hormones, and infections are some of the most common triggers. Specific types of eczema may also have unique triggers, making it essential to understand individual specific condition and its associated factors.
Effectively managing eczema triggers is a critical aspect of controlling the condition and reducing the frequency and severity of flare-ups. By understanding the role of the skin barrier, gut health, and immune system sensitivity in the context of triggers, individuals can take targeted steps to address their eczema.
Share your experiences with us! Tell us what has and hasn’t worked for you. What did we miss in this article that you've found personally impactful? Your insights can help others better understand and manage their eczema.
Identifying and avoiding triggers helps reduce the frequency and severity of eczema flare-ups.
Triggers vary from person to person, and recognizing them enables tailored strategies for better skin health.
Eczema is a chronic skin condition characterized by periodic acute flares, marked by red, itchy, and inflamed skin. The severity and duration of an acute eczema flare is influenced by three main factors:
Identifying and avoiding eczema triggers is a crucial step in managing the condition and reducing the frequency and severity of flare-ups. Each person's experience with eczema is unique, and their specific triggers may vary.
By recognizing the factors that exacerbate their symptoms, individuals can develop personalized strategies for avoiding and overcoming these triggers, ultimately leading to healthier skin and improved quality of life.
In this article, we will provide a brief overview of common eczema triggers and delve into practical tips for minimizing their impact on your skin.
Eczema triggers can be diverse, ranging from stress to environmental factors, dietary, and other less common triggers. Identifying your specific triggers is an essential step in managing your eczema effectively. To learn more about each trigger, please refer to the following pages:
Stress, both physical and emotional, can negatively impact the immune system and trigger or worsen eczema symptoms.
Environmental factors such as pollution, humidity, and temperature changes can influence eczema symptoms.
Food can contain allergens, intolerances, and other stressors.
Allergens are substances that trigger an immune response, causing inflammation and worsening eczema symptoms. Intolerances can create stress in the body and lead to an immune response as well.
Irritants are substances that can cause skin inflammation and exacerbate eczema symptoms.
Hormonal fluctuations, such as those experienced during pregnancy, menstruation, or menopause, can trigger eczema flare-ups.
Once you know which triggers are relevant to your condition, you can tailor trigger avoidance to maximize effectiveness and minimize impact on your life. Read on for actionable strategies to avoid common eczema triggers.
Common eczema triggers include irritants, allergens, stress, environmental factors, pathogens, hormonal changes, and UV exposure. We are going to take them one-by-one and share tips to get started in managing them.
We start with how to identify which triggers are most important to you.
By pinpointing the factors that contribute to your flare-ups, you can develop a targeted approach to avoiding these triggers and improving your skin's health. Here’s how!
To determine your specific eczema triggers, consider maintaining a symptom journal. Document your daily activities, the products you use, the foods you eat, and any changes in your environment. Note any flare-ups or worsening of symptoms, and look for patterns or correlations between these factors and your eczema.
We have a guide on how to make that a little easier.
Consulting with an allergist or dermatologist can provide valuable insights into potential allergens that may be contributing to your eczema symptoms. They may recommend skin patch testing, blood tests, or other diagnostic tools to identify allergens.
We go into more detail here.
Certain chemicals and irritants found in everyday products can trigger eczema flare-ups. The common culprits are detailed here. To minimize exposure:
Wear protective clothing when handling irritants and cover exposed surfaces when there are irritants in the air.
Wash your skin and clothing as soon as possible after exposure, following the guidelines on our washing with eczema page.
Choose toiletries and household products designed for sensitive skin, primarily avoiding fragrances and artificial colorings.
Opt for skin-friendly fabrics and clothing made from soft, breathable fabrics like cotton or bamboo, which are less likely to irritate the skin. Avoid wearing rough or synthetic materials, such as wool or polyester, that can exacerbate eczema symptoms.
Make sure your clothing is loose-fitting and comfortable to prevent friction and irritation.
By minimizing exposure to these irritants, you can reduce the chances of experiencing an eczema flare-up and better manage the factors that cause eczema flare-ups in your daily life.
Reducing exposure to allergens is a critical aspect of managing eczema and preventing flare-ups. In this section, we will provide practical tips for creating an allergen-free environment and embracing an allergy-friendly diet.
Dust mite allergies can exacerbate eczema symptoms, as the microscopic mites and their feces are common household allergens. To minimize exposure to dust mites and their allergens, consider the following tips:
Use a vacuum cleaner with a HEPA filter to reduce dust build-up.
Vacuum floors at least twice a week.
Avoid direct skin contact with items that accumulate dust, such as cushions, fabric sofas, rugs, carpets, and soft toys. Use a clean sheet to cover these areas or wear long sleeves when relaxing.
If possible, minimize carpeted areas in your home and opt for hard flooring instead.
Reduce clutter and ornaments that collect dust.
Control humidity in your home to discourage dust mite activity - Low humidity is preferable but be mindful of the potential for dry air to exacerbate skin dryness.
Use a foam mattress instead of a spring one, as dust can build up in the cavities of the latter.
Air out and beat your mattress on dry, sunny days.
Use non-allergenic mattress and bedding covers.
Wash cotton bedding at high temperatures (above 140 degrees Fahrenheit or 60 degrees Celsius) to remove dust mites.
Regularly dust your home with a damp cloth to prevent dust build-up.
Animal allergies can trigger eczema flare-ups. See the allergy testing and tracking pages to learn how to identify which animals you might be allergic to. To minimize exposure to allergens from animals:
Wash any areas of skin or clothing that have been in contact with allergens.
Avoid touching or getting too close to animals or items they have come into contact with.
If you want to have a pet but are concerned about allergies, consider less allergenic breeds.
If you already live with a pet you are allergic to, limit the pet's access to areas where you spend most of your time.
Vacuum frequently with a high-quality vacuum cleaner with a HEPA filter.
An air purifier installed in your home could reduce the airborne allergens.
Some individuals may experience eczema flare-ups as a result of food allergies or intolerances. To manage food-related eczema triggers:
Identify and avoid triggering foods, replacing them with nutritionally comparable alternatives. Consider the tools available in the tracking page to target your energy.
When traveling, consider preparing your own food so you know what you are consuming. When abroad, carry a translation of your food allergies or intolerances to ask about ingredients in different languages.
Consult a registered dietitian or nutritionist for personalized guidance on creating a balanced, eczema-friendly diet.
See the diet and nutrition page to learn more about how food can be used to improve the skin.
Stress can act as an eczema trigger, as it weakens the immune system and aggravates the skin's inflammatory response. To manage stress-related eczema, consider the following tips:
Identify the sources of stress in your life, such as work, relationships, or personal issues and consider whether you can reduce the exposure or your sensitivity to each individual stressor
Communicate with friends, family, and trusted confidants to explore and address these stressors.(CHA 2021)
Develop healthy coping mechanisms, such as exercise, meditation, or engaging in hobbies.
Seek professional help, such as therapy or counseling, if necessary.
Keep in mind that it is impossible to eliminate all stress from your life, but developing healthy ways to manage it can help reduce eczema flare-ups. Learn more about mental wellbeing tools and how to exercise with eczema.
Various environmental factors can trigger eczema, and understanding how to minimize exposure to these elements is crucial for managing the condition. The triggers are detailed more in the environment page. Below, we outline some common environmental triggers and suggest practical ways to avoid them.
Poor air quality, such as high pollution levels or exposure to airborne allergens, can irritate the skin, affect the skin’s microbiome and exacerbate eczema. To improve air quality and minimize exposure to irritants:
Monitor weather and air quality forecasts, and plan outdoor activities accordingly.
Avoid spending long periods of time in high pollution areas, such as busy roads or city centers. Consider covering the skin and wearing a mask if exposure cannot be avoided.
Use air purifiers to remove particulates from the air in your home or workspace.
Rinse your skin if you have been exposed to high levels of pollutants. Refer to the [washing] page to learn more about eczema-safe cleaning.
Ensure proper ventilation when working with chemicals, paints, or burning materials.
Keep your skin well-moisturized during dry, cold weather by applying a fragrance-free, hypoallergenic moisturizer regularly. Use a humidifier in your home to maintain optimal humidity levels and prevent skin dryness.
During hot weather, stay in air-conditioned environments and wear lightweight, breathable clothing to reduce sweating and skin irritation.
Extreme temperature and humidity levels can trigger eczema flare-ups. To manage these factors:
Regulate temperature and humidity at home with air conditioning or humidifiers, as needed, aiming for room temperature with relative humidity between 40 and 60%.
Dress appropriately for the weather, wearing breathable fabrics and using layers for temperature control.
Shield your skin from cold winds and long periods of time in direct sunlight.
Moisturize regularly, especially in cold or low-humidity environments or at higher altitudes.
Avoid overheating during hot weather and stay hydrated. Consider wearing multiple thin layers to enable the control.
Be mindful of how sweaty you are, wash in cool water if you are sweaty and this is triggering your skin.
Regularly clean and maintain your humidifier to prevent the growth of mold and bacteria.
Bacterial, viral, and fungal infections can exacerbate eczema symptoms, leading to discomfort and increasing the risk of complications. Here are some tips to avoid that.
Good hygiene practices are essential for preventing infections that can exacerbate eczema. Wash your hands frequently with gentle, fragrance-free soap and water, and avoid touching your face or eczema-prone areas. Keep your nails short and clean to minimize skin damage from scratching. Clean and sanitize objects and surfaces that you frequently touch, such as cell phones, keyboards, and doorknobs.
If you suspect an infection in your eczema-affected skin, consult with a healthcare professional promptly. Early detection and treatment can help prevent the infection from worsening and causing further damage to your skin. Follow your healthcare provider's advice on proper wound care and medication use to promote healing and reduce the risk of complications.
Be aware of how hormonal changes during pregnancy, menstruation, or menopause may affect your eczema symptoms. If you notice a pattern, discuss it with your healthcare provider, who can provide guidance on managing hormonal fluctuations and their impact on your eczema.
In some cases, hormonal therapy or adjustments to your skincare routine may be recommended.
Moderate exposure to sunlight can have anti-inflammatory effects on eczema-prone skin. However, it is crucial to balance sun exposure with proper sun protection to avoid sunburn and other skin damage. Use a broad-spectrum, fragrance-free sunscreen with an SPF of at least 30, and wear protective clothing, such as wide-brimmed hats and sunglasses, when spending time outdoors.
Limit your sun exposure during peak UV hours, typically between 10 a.m. and 4 p.m., and follow your healthcare provider's recommendations on safe sun exposure practices.
In addition to the common triggers mentioned earlier, there are other factors that may contribute to eczema flare-ups. By being aware of these factors and taking appropriate measures, you can better manage your eczema and improve your overall health.
Some medications, including certain prescriptions and over-the-counter drugs, can have side effects that contribute to eczema flare-ups. To manage medication-related triggers:
Be aware of the potential side effects of any medication you are taking.
Consult with your healthcare provider to discuss alternatives or adjustments in dosage if necessary.
Keep track of any changes in your eczema symptoms when starting or stopping a medication, and inform your healthcare provider.
While you cannot change your genetic predisposition, being aware of your family history can help you be more proactive in managing your eczema. To better understand your genetic risk factors:
Learn about your family's history of eczema, allergies, or other atopic conditions.
Share this information with your healthcare provider to help create a more personalized eczema management plan.
Be vigilant about avoiding triggers and maintaining a healthy skincare routine, as individuals with a family history of eczema may be more susceptible to flare-ups.
Certain existing medical conditions, such as asthma or allergies, can exacerbate eczema symptoms. To manage and treat any existing conditions that may contribute to your eczema flare-ups:
Work closely with your healthcare provider to create a comprehensive treatment plan that addresses both your eczema and any underlying medical conditions.
Keep your healthcare provider informed of any changes in your symptoms or the effectiveness of your treatment.
Follow prescribed treatment plans and attend regular check-ups to monitor your progress and make adjustments as needed.
Understanding and avoiding your eczema triggers is crucial for preventing and managing flare-ups. By implementing the strategies discussed in this article, you can reduce your exposure to common triggers and improve your overall skin health.
To learn more about your causes of eczema, see the triggers and how to uncover them. There are many other treatments available for eczema.
Share your experiences with us! Tell us what has and hasn’t worked for you. What did we miss in this article that you've found personally impactful? Your insights can help others better understand and manage their eczema.
The immune system, including the skin, is responsible for inflammation in a flare.
Systemic inflammation can worsen eczema symptoms and is influenced by diet, gut and skin microbiome health, and autoimmune diseases.
Ask internet forums and they will tell you: eczema == immune system dysfunction.
Are they right? Is that where the story ends?
This article will delve into the intricate connection between eczema and the immune system. By gaining a deeper understanding of this relationship, we aim to provide you with valuable insights and practical strategies to manage eczema more effectively.
(And yes, you have probably guessed that the immune system plays a critical role in eczema symptoms, but a smaller story in eczema overall than many people think.)
The immune system is a complex network of organs, cells, and processes which protect the body from infection and toxins. The skin is a critical part of the immune system and acts as the first line of defense and part of the innate immunity.(KIM 2011)
The immune system helps to protect the body from infection and injury by removing harmful stimuli (triggers) and initiating the healing process. Immune cells release chemical signals, such as cytokines and chemokines, when a part of the body is injured or infected, and this attracts more immune cells to the affected site.(MAR 2018)
The immune cells can then work to remove the harmful stimulus and facilitate the healing process.(PAH 2022)
If the immune system overreacts to harmful substances, such as allergens, this can lead to chronic inflammation and can contribute towards inflammatory diseases, such as eczema. (PAH 2022)
Atopic eczema sufferers have an imbalance of certain immune cells, specifically T cells, which play a crucial role in the immune response. People with allergic eczema have more Th2 cells (MAR 2018), which are responsible for the release of cytokines which instruct immune cells to produce antibodies called immunoglobulin E (IgE) that trigger an allergic response.(ANN 2014) In particular, the cytokines interleukin 4 and 13 (IL-4 and IL-13) are considered central to the pathogenesis of atopic eczema.(CHI 2020)
This results in an overproduction of IgE antibodies, which bind to allergens and trigger the immune system's inflammatory response.(DAV 2011) This leads to itching, redness, and inflammation, which are common symptoms of eczema.
Immune system modulation, how does the immune system calm down.
Think of your body as a castle. The skin acts like the walls of the castle. Inside the castle are guards (the immune system). Outside the walls are townspeople (the microbiome) and, over the hills, there are invaders (triggers).
Itching, redness, and inflammation happen when something stirs up the guards of the castle. This can be a justified reaction to something - a bug bite, an infection, or an irritant - something has breached the walls.
How strongly the immune system reacts is a result of:
How inflamed the body is in general
How weak the skin barrier is: more triggers get through
How many triggers are in the environment
How the skin’s microbiome is reacting to the triggers
And finally, is there an inherent problem with the immune system?
The full story of eczema then is threefold: something has come to the castle (trigger), the walls are porous (skin barrier weakness), and the guards are trying to defend the castle (inflammation).
In the case of acute eczema (i.e., a “flare”), how excited the immune system is controls a large part of the strength of the response and the severity of the symptoms.
The skin is not an enemy to the immune system, but a first-line member. Constant bombardment of triggers to a weak skin barrier can drive up inflammation in the entire body and cause additional diseases. (KIM 2011)
While we present the following details on the immune system, please remember that reducing systemic inflammation and triggers, while increasing the strength of the skin barrier, will have a powerful effect on your eczema before, during, and after a flare.
Inflammation is a natural response of the immune system that helps to protect the body from infection and injury by removing harmful stimuli and initiating the healing process.
Immune cells release chemical signals, such as cytokines and chemokines, when a part of the body is injured or infected, and this attracts more immune cells to the affected site.(MAR 2018) The immune cells can then work to remove the harmful stimulus and facilitate the healing process.(PAH 2022)
If the immune system overreacts to injury or infection or reacts to harmful substances, such as allergens, this can lead to chronic inflammation and can contribute towards inflammatory disease, such as eczema.(PAH 2022)
Systemic inflammation refers to a widespread immune response that can affect various tissues and organs throughout the body.
In the case of eczema, systemic inflammation may exacerbate eczema symptoms by promoting the release of inflammatory mediators, such as cytokines.(ZOT 2016) Those cytokines travel throughout the body and increase inflammation, including at areas of eczema flares.
In other words, systemic inflammation causes the castle guards to be on edge and can cause eczema symptoms to be worse than they otherwise would be.
Systemic inflammation can be influenced by various factors, with major factors including:
Health of the gut microbiome
Health of the skin microbiome
Autoimmune diseases
If you are concerned about systemic inflammation, please consult with a physician about whether any of these options might be right for you:
It is important to note that the effectiveness of these interventions may vary among individuals, and a personalized approach may be necessary to address your specific needs.
Skin barrier weakness plays a crucial role in the modulation of immune response and is particularly relevant in the context of eczema.
The skin barrier provides protection from external threats, such as pathogens, chemicals, irritants, and allergens, which might cause an immune response if they were to pass through to the deeper epidermal or dermal layers of the skin.(DermNet - BFAD)
The skin barrier resembles a microscopic, flexible brick wall. Dead skin cells act as bricks and ceramides, along with several other fats, act as mortar to connect those bricks. The strength, smoothness, and suppleness of your skin is largely controlled by the ceramides and fats.
Skin barrier barrier weakness is generally thought to be caused by a lack of long chain ceramides, or a disorganization of those long chain ceramides.
A lack of long chain ceramides in otherwise healthy skin can arise from a genetic defect in the body, poor nutrition, and a number of other factors. Whereas disorganization of the ceramides can be a result of genetic or environmental factors.
In unhealthy or inflamed skin, ceramides are sometimes broken down by the immune reaction or by environmental factors. This helps explain why eczema sometimes “spreads”. The skin near the initial flare loses its long chain ceramides and the new triggers are allowed through in the areas surrounding the initial flare, leading to additional inflammation in the adjacent areas.
The skin contributed to systemic inflammation as well. A flare in one area of the skin will raise overall inflammation levels, which in turn could lead to new flares in another part of the body.
Treatments that focus on improving the skin barrier strength can help alleviate eczema symptoms and prevent relapses.
Our skin is our largest and most active interface with the outside world. Unlike our gut, we cannot always control what comes into contact with our skin.
Some common environmental triggers for eczema flare-ups include:
Metals (e.g., chromium, cobalt, chloride, copper, gold, nickel)
Exposure to smoke, air pollutants, harsh soaps, fabrics such as wool, and some skin care products
Low humidity (dry air) causing skin to become dry and itchy
Heat and high humidity causing sweating and increased itchiness
Allergens such as pollen, dust and mold
Continuing our castle analogy - triggers are like invaders coming to the castle walls. Even if the walls are strong and high, with enough invaders, they will get into the castle. At that point, the guards come to our aid and a flare-up is born!
Learn more about identifying, avoiding, and removing triggers and allergens.
The activity of the immune system results in inflammation. In the skin, this can manifest as eczema. The causes of the inflammation can be considered “triggers” and can come from various aspects of life. The factors affecting the severity of a reaction are the intensity and duration of trigger exposure as well as the sensitivity to a trigger.
Stress can amplify the immune sensitivity, leading to increased severity of eczema symptoms. Dietary and environmental allergies such as pollen, dust and mold can result in immune system reactions in and on the skin, leading to eczema symptoms. Learn more about identifying allergies in the allergy tests page and more about triggers in the triggers page.
The skin microbiome consists of bacteria, viruses, and fungi that together form a complex and dynamic community on the skin's surface. It plays a vital role in fending off disease-causing microorganisms (pathogens), boosting skin barrier protection, and aiding immune defenses.
The skin microbiome works with the immune system to fight infection and modulate inflammation. A healthy skin microbiome will signal to the immune system that things are ok and will lower inflammation.
The opposite is true as well: the skin’s microbiome will alert the immune system to harmful bacteria or viruses, inducing a reaction. An unhealthy microbiome can also induce harmful inflammation.
To maintain a healthy skin microbiome, be mindful of the skin care products and household chemicals that you use.
Eczema is not classified as an autoimmune disease as it is not directly a result of a mistargeted immune system, but there can be problems with the immune system that can affect the severity of eczema symptoms.
In the case of atopic dermatitis, there is often an imbalance of certain immune cells, specifically T cells. In particular, the cytokines interleukin 4 and 13 (IL-4 and IL-13) are considered central to the severity of the symptoms.(CHI 2020) This results in an overproduction of IgE antibodies, which bind to allergens and trigger a stronger inflammatory response.(DAV 2011)
Allergic eczema sufferers can often have more Th2 cells.(MAR 2018) Th2 cells are responsible for the release of cytokines which instruct immune cells to produce antibodies called immunoglobulin E (IgE) that trigger an allergic response.(ANN 2014)
There are new drugs and therapies that can modulate the above immune concerns.
Effectively managing the immune response can have a significant impact on controlling eczema symptoms. Here are several areas of immune control that can be addressed to help improve the condition:
Identifying and avoiding triggers that cause or exacerbate eczema is essential for managing immune response. Common triggers include allergens, irritants, and environmental factors such as extreme temperatures or humidity.
Implementing a thorough skincare routine, using gentle cleansers and moisturizers, and wearing non-irritating clothing can help minimize exposure to these triggers.
Adopting a healthy lifestyle can help modulate the immune system and decrease inflammation.
Some foods facilitate the modulation of inflammation. Read about adjusting your diet and nutrition when you have eczema here.
The Th2 response can be mediated by exercise, therefore reducing the sensitivity of the allergic immune response. Sweating can improve skin health by helping to fight infection. Learn more about how to exercise when you have eczema here.
The mind-body connection is powerful: stress can lead to reduced Th1 and increased Th2 immune response which results in increased chance of infection and increased sensitivity to allergens respectively. Learn more about mental health with eczema here.
Topical or ingested probiotics and prebiotics can promote a healthy gut and skin microbiome, which in turn can help regulate inflammation.
To improve skin barrier function, choose skincare products that contain long chain ceramides and other barrier-repairing ingredients.
Consistently using these products can help to strengthen the skin barrier and reduce the likelihood of triggers penetrating the skin.
The presence of damaging pathogens or imbalance of the microbiome can lead to problematic infections. On the skin, this can lead to increased inflammation and damaged skin barrier resulting in irritation and worsening eczema. It’s important to know how to prevent, identify and treat infections to maintain good skin health. Learn more in the infections in eczema here.
Immune-modulating and suppressing medications can help regulate immune system responses and reduce inflammation in individuals with eczema. Some of these medications include topical corticosteroids, calcineurin inhibitors, and biologic drugs.
Always consult a healthcare professional before starting any new medication to ensure its appropriateness for your specific condition.
It is essential to remember that you are not alone in dealing with eczema, and there are numerous approaches to managing this challenging skin condition.
Do not hesitate to consult your doctor or healthcare professional for personalized advice on managing your eczema, as they can help tailor a plan that addresses your unique needs. We hope the above will help you in your discussions.
We understand the difficulties that come with living with eczema, and we are here to help. If you need further assistance or have any questions, please feel free to reach out to us. Together, we can work towards improving your quality of life and gaining control over your eczema.
Allergy testing for eczema helps identify substances triggering the immune system, aiding in managing the condition.
Eczema triggers can change over time, so regular reevaluation and testing can help manage symptoms effectively, especially for adults exposed to different allergens.
Eczema, affecting millions of individuals globally, is a recurring skin condition typified by red, itchy, and inflamed skin outbreaks. The degree and length of these flare-ups are influenced by three key factors:
Trigger intensity is the product of the quantity of substances your body is exposed to which trigger your immune system to react and the amount of time your body is exposed to them. These can often be common allergens, or they can be more specific to your body. Identifying your triggers allows you to lower exposure time and quantity of triggers in your environment.
Allergy testing for eczema can help you discover which substances, or allergens, are triggering your immune system and causing your symptoms. These tests can provide valuable information that your healthcare provider can use to help you manage your condition.
It is important to note that while these tests are extremely useful, they do not cover all potential triggers. Substances that are not common allergens or other factors, like stress or certain fabrics can also trigger eczema but are not typically part of a standard allergy test. Don’t worry - we have you covered on those as well.
Allergy testing can provide valuable insights into what might be causing your flare-ups. There are several types of skin allergy tests that your doctor may suggest: blood tests, skin tests, and patch tests. Each of these tests offers different insights and can be valuable tools in your broader eczema management strategy.
In skin prick tests an extract is applied to a clean and marked patch of skin. A small needle or lancet is used to prick the skin through the allergen extract to break the outer skin barrier.
This is usually not painful, nor deep enough to draw blood. The skin is then observed 15 minutes after the prick to look for reactions. If you're allergic to the substance, you'll develop a raised bump or rash at the test site.(OLE 2021)
Skin prick tests can test numerous allergens simultaneously and are generally used to determine if there is an immediate allergic reaction.
However, like every other test, they come with certain limitations. For instance, they may not be suitable for individuals with severe eczema, as their skin could react differently to allergens. Furthermore, certain medications may interfere with the results, making it less reliable in such cases.
In a patch test, tiny amounts of potential allergens are applied to adhesive patches, which are then placed on your skin. The patches stay on for 48 hours, and your skin's reaction is assessed at 48 and possibly 96 hours after application making it a great test for assessing delayed reactions.(DAV 2011)
Common allergens to test with this method include latex, medications, fragrances, resins, hair dyes, metals, sulfates, and preservatives.(OLI 2012)
A patch test can be particularly helpful in identifying triggers for a type of eczema known as contact dermatitis, which is caused by direct skin contact with allergens. Common triggers for contact dermatitis include metals (such as nickel), rubber, and certain hair dyes.
Patch testing requires an area of skin which is clear from eczema for the allergens and patches to be applied. In adults, it is often applied to the back.(OLE 2021)
Like other tests, patch testing has its pros and cons. While it can be a valuable tool in identifying triggers, it can be a bit cumbersome as it requires multiple visits to the clinic and you need to keep the test area dry for the entire period.
A blood test for eczema works by looking for specific antibodies in your blood. During a Th2 immune response, it produces antibodies called immunoglobulin E (IgE). These antibodies trigger the release of certain chemicals, one of which is histamine, that lead to allergy symptoms.
During a blood test, a small volume of blood is taken from an individual and this is inspected for the presence of IgE for a number of allergens. The result will give a count per unit volume of blood and this can indicate the likelihood of an allergy being present. The count does not necessarily indicate the severity of the sensitivity. It is possible for someone to have specific IgE for a substance but actually not experience any noticeable allergic reaction when exposed to the substance.
Blood tests are not always the first choice for allergy testing, as they can be less sensitive than other methods. They are typically used when skin tests are not possible or practical: for instance, during pregnancy, or in individuals who have severe skin conditions, or those on certain medications.
Food allergies are another potential trigger for eczema, especially in children. It is estimated that up to 30% of children with eczema may also have food allergies. The most common foods associated with eczema and food allergies include milk, eggs, wheat, soy, and nuts. However, any food can potentially cause an allergic reaction.
If you suspect that certain foods are triggering your eczema symptoms, your healthcare provider may suggest a food allergy test. There are several types of food allergy tests, including blood tests and skin prick tests. These tests work similarly to the tests described earlier, by detecting the presence of IgE antibodies in response to specific foods.
Another method of food allergy testing involves an elimination diet, where you remove suspected foods from your diet for a few weeks and then gradually reintroduce them, one by one, while monitoring for symptoms. This can help identify foods that are causing reactions. However, elimination diets should always be carried out under the supervision of a healthcare professional to ensure that you're still getting all the nutrients you need.
It is important to understand that food allergies are just one potential cause of eczema. Not everyone with eczema will have food allergies, and not all eczema is caused by food allergies.
The triggers of eczema can change and evolve over time, and thus it is essential to reevaluate triggers and management strategies regularly.
Allergy testing can be equally beneficial for adults with eczema as it is for children. Adults can develop new allergies, and old ones can fade away. It's also worth noting that adults can sometimes be exposed to different allergens compared to children due to lifestyle factors, such as work environments or dietary changes.
Therefore, regular allergy testing can help adults with eczema stay on top of their triggers and manage their symptoms effectively.
Moreover, adults with eczema should be aware of the risk of developing contact dermatitis. This form of eczema is caused by direct skin contact with certain substances, such as nickel, latex, or certain types of fabric.
If you find yourself developing eczema symptoms after touching certain materials, it could be worth speaking to your healthcare provider about patch testing.
While allergy testing provides valuable insights, quickly, into many potential triggers for eczema, it is not a comprehensive solution. There are certain triggers that allergy tests do not cover or cannot identify. These include non-allergic triggers such as irritants, temperature changes, stress, and hormonal fluctuations.
We recommend tracking your symptoms to help you identify your specific triggers. In our article on tracking we show you how.
Allergy testing, including blood tests, skin tests, patch tests, and food allergy tests, can be a crucial step in revealing your personal triggers and shedding light on what might be causing your eczema flare-ups. Regular allergy testing can be particularly beneficial for adults, as triggers can change over time.
But it is equally important to remember that not all triggers can be identified through standard allergy tests. We cover other potential triggers in our overview on triggers and dive deep into them in our articles on Allergies and Intolerances, Environment, Stress, and Things You Wouldn't Have Thought Of.
Share your experiences with us! Tell us what has and hasn’t worked for you. What did we miss in this article that you've found personally impactful? Your insights can help others better understand and manage their eczema.
Eczema is a complex mix of factors. Tracking your symptoms helps identify what is at the root of your eczema.
Use your symptom diary to engage effectively with healthcare providers and tailor your treatment plan.
Eczema has many different contributing factors making it hard to isolate variables and figure out what your personal triggers are, how your immune system is reacting, and how strong your skin barrier is at any moment. Logging a few parameters can help you understand the progression of your condition, identify triggers that might exacerbate your symptoms, and evaluate the effectiveness of various treatments.
This article aims to guide you through the importance of monitoring eczema, various methods for doing so, and how to translate your observations into an effective management plan.
The degree and length of eczema flare-ups are influenced by three key areas:
Triggers and their intensity in your environment
Within each of those areas reside a broad range of factors. For example, our Trigger Concerns section comprises 6+ articles, each with multiple sections, on everything from allergies to food to stress.
By tracking symptoms against these areas of concern, you will be able to use a scientific approach to locate the keys to your eczema.
With those keys you can:
Find your triggers - you will be able to see through delayed reactions to substances
Know what to look for next - in a multivariate situation like eczema, it can be challenging to isolate specific variables to test. With thorough tracking and enough data, the statistical significance of one relationship can be determined simultaneously to other relationships
Free from mental baggage - logging skin symptoms, trigger exposure and treatments in one place releases your mind from attempting to follow all the parameters of time
Communicate clearly with your health team - for some treatments, e.g. topical steroids, it is important to limit their usage. With a tracking sheet, it is easy to follow how much you have used and figure out when you need to stop and to communicate with your team how well treatments are working.
Improved confidence - it is all too easy to question everything in your life as a trigger. The tracking sheet can reveal what is good and what’s not and improve your confidence in these assertions.
All of the above are great to share with your treatment team. It helps smooth conversations with providers if you can offer direct evidence over time.
Your detailed records can guide the conversation and help your provider tailor your treatment to your specific needs.
Tracking is a quantified approach to learn more about your condition and determine triggers and effective treatment.
If it were possible to know the symptom intensity of your flare at all times and all the things that you have been exposed to, it would be very easy to understand what is causing the skin to get worse and what helps it to recover. The aim with tracking is to log relevant parameters about your skin condition and certain trigger and treatment parameters to determine if there is a relationship.
It is not possible to log everything all the time, so some simplifications must be made, and we are here for you on that front.
To get set up, here are some things to figure out:
What symptoms define your flare? For example: itchiness, dryness and inflammation
What treatment do you use? For example: moisturizers, topical steroids and antihistamines
What triggers do you know you have (whether for your skin or somewhere else)? For example: grass pollen allergy, dairy and bio laundry detergent
What treatments would you like to test out? For example: prescriptions, salt bathing and meditation
What potential triggers are around you? For example: alcohol, cat allergy and dry weather
Are there any notes you can add to add some context? Similar to a journal entry
Once you already know what parameters to track, you can define the scoring system you will use. It is important to be consistent with the scoring so try to write this down so you can refer back to it. For example: every parameter is scored between 1 and 10. For symptoms “1” means “no symptoms”, “5” means “widespread coverage and/or moderate intensity” and “10” means “full body and/or extreme intensity”.
It is recommended that tracking is done digitally so that you can make full use of the dataset. With a spreadsheet, you can plot the symptoms, triggers and treatment over time for analysis. Further statistical analysis can expose the statistical significance of any correlations.
It can be beneficial to take photos of symptoms to be able to compare how these change over time and show these to a doctor for context.
Journaling is a method of making notes of your thoughts and feelings. In the context of eczema, one could make notes of the severity of skin symptoms and how they changed through the day as well as how this felt and the thoughts that came up.
The act of putting these things into words can help to build awareness of what is going on, gain perspective of how you feel and notice trends. This can help to draw information out of the apparent chaos of eczematous life.
Examples of things to note down in an eczema journal are but not limited to:
Date
Weather (including relevant pollen forecast)
How your skin felt
What treatment you used and how much
Of the triggers you have selected to monitor, were any present in your environment?
Did you notice anything helped with your eczema?
When you have time, it can be beneficial to revisit your journal to flick through past entries to see if there are any trends. You can look for repeat offenders or certain potential triggers to pay attention to in the future. Including your feelings and thoughts can help to offload the mental burden of living with eczema.
It can help with self-awareness and benefit your mental wellbeing. For more on mental health, see the mental health page.
If necessary, you can take photos of your skin to keep a visual log of the severity of your skin. This can be a good way to track how your condition changes over time and therefore notice if your treatment needs to change.
Another opportunity is to log what you eat each day. If you have skin symptoms and the ingredients you have eaten, you might notice that certain foods are good and others are bad for your skin. See the food and diet and nutrition pages for more information on diet.
There are some challenges to be aware of with proper eczema tracking:
Setup - once the spreadsheet is set up, it is simply a case of filling it in each time. The setup can be a challenge if you are less technically savvy or not in front of a convenient device.
Consistent scoring - it is super important that the numbers you assign are consistent with the scoring system. Try to assign a score objectively
Consistent rate - decide a rate to enter information and try to stick to it. Any more than once a day can be very challenging over the long run. If you miss an entry, try to fill it in as best you can
Complexity - it is not possible to log everything and the more you try to follow the less likely you’ll be able to sustain it so try to keep it simple. If you do not see a correlation between triggers and worsening symptoms after two weeks, consider changing the triggers you are tracking.
Emotional challenges - Living with a chronic condition like eczema can take a toll on your emotional and psychological well-being. The process of symptom tracking can sometimes amplify these feelings, as it involves regular focus on your condition and its impact on your life. It's important to acknowledge these feelings and seek support when needed.
Once you've begun monitoring your eczema symptoms and identifying possible triggers, the next step is to use this information to create an effective management plan. Here's how to go about it:
A symptom diary can be a valuable tool during your appointments with your healthcare provider. It offers a comprehensive view of your symptoms over time and can provide insights that might not be apparent from a single office visit.
During your appointment, discuss your observations with your provider, and don't hesitate to ask questions. The more information your provider has about your condition, the better they can tailor your treatment plan to your specific needs.
For those concerned about topical steroids and topical steroid withdrawal, a symptom diary can provide objective proof of how the treatment is affecting your skin.
Your symptom diary can also help you make informed decisions about your treatment approach. For example, if you've noticed that certain skincare products exacerbate your symptoms, you might decide to avoid these products or find alternatives.
Similarly, if you find that your symptoms improve with specific treatments or self-care practices, these can become key components of your management plan. Remember, effective eczema management is not a one-size-fits-all process; it's about finding what works best for you as an individual.
Based on your symptoms, some common first steps in eczema management might include implementing a regular skincare routine, avoiding known triggers, and using over-the-counter or prescription treatments as directed by your healthcare provider.
For example, if dryness and itching are significant symptoms for you, a regular routine of gentle cleansing and moisturizing might be beneficial. If stress triggers your flare-ups, stress management techniques like meditation or yoga might be worth exploring.
The act of tracking your symptoms, while initially challenging, is a powerful strategy to gain insights into your condition, identify triggers, and evaluate treatment efficacy. These insights can greatly enhance your quality of life and empower you to take control of your eczema.
In furtherance of this understanding, we recommend delving into the different sections of our eczema guide. This will provide a comprehensive perspective on the various aspects of eczema management:
Visit our allergy tests section to gain insights into potential allergenic triggers and consider getting tested to know what allergies you may have.
Explore the food and diet and nutrition sections for information on the potential impact of dietary choices on eczema.
Check out the triggers section to learn about different eczema triggers and how to monitor them effectively.
Remember, managing eczema is a journey that you don't have to navigate alone. Regular consultations with healthcare providers ensure professional evaluation and personalized treatment plans. They can help you interpret your symptom diary, provide expert advice, and offer support when needed.
Finally, we invite you to share your experiences. Tell us about your successes and challenges in managing eczema. Are there strategies that have been particularly effective or ineffective for you? Is there anything you feel we've missed in this article? Your insights and experiences are invaluable, both for us and for others trying to better understand and manage their eczema.
The microbiome plays a crucial role in mitigating eczema by regulating the immune system, generating protective skin compounds, and warding off pathogens.
Understanding the relationship between the skin microbiome and eczema is key to effective eczema treatment.
The microbiome has increasingly been recognized as a pivotal player in mitigating eczema flares and, importantly, expediting their resolution. Neutral or beneficial microorganisms, often referred to as "commensals" or “mutualists”, contribute to skin health through immune system regulation, the generation of compounds that can safeguard the skin, and warding off pathogenic microorganisms.
In this blog post, we delve into the intricate relationship between the microbiome and eczema, explore the factors that influence which microbes are found on the skin, and offer practical advice for preserving a healthy microbial community in ways that help to manage eczema symptoms.
The term "microbiome" often refers to the complex community of microorganisms, including bacteria, fungi, viruses, and other microscopic life forms, that inhabit our bodies.(COS 2009) These skin microbes reside on the skin barrier and extend into the skin's dermis.(SEN 2016)
The specific composition of the skin microbiome varies among individuals, but some of the most prevalent bacterial groups found on healthy skin include Staphylococcus epidermidis, Propionibacterium acnes, and Corynebacterium.(Byrd et al., 2018)
The key functions of a healthy skin microbiome include:
The astute reader will see the list above and recognize that all five of these functions provide critical support in the prevention and resolution of eczema flares.(Belkaid & Segre 2014)(Grice & Segre 2011)
Research has shown that individuals with eczema often have a disrupted skin microbiome, with a reduced diversity of microorganisms and elevated levels of specific bacteria that are enriched with inflammation, such as Staphylococcus aureus.(Kong et al., 2012)(Byrd et al., 2018)
Various factors can induce changes in the skin microbiome, such as age, diet, medication, and environmental factors.(DIM 2019) Daily interactions with our surroundings, including contact with other people or objects, can introduce new microorganisms to our skin and change its overall composition in the short term.(ROS 2017) Sweat, diet, and exposure to chemicals can all influence the skin's microbial balance.(BYR 2018)
However, the microbiome and the body are generally self-regulating. They strive to return to a state of homeostasis with their long-term environment.
Persistent dysbiotic microbiome composition is primarily driven by three factors:
A disrupted skin barrier (including a lack of long chain ceramides and disorganization in the skin barrier)
Sustained exposure to environmental factors (such as a new roommate or a move to a new location)
The use of skin care products
In the following sections, we will delve deeper into these factors and their impact on the skin microbiome.
A weakened skin barrier can result in higher levels of inflammation. In turn, this can alter the skin’s surface environment in ways that allow for specific microbes to thrive.
Many people with eczema have a root-cause problem with skin barrier formation that decreases skin barrier strength. In these patients, their skin (even in locations on the body where there is not an eczema flare) will show elevated levels of S. aureus relative to that of an individual without eczema.(Irvine et al., 2011)
Though S. aureus is a common resident of the skin microbiome, certain strains of this bacteria can become pathogenic if induced to do so, particularly in individuals with a compromised immune system.
Environmental factors play a significant role in shaping the composition of the skin microbiome. Exposure to toxins, pollution, and other harsh environmental elements can lead to an imbalance in the skin microbiome, favoring the growth of potential pathogens.(Fyhrquist et al., 2014)
In addition, gene transfer and expression in microorganisms can occur in response to environmental stressors, contributing to dysbiosis and potentially exacerbating eczema symptoms.(Shade & Handelsman, 2012)(ZEL 2023)(ARC 2010)
The ingredients in skin care products can influence which microbes are found on the skin. For example, the use of harsh soaps or over-cleansing can strip the skin of its natural oils and decrease the diversity of microbes, potentially exacerbating eczema symptoms.(Skroza et al., 2018)
Some skin care ingredients are even intentionally designed to induce inflammation in an effort to reduce fine lines and wrinkles, and other beauty concerns. As discussed above, inflammation can then promote the growth of unfavorable, or even pathogenic, microbes. Some common skin care ingredients are toxic to the microbiome, driving a shift to more pathogenic microorganisms.
Further, there are treatments for eczema, like bleach baths, that are unintentionally resulting in an unhealthy balance in your skin community.
Maintaining a healthy skin microbiome is crucial for the effective management of eczema-related symptoms. However, it's important to approach microbiome maintenance with caution. While an unbalanced microbiome might not be optimal for controlling inflammation, healing the skin, and reducing the effect of environmental triggers, it is still preferable to an infection.
Understanding the distinctions between a dysbiosis of the microbiome and an infection is crucial to understand the role that each plays in eczema.
One example comes from that of S. aureus. S. aureus is broadly considered a common skin commensal and normal member of the skin microbiome. In eczema sufferers, however, the disrupted skin barrier feeds S. aureus which can lead to a dysbiotic microbiome, which in turn can no longer regulate the immune system or repair the skin barrier, resulting in a sustained flare.
This imbalance of S. aureus would be considered “unbalanced”, and like a canary in the coal mine, can be used as both a marker of skin barrier strength and the severity of an eczema flare.(KOH 2022)(FOL 2022) On the other hand, an infection occurs when “pathogenic” microorganisms (whether they be bacteria, viruses, or fungi) invade the body's tissues causing damage to cells and eliciting an immune response. In the context of skin infections, this typically involves redness, swelling, warmth, and sometimes pus production.
Infections are different from the elevated levels of S. aureus that can occur during a flare. Infections involve active invasion of the pathogens, potentially leading to significant tissue damage and a more severe immune response. See our section on infections to learn more and consult your physician to determine if you have an infection.
Always follow your doctor’s direction. We offer the below only to add context to treatment decisions and anticipated outcomes.
The use of antibiotics, bleach baths, and other disinfection methods can have both positive and negative effects on the skin microbiome. Although these methods can help to control infections and/or reduce the bacterial load in certain skin conditions, they can also lead to dysbiotic microbiome and an increased risk of infection when used excessively or inappropriately. Additionally, their use could result in long-term skin conditions such as eczema or dermatitis.(Kong et al., 2012)
For example, systemic antibiotics may be necessary to successfully treat an infection, but there is poor evidence that the use of systemic antibiotics to reduce S. aureus in noninfected individuals will improve eczema-related symptoms.(BAT 2010)
A decrease in microbial diversity created by the use of antimicrobials or chemicals (e.g., bleach) could provide an opportunity for pathogens to colonize the skin, potentially leading to skin disorders and infection.(Adebayo et al., 2020)
When under stress, microbes such as S. aureus can shift from simply being more abundant, to near-pathogenic, and release toxins that cause inflammation and aggravate the skin.(Geoghegan et al., 2018) This can lead to additional skin barrier impairment and a sustained flare.(Nature)(BYR 2018)
One way that can occur is through horizontal gene transfer (HGT) - the transfer of genetic material between microbes. In harsh environments, stressed bacteria might be more likely to acquire DNA from other bacteria through HGT events. This can result in the increased transfer of antibiotic resistance genes and/or genes that are associated with how successfully a pathogen can invade the body.(von Wintersdorff et al., 2016)
Exposure to toxic environmental factors can cause the expression of genes that promote pathogenic potential. Consequently, microbes that were once harmless may become harmful under these conditions.(Kaplan et al., 2016)
S. aureus and other inflammation-loving species can sustain a flare, but their presence alone does not always lead to an infection. Please consult a doctor if you think you may have an infection.
Then what can you do to support your microbiome and restore its natural immune controlling functions?
Emerging research points to the potential of prebiotics and probiotics in promoting a healthy skin microbiome and alleviating eczema symptoms.(NAK 2017)(KOH 2022) By incorporating prebiotic and probiotic supplements, individuals can support the growth of beneficial bacteria and fungi on their skin, leading to a more balanced and healthy microbiome.
At Rulo, we are microbiome aware in every ingredient that we use. We offer prebiotics and probiotics that have been shown to displace inflammatory microorganisms and restore a healthier microbiome.
Understanding an individual's unique skin community can help tailor treatments that more effectively target the root cause of eczema.(KOH 2022) We also provide a test kit that can give you insights into your skin.
Avoid antiseptic and antimicrobial washes. Overdoing it can break the skin barrier and allow for the invasion of harmful bacteria and fungi.
See our washing article for more information.
Food avoidance diets have been shown to restore the microbiome to a more normal distribution.(SCO 2015) Adopting a healthier, anti-inflammatory diet can also help manage eczema symptoms.(PES 2021)
See our article on diet for more.
Understanding the complex relationship between the skin microbiome and eczema is crucial in providing effective treatments and improving the quality of life for individuals living with this chronic condition. By maintaining a balanced, healthy microbiome and addressing eczema triggers, one can experience relief from symptoms and lead a more comfortable life.
Explore our range of resources and articles to learn more about how ceramides can aid in the treatment and management of eczema.
Share your experiences with us! Tell us what has and hasn’t worked for you. What did we miss in this article that you've found personally impactful? Your insights can help others to better understand and manage their eczema.
Stress can worsen eczema symptoms by increasing inflammation, weakening the skin barrier, and disrupting the immune system.
Chronic stress can increase Th2 immune response, leading to exacerbated allergies and frequent, severe flares.
Eczema is a chronic skin condition characterized by periodic acute flares, marked by red, itchy, and inflamed skin. The severity and duration of an acute eczema flare are influenced by three main factors:
One frequently overlooked but significant factor in the onset and worsening of eczema symptoms is stress, which can affect all three of the factors mentioned above. (YAR 2017)
In this blog post, we will explore the role of stress in triggering an eczema flare, delve into the connections between eczema and the immune system, and provide valuable insights on how to identify and manage stress-induced eczema.
Overcoming acute stressors in life can be beneficial for personal growth, pushing oneself, and even for enjoyment.
Stress, a natural response to external or internal demands, can adversely affect various aspects of our health, including our skin. When we experience stress, our body releases stress hormones like cortisol, which can trigger the immune system's inflammatory response. This increase in inflammation can exacerbate existing eczema symptoms or initiate a flare-up.(GAR 2013)(MIS 2018](SUA 2012)(DAB 2011) Those suffering from eczema who report high stress levels subjectively often know that their stress levels are contributing to their eczema.(NIE 2002)
Chronic stress may also weaken the skin barrier, which serves as our body's first line of defense against environmental irritants, allergens, and bacteria. A weakened skin barrier allows moisture to escape and irritants to enter, worsening eczema symptoms and increasing the risk of infection.(GLA 1987)(CHA 2020)
The Th2 immune response is heightened when under chronic psychological stress, leading to amplified allergies. With an overabundance of Th2 cells, existing allergies are amplified, and flares can occur more often and with greater severity for people with allergies.(DAV 2011)
Another effect that stress can have on skin health is through the gut: increased stress levels can weaken the intestinal barrier, resulting in what is known as "leaky gut". This is where larger substances, including pathogens and toxic particles, can enter the bloodstream.(APA 2023)(HHP) This can lead to an increased immune response and inflammation, subsequently contributing to eczema symptoms.(IMU 2020)
Aside from the physiological effects of stress on our skin, psychological factors can also contribute to the development or worsening of eczema symptoms.
An individual's quality of sleep can be reduced when under stress. Eczema sufferers can already struggle with sleep due to the discomfort of the physical symptoms and waking up in the night scratching.(SCH 2020) These compounding problems can contribute to increasing levels of sleep deprivation, which result in increased inflammatory proteins in the body, further raising cortisol levels, and therefore ongoing disease.(WRI 2015) Additionally, poor sleep has detrimental effects on mental wellbeing and can ultimately lead to burnout and reduced quality of life.(RC)(SMI 2022)
This creates a feedback loop where stress worsens eczema, and the impact of eczema increases stress. Moreover, stress may lead to behavior changes that further exacerbate eczema. For example, stress can increase the urge to scratch, which can cause further damage to the skin barrier, intensify inflammation, and increase the risk of infection.
Understanding the interplay between stress and eczema is crucial for effectively managing the condition and minimizing the frequency and severity of flare-ups.
The relationship between stress and eczema is complex, as stress directly and indirectly affects various aspects of the skin, immune system, and behavior. This section will delve deeper into the mechanisms behind cortisol release, immune response, and skin barrier weakness in the context of stress-induced eczema.
Cortisol, a hormone released during stress, suppresses the activity of pro-inflammatory immune cells and signaling molecules.
Sustained exposure to high cortisol levels can cause immune cells to become less sensitive to cortisol's anti-inflammatory effects, a phenomenon known as glucocorticoid resistance.
The skin releases cortisol to control inflammation. As resistance to cortisol builds up, the skin is no longer able to suppress inflammatory responses to external stimuli as easily. This same effect is seen when topical steroids like hydrocortisone (cortisol in the form of medication) are used and topical steroid withdrawal occurs.
Moreover, chronic stress has been associated with a shift in the balance between immune cells, such as Th1 and Th2 cells. A shift towards Th2 cells occurs with chronic stress. This shift can be problematic, particularly in the context of atopic diseases like eczema, because it can lead to an exaggerated immune response and increased inflammation. Th2 cells produce cytokines like interleukin-4 (IL-4), interleukin-5 (IL-5), and interleukin-13 (IL-13), which contribute to inflammation, itching, and the worsening of eczema symptoms. An abundance of Th2 cells may also worsen existing allergic reactions.
The release of IL-4 by Th2 cells also disrupts skin barrier strength, leading to flares spreading and persisting for longer periods of time. In contrast, Th1 cells can help maintain a balanced immune response and counteract the negative effects of Th2 cells. Th1 cytokines can help regulate the Th2 immune response by suppressing the production of Th2 cytokines, thus reducing the likelihood of an exaggerated immune response and inflammation.
The skin barrier is an essential component of our body's defense system, providing a physical and chemical barrier against environmental irritants, allergens, and pathogens. Stress can negatively impact the skin barrier's function through several mechanisms:
Elevated cortisol levels can impair the creation of skin barrier proteins, leading to new triggers passing through the skin barrier.
Elevated cortisol levels also disrupt the production of lipids, resulting in reduced skin hydration. This, in turn, can cause scratching, cracking, and further disruption of skin barrier repair.
Th2 cells can disrupt the existing skin barrier proteins and lipids.
A compromised skin barrier allows moisture to escape and irritants to penetrate more easily, exacerbating eczema symptoms.
Stress management techniques, such as relaxation methods and exercise, may be more effective for stress-related eczema than for eczema triggered by other factors. Identifying if your eczema has a major stress component can allow you to avoid or shorten flares by using the proper stress reduction techniques as a first-line treatment.
Stress triggers can share some similarities with other eczema triggers, but they also have some unique characteristics:
Similarities:
Both stress and other triggers, such as allergens, irritants, and infections, can cause inflammation and exacerbate eczema symptoms.
Both stress and other triggers may require a combination of lifestyle changes and medical treatments to manage effectively.
Differences:
Stress triggers can be more challenging to identify and address, as they often involve complex psychological and emotional factors.
Stress management techniques, such as relaxation methods and exercise, may be more effective for stress-related eczema than for eczema triggered by other factors.
Stress-related eczema can be triggered by various factors that contribute to an individual's overall stress levels. Some common major stressors include:
Emotional stress: Significant life events, such as the loss of a loved one, divorce, or job loss, can cause emotional stress and exacerbate eczema symptoms.
Work-related stress: Deadlines, heavy workloads, and work-related conflicts can contribute to stress and trigger eczema flares.
Relationship stress: Tensions and conflicts in personal relationships can also contribute to stress and aggravate eczema.
Physical stress: A lack of sleep, poor diet, and inadequate exercise can cause physical stress, which may lead to eczema flare-ups.
To determine whether stress is triggering your eczema, consider using these self-assessment methods:
Keep a stress and eczema diary: Track your daily stress levels, eczema symptoms, and potential triggers to identify patterns that suggest a link between stress and eczema flare-ups.
Evaluate the timing of flare-ups: Consider whether eczema symptoms worsen during periods of high stress, such as work deadlines, exams, or personal conflicts.
Identify personal stressors: Reflect on your unique stressors and determine if they coincide with eczema flare-ups.
Assess your stress management strategies: Evaluate the effectiveness of your current stress management techniques and identify areas for improvement.
Learn more about how to use these techniques on our Mental Health page.
To effectively manage stress-induced eczema, it is essential to address the underlying stressors and incorporate stress management techniques into your daily routine. By doing so, you can reduce the frequency and severity of eczema flare-ups. Here are some effective stress management techniques to consider:
Relaxation methods: Engage in relaxation techniques such as deep breathing exercises, progressive muscle relaxation, meditation, or mindfulness to help calm your mind and body. Practicing these techniques regularly can help reduce stress levels and improve your overall well-being.
Exercise: Incorporate physical activity into your daily routine to help alleviate stress and promote overall health. Exercise releases endorphins, which are natural mood elevators, and can improve sleep quality, both of which are beneficial for stress management and eczema.
Sleep hygiene: Prioritize good sleep habits to ensure you are well-rested and better equipped to handle stress. Establish a regular sleep schedule, create a comfortable sleep environment, and develop a relaxing bedtime routine to promote better sleep quality.
Time management: Develop time management skills to help you stay organized and reduce stress caused by feeling overwhelmed. Break tasks into smaller, manageable steps, set realistic goals, and prioritize your responsibilities to make your daily routine more manageable.
Seeking social support: Reach out to friends, family, or support groups to share your experiences and feelings related to stress and eczema. Having a strong support network can help you feel more understood and provide valuable insights into coping strategies and stress management techniques.
By implementing these stress management techniques, you can effectively manage stress-induced eczema and reduce the impact of stress on your overall well-being. Remember, managing stress is an ongoing process, and it's essential to be patient with yourself and continually refine your stress management strategies.
Evaluating the role of stress as a contributing factor to your eczema is crucial for effectively managing your symptoms and improving your overall well-being.
By identifying the role that stress plays in your eczema, you can take proactive steps to manage it more effectively. Implementing stress management techniques such as relaxation methods, exercise, proper sleep hygiene, time management, and seeking social support can help you reduce the impact of stress on your eczema and overall health.
Moreover, sharing your experiences with stress and eczema with others can help create a sense of community and foster a greater understanding of the connection between stress and eczema.
We encourage you to share your thoughts, experiences, and strategies in the comments section below or on social media to support and learn from one another.
Eczema is a complex disease with contributions to flares coming from skin barrier strength, immune sensitivity, and the triggers in the environment.
Here we cover a broad variety of ways eczema can be activated that you might not think of such as hormonal changes, sleep quality, and exposure to secondhand smoke.
Eczema is a chronic skin condition characterized by periodic acute flares, marked by red, itchy, and inflamed skin. The severity and duration of an acute eczema flare are influenced by three main factors:
While many are aware of common eczema triggers such as stress, food, allergies and intolerances, and environmental factors, there are several lesser-known factors that can contribute to the development or exacerbation of eczema symptoms.
Understanding these lesser-known triggers can help individuals better manage their condition and improve their overall skin health.
In this article, we will explore some of the less commonly discussed factors that may play a role in eczema, such as hormones, genetics, other health conditions, medical treatments, and the types of fabrics to avoid or prefer when dealing with eczema.
While it is crucial to understand common eczema triggers, being aware of the less commonly discussed factors can also help individuals manage their symptoms more effectively. Read on to discover a broad variety of lesser thought of conditions that can contribute to eczema symptoms and exacerbations.
Hormones serve as chemical messengers in the body, traveling through the bloodstream to influence various aspects of life, including growth, development, metabolism, mood, reproduction, sexual function, and skin health.
Experiencing hormone fluctuations is normal and healthy, but these fluctuations may affect your eczema, altering the severity of your symptoms.
Two crucial components of the immune system affected by hormones are Th1 and Th2 cells. Th2 cells have been associated with allergic responses and eczema.
Specific hormones, such as estrogen and progesterone, can increase Th2 activity, while androgens, including testosterone, can decrease Th2 activity. As your hormone levels change, you might notice variations in your eczema symptoms.
Estrogen and progesterone, the hormones that often exacerbate eczema, are female sex hormones. This fact may explain why eczema is more prevalent among adult females than adult males.
Several life stages involve more pronounced hormonal fluctuations, which may trigger or worsen eczema symptoms.
These stages include:
Puberty: During puberty, a child's body undergoes changes that enable it to become an adult body. Hormonal changes occur in both sexes. Interestingly, puberty is often a period of reduced eczema symptoms for many people. However, for those who continue to experience severe eczema flare-ups, the physical manifestation of eczema can lead to emotional distress and low self-esteem.
Menstruation: Hormonal changes during the menstrual cycle are closely linked to eczema symptoms. Many women report that their symptoms worsen in the week preceding their period. This time is characterized by a dip in estrogen levels and a rapid increase in progesterone levels.(KAN 2019)(GIR 2022) There is also evidence that protease, which is connected to epidermal barrier deterioration, is more prevalent during women's premenstrual phase.(GIR 2022)
Pregnancy: Pregnancy increases Th2 immune cell activity, which can heighten the risk of eczema flare-ups. Some women experience more severe flare-ups during pregnancy, while others find their symptoms improve. The effects of pregnancy on eczema can vary depending on the trimester and the individual.
Menopause: Menopause significantly reduces both progesterone and estrogen levels, leading to skin changes such as increased water loss, a shift in the microbiome, and impaired wound healing. These processes can worsen skin affected by eczema, which already has a compromised skin barrier.
Hormone-related eczema flare-ups can be frustrating and uncomfortable, but several steps can help you better manage them: refer to our pages on trigger control and treatments.
If you believe your eczema is highly reactive to hormones, consider hormone therapy. Hormone therapy may be an option for some women who experience menopause-related eczema flare-ups. It can balance hormone levels and improve skin conditions. However, hormone therapy has risks and side effects, so discuss the option with your doctor before starting.
One factor that can influence eczema development is genetics. Research suggests that eczema is a hereditary condition, meaning it can be passed down from parents to children. The probability of inheriting atopic eczema is approximately 75%, and the chances of both twins having eczema are 80%.(MYE 2010) However, not everyone with a family history of eczema will develop the condition, and not everyone who develops eczema has a genetic predisposition.
Researchers have linked around 30 different gene mutations to atopic eczema. For instance, mutations in a gene responsible for producing filaggrin have been associated with eczema: atopic eczema sufferers are twice as likely to have a filaggrin gene mutation.(MOR 2007) Filaggrin, along with long chain ceramide production, plays a vital role in skin barrier function.(BYR 2018)
Atopic individuals have demonstrated elevated expression of a specific gene responsible for regulating sex steroid hormones, HSD3B1. This gene is stimulated by cytokines released during the Th2 immune response. Thus, treatments that reduce the presence of cytokines, such as Dupilumab, can restore HSD3B1 expression to normal levels.(ZHA 2021) As previously discussed, hormone dysregulation can result in skin barrier impairment.
Furthermore, several genes involved in vitamin D pathways have been associated with atopic eczema.(WAN 2014) One theory is that eczema sufferers with specific gene variations have a genetically altered responsiveness to vitamin D, which is known to influence immune system function and skin barrier function.(PAL 2015)
Gene therapy is a potential treatment option for eczema that aims to correct or replace faulty genes with healthy ones. Introducing normal copies of the genes into affected cells may allow gene therapy to restore regular immune system and skin barrier function, reducing eczema symptoms.
However, gene therapy is still in the early stages of development and faces numerous challenges, such as safety, efficacy, delivery methods, and ethical issues. Further research is required to determine whether gene therapy can become a viable and effective treatment for eczema in the future.
Refer to our pages on trigger control and treatments for other options.
Atopic dermatitis is one of the most common chronic inflammatory skin conditions and is associated with sleep disturbances in 47% to 80% of children and 33% to 90% of adults. (NIH) Eczema can cause itching, pain, and discomfort that interfere with falling asleep or staying asleep. Moreover, poor sleep quality can worsen eczema by lowering the immune system.
To improve your sleep quality and reduce eczema flare-ups, you can follow some simple tips for better sleep hygiene and a more comfortable sleep environment. These include:
Stick to a regular sleep schedule and avoid napping during the day.
Avoid caffeine, alcohol, nicotine, and other stimulants before bedtime.
Keep your bedroom cool, dark, quiet, and well-ventilated.
Use a humidifier or a fan to maintain optimal humidity and air circulation in your bedroom.
Choose bedding materials that are soft, breathable, and hypoallergenic, such as cotton or silk. Avoid fabrics that are rough, scratchy, or synthetic, such as wool or polyester.
Wash your bedding frequently with mild detergents and avoid fabric softeners or dryer sheets that may contain irritants or allergens.
Wear loose-fitting pajamas that are made of natural fibers and do not have seams or tags that may rub against your skin.
Apply moisturizer to your skin before going to bed and reapply as needed throughout the night.
Trim your nails and wear gloves or socks to prevent scratching your skin while sleeping.
Certain fabrics can cause irritation and exacerbate eczema symptoms. Fabrics made from synthetic fibers, such as nylon, polyester, acrylic, and spandex, can irritate sensitive skin and cause a histamine reaction, which results in skin inflammation and itching. Some common fabrics that can cause irritation include:
Wool: Although a natural fiber, wool can be scratchy and rough on the skin. It can trap heat and moisture, creating an environment conducive to bacterial and fungal growth that can infect eczema. Wool can also contain lanolin, a natural oil to which some people are allergic.
Synthetic fabrics: Chemicals used in the production of synthetic fabrics like polyester, nylon, acrylic, and spandex can irritate the skin or cause allergic reactions. These fabrics can also trap heat and moisture, increasing the risk of infection and inflammation. Synthetic fabrics may also be stiff and clingy, causing friction against the skin.
Coarse fabrics: Coarse fabrics have a rough texture or tight weave that can scratch or chafe the skin. Examples include denim, corduroy, linen, and hemp. These fabrics can also be heavy and stiff, leading to discomfort and restricted movement.
To minimize eczema flare-ups caused by clothing, choose garments that are:
Soft and smooth: Opt for gentle fabrics like cotton, silk, bamboo, modal, and Tencel. These breathable, lightweight materials allow air circulation, keeping the skin cool and dry.
Loose-fitting: Loose clothing allows the skin to breathe, prevents overheating and sweating, and reduces pressure and rubbing on the skin, which can trigger itching and scratching. Avoid tight or constricting garments such as leggings, skinny jeans, or tight collars.
Hypoallergenic: Choose hypoallergenic fabrics like organic cotton, silk, bamboo, hemp, and linen, or look for clothing labeled as hypoallergenic, anti-microbial, or anti-inflammatory.
When shopping for eczema-friendly clothing:
Read the labels: Check clothing labels for materials and care instructions. Look for garments made of natural fibers or blends containing at least 50% natural fibers. Avoid wool or synthetic fibers and clothing with dyes, bleaches, or chemicals that can irritate the skin.
Feel the fabric: Assess clothing for softness, smoothness, and lightness. Avoid rough, scratchy, or stiff materials.
Try it on: Ensure clothing fits comfortably and does not restrict movement. Avoid items that are too tight, too loose, or have seams, buttons, zippers, or tags that can rub against the skin.
To minimize clothing-related irritation:
Wash new clothing before wearing: Remove any potential irritants and soften the fabric by washing new garments before use.
Use gentle detergents: Choose mild, fragrance-free, dye-free, and hypoallergenic detergents. Avoid harsh chemicals, enzymes, or optical brighteners that can leave residues on clothing and cause irritation.
Rinse well: Ensure clothing is thoroughly rinsed after washing to remove any detergent or dirt remnants. Add a cup of white vinegar to the rinse cycle to help remove residues and soften the fabric.
Dry naturally: Hang or lay clothing flat to dry, avoiding shrinkage or fabric damage. Steer clear of dryers or irons, which can generate heat and static electricity that irritate the skin.
Smoking is a well-known risk factor for various health issues and can also exacerbate eczema symptoms. Studies have shown that smoking can impair skin barrier function, increase inflammation, reduce blood flow and oxygenation, and lower vitamin A levels, which are essential for maintaining healthy skin.
Exposure to secondhand smoke, also known as environmental tobacco smoke (ETS), can be harmful to individuals with eczema. Secondhand smoke contains many harmful substances found in cigarette smoke, such as nicotine, carbon monoxide, and free radicals, which can irritate the skin and trigger eczema flare-ups.
Some studies have found a positive association between secondhand smoke exposure and eczema prevalence and severity, particularly in children and those with a genetic predisposition to eczema.
Quitting smoking can benefit individuals with eczema by improving skin barrier function, reducing inflammation, increasing blood flow and oxygenation, and restoring vitamin A levels. Additionally, quitting smoking can lower the risk of developing other skin diseases and cancers associated with smoking. Strategies to help quit smoking include:
Setting a quit date and listing reasons for quitting
Finding alternative activities to cope with stress and cravings
Using nicotine replacement therapy or other medications to ease withdrawal symptoms
Seeking professional counseling or joining a support group
Asking friends and family for encouragement and accountability
If you are not a smoker but are exposed to secondhand smoke, you may want to take some steps to protect yourself and your skin from its harmful effects. To avoid exposure to secondhand smoke, consider the following strategies:
Avoid locations where smoking is allowed or common
Use air purifiers or ventilation systems to reduce indoor air pollution
Wash clothes and hair after exposure to smoke
Apply moisturizers and sunscreen to keep skin hydrated and protected
Many people with eczema look for natural ways to manage their symptoms and reduce their reliance on medications. Some herbs and supplements may have anti-inflammatory, anti-itch, and wound-healing properties that could benefit people with eczema.
However, it is important to be aware of the potential benefits and risks of using herbs and supplements for eczema, and to consult a healthcare provider before trying them.
Some of the potential benefits of using herbs and supplements for eczema include:
Some of the potential risks of using herbs and supplements for eczema include:
Hormone-disrupting chemicals, or endocrine disruptors, are substances that interfere with the normal functioning of the endocrine system, which regulates hormone production and activity. These chemicals can lead to hormonal imbalances and health problems, including altering the immune system's response to inflammation and influencing the skin barrier function, both of which can affect eczema.
For example, some studies have shown that exposure to bisphenol A (BPA), a common hormone-disrupting chemical found in plastics and food containers, can increase the levels of pro-inflammatory cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) in the blood and skin of mice with eczema. These cytokines can stimulate the production of immunoglobulin E (IgE), an antibody that mediates allergic reactions and eczema.
Another way that hormone-disrupting chemicals can affect eczema is by influencing the skin barrier function. Some hormone-disrupting chemicals can impair the skin barrier function by altering the lipid composition and structure of the skin. For example, some studies have shown that exposure to phthalates, a group of hormone-disrupting chemicals used as plasticizers and solvents in various products such as cosmetics, personal care products and vinyl flooring, can reduce the levels of ceramides in the skin.
Ceramides are a type of lipid that play a key role in maintaining the integrity and hydration of the skin barrier. A deficiency of ceramides can lead to increased transepidermal water loss (TEWL), which is a measure of how much water evaporates from the skin surface. Increased TEWL can result in dryness, cracking and itching of the skin, which can trigger or aggravate eczema.
Hormone-disrupting chemicals, also known as endocrine-disrupting chemicals (EDCs), are substances that can interfere with the normal functioning of your hormones. Hormones are chemical messengers that regulate many aspects of your health, such as growth, metabolism, reproduction, mood and sleep. EDCs can mimic or block your natural hormones, or alter their production or elimination, leading to various health problems.
Some of the most common sources of EDCs are plastics, pesticides, cosmetics and personal care products. For example:
While it may be impossible to avoid EDCs completely, there are some steps you can take to reduce your exposure and protect your health:
Physical contact with certain materials and products, including those used by your significant other, can trigger or worsen eczema symptoms by irritating the skin and causing inflammation. Common culprits include:
Fabrics: Wool, synthetic fibers, and rough or scratchy fabrics can cause itching and irritation. They can also trap heat and sweat, leading to skin dryness and increased risk of infection.
Metals: Nickel, cobalt, and chromium can cause allergic contact dermatitis in people with eczema. These metals are often found in jewelry, buttons, zippers, watches, eyeglasses, and other accessories.
Jewelry: In addition to metals, jewelry may contain substances like fragrances, dyes, resins, latex, and rubber that can trigger eczema. Jewelry can also cause friction by rubbing against the skin.
To prevent or reduce physical contact with common irritants, consider the following strategies:
Opt for clothing made from natural fibers like cotton, silk, or bamboo, which are soft, breathable, and less likely to irritate the skin.
Avoid tight, loose, or abrasive clothing, or those with seams or tags that can rub against the skin.
Wash new clothing before wearing to remove any chemicals or residues.
Use fragrance-free and dye-free detergents and cleansers for clothing and bedding, and rinse thoroughly. Avoid fabric softeners or dryer sheets.
Wear gloves when handling chemicals, detergents, or other skin irritants. Cotton gloves under rubber or latex gloves can prevent sweating and irritation.
Remove jewelry before washing hands, showering, or swimming. Apply barrier cream or clear nail polish to parts of jewelry that touch the skin to reduce exposure to metals.
Test new jewelry or accessories on a small skin area before extended wear. If irritation or allergy symptoms appear, stop wearing the item and consult a doctor.
Hard water is water that contains high levels of minerals, such as calcium and magnesium. According to some research, hard water may damage the skin barrier, which is the outermost layer of the skin that protects it from harmful substances and keeps it moisturized. A damaged skin barrier can lead to dryness, irritation, and inflammation, which are common symptoms of eczema .
Chlorine is a chemical that is often added to water to kill bacteria and other microorganisms. However, chlorine can also have negative effects on the skin, especially for people with eczema. Chlorine can strip away the natural oils and moisture from the skin, leaving it dry and vulnerable to irritation and infection. Chlorine can also trigger allergic reactions or contact dermatitis in some people with sensitive skin.
If you have eczema and live in an area with hard water or chlorinated water, you may want to consider using water softeners and chlorine filters to improve your water quality and reduce your eczema symptoms.
Water softeners are devices that reduce the mineral content of hard water by replacing them with sodium or potassium ions. Water softeners can help prevent the formation of soap scum on the skin, which can clog pores and irritate the skin. Water softeners can also help improve the effectiveness of moisturizers and other skin care products by allowing them to penetrate deeper into the skin.
Chlorine filters are devices that remove chlorine and other chemicals from water by using activated carbon or other media. Chlorine filters can help restore the natural pH balance of the skin, which can affect how well the skin barrier works. Chlorine filters can also help prevent chlorine from drying out the skin or causing allergic reactions.
If you have eczema and are exposed to hard water or chlorinated water, here are some tips to help you maintain your skin moisture and barrier function:
Use gentle cleansers that are fragrance-free, dye-free, and pH-balanced. Avoid harsh soaps or detergents that can strip away the natural oils from your skin.
Rinse your skin thoroughly after bathing or showering to remove any soap residue or mineral deposits from your skin.
Apply a moisturizer within three minutes after bathing or showering to lock in the moisture and repair the skin barrier. Choose a moisturizer that is suitable for your skin type and condition. Look for ingredients such as ceramides, glycerin, hyaluronic acid, or urea that can help hydrate and protect the skin.
Avoid long or hot baths or showers that can dry out your skin or worsen inflammation. Limit your bathing or showering time to 10 minutes or less and use lukewarm water instead of hot water.
Wear soft and breathable fabrics that do not irritate your skin. Avoid fabrics such as wool, polyester, nylon, or acrylic that can cause itching or friction on your skin. Cotton, silk, bamboo, or linen are some of the best clothing materials for eczema.
Dental issues are often overlooked as a possible trigger of eczema symptoms, but they can have a significant impact on your skin and overall health. Dental issues can affect your oral microbiome, which is the collection of bacteria that live in your mouth and influence your immune system and inflammation. Some dental issues that can affect your oral microbiome and eczema symptoms are:
Oral health is an important aspect of eczema management because it can help prevent or reduce dental issues that can trigger or exacerbate eczema symptoms. Oral health can also help maintain a balanced oral microbiome, which can support your immune system and reduce inflammation. Some oral health tips for eczema management are:
If you suspect that you have a dental issue that may be affecting your eczema symptoms, you should seek professional help from your dentist as soon as possible. Your dentist can diagnose and treat any dental issue that may be causing or worsening your eczema symptoms.
Some strategies for identifying and managing dental issues that may exacerbate eczema symptoms are:
Studies have shown significant association of atopic eczema with multiple autoimmune diseases, including alopecia areata, celiac disease, Crohn’s disease, rheumatoid arthritis, systematic lupus erythematosus, ulcerative colitis and vitiligo.(LU 2021) The “association” here means that atopic eczema is more likely to occur in individuals with the listed autoimmune diseases. The “significant” refers to the statistical confidence rather than severity of the eczema.
In addition to the above, any disease or treatment which can increase the dryness of the skin or increase inflammation levels can exacerbate eczema symptoms.
Autoimmune diseases that affect the skin, such as alopecia areata and vitiligo, can cause patches of hair loss or changes in skin color. These conditions may also affect the skin barrier function and make it more prone to irritation and infection. Autoimmune diseases that affect the gastrointestinal tract, such as celiac disease, Crohn’s disease and ulcerative colitis, can cause inflammation and damage to the lining of the intestines. This can affect the absorption of nutrients and lead to deficiencies that may affect the skin health. Autoimmune diseases that affect the connective tissue, such as rheumatoid arthritis and systemic lupus erythematosus, can cause joint pain and inflammation, as well as skin rashes and lesions.
The exact mechanism of how these autoimmune diseases are linked to atopic eczema is not fully understood. However, some possible explanations include shared genetic factors, dysregulation of immune cells and cytokines, and alterations in the microbiome. More research is needed to clarify the causal relationship between atopic eczema and autoimmune diseases, and whether treating one condition can improve the other.
Eczema can be a challenging skin condition to manage, but with proper knowledge of treatments and preventions, it is possible to minimize symptoms and improve your quality of life. By considering the above factors and implementing strategies to avoid them, you may be better able to manage your eczema symptoms.
However, it is essential to explore various treatments and prevention methods to find the best approach for your unique situation. To learn more about eczema treatment options and how to create a comprehensive management plan, head to the treatment page.
Share your experiences with us! Tell us what has and hasn’t worked for you. What did we miss in this article that you've found personally impactful? Your insights can help others better understand and manage their eczema.
Washing is essential to remove triggers but needs to be done correctly to avoid new flare-ups.
We cover a host of expert tips for washing with eczema.
Eczema is a chronic skin condition characterized by periodic acute flares, marked by red, itchy, and inflamed skin. The severity and duration of an acute eczema flares are influenced by three main factors:
Triggers, such as pollen, pollution, and allergens can build up on the surface of our clothes and our skin. Washing is essential to remove this build up.
However, washing too much or with the wrong soaps or detergents can introduce new irritants and allergens or dry the skin out, triggering a new flare.
Here, we explore the importance of washing for those with eczema and provide guidance on selecting the right products and techniques to minimize irritation and flare-ups.
As discussed in the ceramides page, ceramides provide the suppleness and impermeability of the skin barrier. The skin is naturally acidic which aids in protecting against infection. The pH varies from 4 to 6.5, depending on the specific body part.
Soaps, on the other hand, are often alkaline and designed to break down oils, including ceramides, so they can be easily rinsed off the skin's surface. Consequently, soaps can be quite drying, particularly for skin already prone to dryness such as when there is a deficiency in long chain ceramides.
Selecting an appropriate face wash for eczema-prone skin is critical since the wrong product can trigger inflammation and worsen the symptoms.
It's important to choose a gentle, fragrance-free cleanser specifically formulated for sensitive skin. Look for products containing soothing ingredients like colloidal oatmeal which helps reduce itching and inflammation.
Avoid products containing harsh chemicals, such as sulfates, artificial fragrances, artificial colors, are strongly alkaline, or contain alcohol, as these can exacerbate eczema symptoms by causing further irritation and disrupting the skin's natural barrier.
Frequent handwashing is essential for maintaining hygiene. But individuals with eczema should prioritize using a mild, hydrating hand soap. Opt for soaps that are:
Sulfate-free - Sulfates can strip the skin's natural oils, leading to dryness and irritation.
Fragrance-free and dye-free - Artificial fragrances and dyes can cause allergic reactions and exacerbate eczema symptoms.
Are not strongly alkaline and do not contain alcohol
Moisturizing - you might even use a moisturizer as the soap. See below for more.
Laundry detergent residue on clothes, bedding, and other fabrics can cause skin irritation for those with eczema. It's crucial to use a laundry detergent designed for sensitive skin, which should be:
Free of dyes and fragrances - These additives can trigger allergic reactions and worsen eczema symptoms.
Hypoallergenic - These products are less likely to cause irritation or allergic reactions.
In some cases, a dermatologist may recommend a medicated soap for eczema treatment. These soaps typically contain active ingredients like:
Coal tar - Known to have anti-inflammatory, antifungal, and antipruritic properties, coal tar can help alleviate itching and inflammation.
Salicylic acid - This ingredient aids in the removal of dead skin cells, reducing scaling and promoting smoother skin.
Zinc pyrithione - With its antimicrobial and anti-inflammatory properties, zinc pyrithione can help reduce itching and inflammation.
You may need to make your own at some point! Here's a simple recipe for an all-purpose cleaning surface solution using vinegar, baking soda, and essential oils:
Ingredients:
1/2 cup white vinegar
2 cups water
1 tablespoon baking soda
[Optional] 10-15 drops of your favorite scent (e.g., lemon)
Instructions:
In a small bowl, mix the baking soda and water until the baking soda is dissolved.
Slowly add the white vinegar to the baking soda mixture. The combination will cause a temporary fizzing reaction as the vinegar reacts with the baking soda. Wait for the fizzing to subside before proceeding.
Add your preferred scent to the mixture. A squeeze of lemon not only add a pleasant scent but can also provide antimicrobial properties.
Pour the mixture into a clean spray bottle, preferably one made of glass, as some plastic can degrade over time.
Shake well before each use to ensure the ingredients are well mixed.
This all-purpose cleaner can be used on various surfaces such as countertops, sinks, and appliances. However, avoid using it on porous surfaces like natural stone or unsealed wood, as the vinegar can damage these materials. Also, test the cleaning solution on a small, inconspicuous area before applying it to a larger surface to ensure it doesn't cause any discoloration or damage.
Remember that anything has a possibility of being irritating to the skin, especially for those with eczema or sensitive skin. If you're prone to skin reactions, use gloves when handling the cleaning solution.
Using hot water can strip the skin of its natural oils, leading to increased dryness and irritation. Cold water can tighten the skin and allow triggers to penetrate. To avoid exacerbating symptoms, use lukewarm water when washing your face, hands, or body.
Excessive washing can strip the skin of its natural oils and disrupt the skin's barrier function, resulting in increased dryness and irritation. To strike the right balance, wash your face no more than twice a day, and shower or bathe every other day, if possible. Always listen to your skin and adjust your washing frequency based on its needs.
Aggressive scrubbing can cause further irritation and damage the skin barrier, making eczema symptoms worse. To minimize the risk of exacerbating your eczema, adopt the following gentle washing techniques:
Moisturize delicate skin before washing.
Some moisturizers can be used to wash with, as they dry the skin less while still functioning like a soap.
Use your fingertips or a soft washcloth instead of abrasive scrubbers or exfoliating brushes.
Apply cleansers and soaps using circular motions, avoiding any harsh rubbing or tugging on the skin.
Do not use loofahs or textured sponges, as these can be too rough for eczema-prone skin.
Wear rubber gloves to protect your hands when washing other items, such as dishes or a car.
Proper rinsing is crucial to ensure as much of the soap or cleanser is removed from the skin as possible. Residual product ingredients can cause irritation and dryness.
Follow these steps for effective rinsing:
Spend extra time rinsing the skin, especially in areas where soap may accumulate, such as skin folds and creases.
Use your hands or a soft washcloth to gently help remove soap and cleanser from the skin.
Dab with the towel rather than rub.
Be mindful of water pressure, as high-pressure showers can also irritate sensitive skin. Opt for a gentle, steady stream of water while rinsing.
Moisturize once your skin is dry.
Showering can be a stressful activity for those with sensitive skin or skin discomforts, but it is an important mechanism for cleaning and preventing infection. Showering can also be used to remove sweat, irritants, and allergens from the skin after exposure, such as after exercising outdoors during pollen season.
Showering can be a double-edged sword for individuals with eczema; while it's essential for hygiene, it can also strip the skin of natural oils and exacerbate symptoms. To make showering more eczema-friendly, follow these tips:
Keep showers short and sweet - Limit your showers to 10-15 minutes to minimize the loss of natural oils and reduce skin irritation.
Moisturize before you wash
Use a gentle, hydrating body wash - Opt for a body wash specifically formulated for sensitive skin. Like face washes, they should be free of sulfates, artificial fragrances, and dyes, and contain soothing ingredients like colloidal oatmeal or aloe vera.
Avoid harsh scrubbing - Use your hands or a soft washcloth to gently cleanse your body. Steer clear of loofahs, textured sponges, and abrasive scrubbers.
Rinse fully
Pat dry, don't rub - After showering, gently pat your skin dry with a soft, clean towel. Rubbing your skin can cause further irritation and damage.
Apply moisturizer immediately - Lock in moisture by applying a fragrance-free, hypoallergenic moisturizer within three minutes of stepping out of the shower. This practice, known as the "soak and seal" method, can help maintain the skin's natural barrier and reduce dryness
Consider a blast of cold water at the end of the shower - the cooling effect can be soothing
If your skin is particularly sensitive, it may be worth avoiding showering too often to let the skin recover. In this instance, consider doing a flannel wash:
Wet the areas of skin you want to clean.
Use a flannel, warm water, and your choice of sensitive soap to lightly wash the areas.
Rinse off and dab dry with a towel.
Moisturize.
If exposed to sweat, irritants, and allergens, try to shower as soon as you can to reduce the time your skin is exposed.
Bathing can provide a stable environment to wash and even treat the skin by soaking in beneficial ingredients.
For those who prefer baths over showers and are dealing with eczema, it's crucial to adapt your bathing routine to be more eczema-friendly:
Limit bath time to no more than 15-20 minutes to minimize skin irritation.
Add soothing ingredients to the water, such as colloidal oatmeal, Epsom salts, or baking soda, to enhance the therapeutic effects of your bath. These ingredients can help soothe the skin, reduce itching, and promote relaxation.
Avoid bubble baths and bath bombs, as many of these products contain harsh chemicals, fragrances, and dyes that can worsen eczema symptoms. Stick to gentle, eczema-friendly bath additives instead.
Wash with chosen sensitive soaps during the bath.
Rinse off, and consider using cold water as this can soothe inflamed skin.
Dab dry with a soft towel rather than rubbing the skin, which can cause further irritation.
Apply a fragrance-free, hypoallergenic moisturizer within three minutes of exiting the bath to lock in moisture and maintain the skin's barrier function. Use an occlusive emollient for the best results.
Allow the moisturizer to soak in before getting fully clothed.
There are some ingredients that can be added to a bath to provide further benefits for the skin. This table summarizes the key information:
Bath Ingredient per typical 100-150 L bath |
Notes |
Duration |
Salt (Table, Epsom, or Magnesium) 1 cup salt (250 g) |
Benefits The salt absorbs into the skin and increases their moisture retention, therefore reducing water loss [CAR 2018][YOO 2020] Avoids Anti-caking or fragrance additives |
Up to 30 mins [D] |
Oat 10 ml or 1 cup of oatmeal in a mesh bag or ground up to a dust |
Benefits “The high concentration of starches and beta-glucans in oat are responsible for its protective and water-holding functions” [PAZ 2012]. |
15 - 20 minutes |
Baking Soda |
Neutralizes skin acidity, soothes itching, and gently exfoliates. |
15 - 20 minutes |
The above table omits two other types of bath supplements: vinegar and bleach.
Your skin needs a healthy microbiome to control inflammation. It is not good to harm it.
Both vinegar and bleach baths are intended to kill the microbiome. Bleach and vinegar will kill indiscriminately all or most of the members of the microbiome.
Always follow your doctor’s advice. In the absence of doctor’s advice though, we cannot recommend vinegar or bleach baths.
While you might think “hitting the reset button” seems like a good idea, understand that doing so sort of makes your body like a post-apocalyptic wasteland. Who runs the wasteland in every movie you have seen? It is usually not the nice guys. The same is true here - in challenging environments, pathogenic bacteria are more likely to rise. By using harsh chemicals like these, you risk giving room to pathogenic bacteria to rise and create more inflammation later.
That said, we are including the below for reference, along with the evidence in support of these tools. We leave it to you and your doctor to determine what is right for your situation as during an acute flare, it is possible that there is an overgrowth of bacteria.
Vinegar 2 to 4 cups of apple cider vinegar |
Benefits The natural acidity of the vinegar complements the acidity of your skin to aid in managing a healthy skin microbiome. Use 2 to 3 times a week. Some studies suggest that vinegar baths may help reduce skin infections, but more research is needed.(SCH 2011)(LEE 2018) |
10 minutes |
Bleach ¼ to ½ cup of bleach |
Benefits Some studies support the use of bleach baths for eczema patients with frequent skin infections, but results are mixed. Always consult your doctor before trying bleach baths, as they may not be suitable for everyone.(BYR 2018)(ALY 1996) Avoid No more than 3 times a week |
10 minutes |
As covered in the environment page, the clothing, bedding and the chemicals they are washed come into contact with your skin can trigger eczema to flare.
If there are irritants in the laundry detergent or excessive bacteria in the fabric, this can disrupt the microbiome and damage the skin. Standard detergents can contain various fragrances and colorings to make the laundry smell and look appealing. These ingredients can be problematic for sensitive skin.
Managing eczema symptoms requires special attention to your laundry practices, as clothing, bedding, and towels are in constant contact with the skin. To create an eczema-friendly laundry routine, consider the following guidelines:
Laundry Products and Materials
Use a gentle laundry detergent: Choose a detergent specifically designed for sensitive skin that is hypoallergenic, dermatologist-tested, and free of dyes and fragrances.
Avoid fabric softeners and dryer sheets: These products often contain fragrances and chemicals that can irritate eczema-prone skin. Use wool dryer balls or fragrance-free, hypoallergenic fabric softeners instead.
Opt for natural fabrics: Choose clothing and bedding made from natural, breathable materials like cotton, bamboo, or linen, which are less likely to cause skin irritation than synthetic fabrics such as polyester or nylon.
Things to Avoid in a Gentle Laundry Detergent
Fragrances
Dyes and coloring
Optical brighteners
Bio products
Softeners
Drying laundry in the presence of airborne allergens
Laundry Techniques and Practices
Rinse thoroughly: Ensure your washing machine rinses your items adequately to remove all detergent residue. If necessary, use an extra rinse cycle.
Wash new clothing before wearing: New items may contain chemicals or residues from the manufacturing process that can irritate sensitive skin. Always wash new clothing, bedding, and towels before using them for the first time.
Keep clothes clean and allergen-free: Regularly wash your items to minimize exposure to allergens like dust mites, pet dander, and pollen. Wash sheets and pillowcases once a week, and blankets and comforters every two to four weeks.
Be mindful of laundry storage: Store laundry properly to prevent mold and mildew, which can irritate eczema-prone skin. Ensure items are completely dry before storing them, and consider using a dehumidifier in your laundry area to reduce moisture levels.
Wash above 120 degrees, if necessary, to eradicate dust mites.
Personal Considerations and Precautions
Conduct patch or elimination testing to determine if you have an allergy or intolerance to laundry detergent ingredients.
Stick to a detergent that works for you once you find it.
If you share a laundry machine with others, ask them to use your detergent or rinse the machine before you use it to remove any triggering suds.
Be aware of the characteristics of contact eczema and take necessary precautions.
Consider the laundry detergent used by your significant other or anyone you are in close contact with.
By assessing your individual needs, adjusting product choices and techniques as needed, and maintaining consistency in your washing routine, you can create an effective and customized approach to managing your eczema symptoms.
Remember that patience and perseverance are key, and always consult your dermatologist if you have concerns or questions about your skincare routine.
Identify your triggers - Keep a journal or log of your eczema flare-ups, noting any potential irritants, such as specific products, environmental factors, or stressors. This information will help you pinpoint which factors may be contributing to your symptoms.
Consult a dermatologist - If you're unsure about your skin type or the best products for your eczema, consult a dermatologist for professional advice and recommendations.
Trial and error - Introduce new products one at a time and observe how your skin reacts. If a product causes irritation or worsens your eczema, discontinue its use and try a different option.
Adapt to changes in your skin - Your skin's needs may change over time due to factors such as age, hormonal fluctuations, or seasonal weather changes. Be prepared to adjust your washing routine and product choices accordingly.
Experiment with techniques - As you develop your personalized routine, you may find that certain washing techniques, such as patting versus rubbing or using a washcloth versus your hands, work better for your skin. Don't be afraid to try different approaches to find what suits your skin best.
Establish a daily routine - Consistency is key to maintaining healthy skin and minimizing eczema flare-ups. Develop a daily washing routine that includes cleansing, moisturizing, and other skincare steps as needed.
Stick to your routine, even during flare-ups - Maintaining your washing routine during eczema flare-ups is crucial for symptom management. If a flare-up is particularly severe, consult your dermatologist for guidance on adjusting your routine or incorporating additional treatments.
Be patient - It may take time to see improvements in your skin, so be patient and persistent in following your personalized washing routine.
Managing eczema requires paying special attention to various aspects of your daily life, including showering, bathing, and laundry practices. To effectively manage this complex skin condition, remember to keep showers and baths short, use lukewarm water, and choose gentle, hypoallergenic products for both personal care and laundry. Opt for natural fabrics and ensure proper laundry storage to minimize irritation from allergens and chemicals.
We encourage you to explore other factors and treatments by engaging with our other content, as a comprehensive approach is key to effectively managing this complex skin condition.
Share your experiences with us! Tell us what has and hasn’t worked for you. What did we miss in this article that you've found personally impactful? Your insights can help others better understand and manage their eczema.
Eczema flare-ups can be triggered by various environmental factors.
Read on for a comprehensive list of triggers, and some tips on how to manage them.
Eczema is a chronic skin condition characterized by periodic acute flares, marked by red, itchy, and inflamed skin. The severity and duration of an acute eczema flare are influenced by three main factors:
The environment around us is where we find most of our triggers and aspects of the environment can affect our skin barrier strength.
Understanding and managing the environmental triggers that can exacerbate the condition is crucial for minimizing flare-ups and maintaining healthier skin.
As each person's experience with eczema is unique, it's important to identify and avoid individual triggers to help reduce symptoms and improve overall well-being.
Various environmental triggers and factors can contribute to eczema flare-ups. Here we will explore how chemicals found in household cleaners, personal care products, and clothing can exacerbate eczema symptoms, and discuss the impact of temperature, humidity, and air quality on skin health.
By understanding and addressing these environmental factors, individuals with eczema can take proactive steps to minimize their exposure to irritants and improve their overall skin condition. For advice on how to manage these potential triggers, see the trigger avoidance page.
Many household cleaning products, such as soaps, detergents, antiseptics, antibacterials, solvents, machine oils, cement, and chlorinated water, contain harsh chemicals that can irritate sensitive skin and worsen eczema symptoms.(NHS)(NEM 2022) Ingredients like ammonia, bleach, and sodium lauryl sulfate are known to be particularly irritating.
Some chemicals, like disocyanates in paints, coatings, and adhesives, can reduce the essential ceramides in the skin.(ZEL 2023)
To minimize exposure to these chemicals, consider using gentle, fragrance-free cleaning products, or try making your own natural cleaning solutions with ingredients like vinegar, baking soda, and essential oils.
Soaps, shampoos, and other personal care products can also be a source of irritation for those with eczema. Fragrances, certain preservatives, and synthetic dyes are common culprits.
Choose fragrance-free, hypoallergenic products specifically formulated for sensitive skin. Additionally, avoid using harsh exfoliants or scrubbing your skin too vigorously, as this can further damage the skin barrier and increase inflammation.
Synthetic fabrics, such as polyester and nylon, may cause irritation, while residues from laundry detergents and fabric softeners can linger on clothes and come into contact with the skin.
Choose natural, breathable fabrics like cotton and bamboo, and wash clothes with fragrance-free, hypoallergenic detergents. Additionally, avoid using fabric softeners and dryer sheets, as they often contain skin-irritating chemicals.
Extreme temperatures and humidity levels can have a significant impact on eczema symptoms, making the skin more prone to irritation, itching, and inflammation. Let's delve deeper into how hot and cold weather, as well as varying humidity levels, can exacerbate eczema.
Hot weather and humidity:
Cold weather and low humidity:
Airplane cabins typically have lower air pressure than ground level, which can affect blood circulation and contribute to swelling or edema, particularly in the lower extremities.
For those with eczema, this swelling can increase discomfort and irritation in affected areas. Moreover, airplane cabins tend to have extremely dry air, with humidity levels often below 20%. Combined with the lower pressure, this low humidity can strip the skin of its natural moisture, leading to dryness, itching, and exacerbation of eczema symptoms.
Additionally, airplane cabins may contain various potential irritants, including allergens from fellow passengers (such as pet dander or pollen), chemicals from cleaning products, and synthetic fragrances from perfumes or air fresheners.
To help manage eczema while flying, consider the following tips:
Apply a gentle, fragrance-free moisturizer before boarding and throughout the flight to maintain your skin's moisture barrier. Bring a travel-sized container of moisturizer in your carry-on bag for easy access.
Avoid alcohol consumption, as it can increase skin flushing and water loss, further exacerbating eczema symptoms.
To help maintain a comfortable indoor environment, keep the temperature and humidity levels as stable as possible. Use a humidifier in the winter months to add moisture to the air and help prevent skin dryness. In the summer, use air conditioning to cool the air and reduce sweating. Aim for a humidity level between 40-60%, and try to keep the temperature around 68-72°F (20-22°C).
While air conditioning can provide relief from heat and humidity, it can also contribute to skin dryness by removing moisture from the air. To counteract this effect, consider using a portable humidifier in the room where you spend the most time, or invest in a central humidification system for your home.
Make sure to clean and maintain your air conditioning unit regularly to reduce the presence of allergens and irritants in the air.
The temperature of the water used for showering can have a significant impact on eczema symptoms. Both extremely hot and cold water can cause irritation and exacerbate existing eczema, making it crucial to find the right balance when it comes to water temperature.
Hot water:
Dilates blood vessels: Hot water can cause blood vessels in the skin to dilate, which can increase inflammation and redness in eczema-prone areas.
Triggers itch-scratch cycle: Hot showers may temporarily provide relief from itching due to their numbing effect on the skin. However, this relief is short-lived and often followed by increased itching, as the hot water can further irritate the skin and trigger the itch-scratch cycle.
Cold water:
Tightens skin: Extremely cold water can cause the skin to tighten, which may lead to discomfort and irritation, particularly in eczema-prone areas.
Reduced skin barrier function: Like hot water, cold water can also compromise the skin's barrier function, allowing allergens and irritants to penetrate more easily and worsen eczema symptoms.
To minimize the impact of showering on eczema, consider the following tips:
Opt for lukewarm water: Instead of using hot or cold water, use lukewarm water for showering. This will help prevent the skin from drying out and reduce the risk of irritation.
Limit shower duration: Keep your showers short, ideally under 10 minutes, to minimize the amount of time your skin is exposed to water, which can strip away natural oils and moisture.
Use gentle, fragrance-free cleansers: Choose a mild, fragrance-free cleanser specifically designed for sensitive skin to minimize the risk of irritation. Avoid harsh soaps and scrubbing, as these can further damage the skin barrier.
Pat skin dry: After showering, gently pat your skin dry with a soft towel instead of rubbing, which can cause further irritation.
Moisturize immediately: Apply a gentle, fragrance-free moisturizer within a few minutes of showering to lock in moisture and maintain a healthy skin barrier. This is especially important after using lukewarm water, which may not be as effective as hot water in opening up the skin's pores to allow for optimal moisturizer absorption.
Air pollution from vehicle emissions, industrial activities, and other sources can also exacerbate eczema symptoms.
Poor air quality has also been linked to heightened eczema severity, with airborne sulfites causing skin irritations.(LUS 2021)(VAL 2012) Pollutants released from burning fossil fuels or in chemical manufacturing can increase eczema rates.
Concentrations of very fine dust are elevated within 200 feet of a frequently used roadway like a highway, freeway, or other multilane road.
Pollutants also have a negative impact on the skin’s microbiome. Eczema flares can be instigated directly from a disrupted microbiome. Pollution can also disrupt the microbiome’s production of ceramides (a valuable skin barrier component).(ZEL 2023) A weaker skin barrier from a lack of ceramide production is more susceptible to triggers.
On days with high pollution levels, consider staying indoors and using air purifiers to minimize exposure to pollutants. When you do go outside, protect your skin by wearing loose, long-sleeved clothing and applying a gentle, fragrance-free barrier cream or ointment.
Smoke from fires, whether from wildfires or indoor sources like fireplaces and tobacco, can irritate the skin and aggravate eczema. Smoke contains particulate matter and chemicals that can cause inflammation and disrupt the skin barrier.
If you live in an area prone to wildfires, consider investing in an air purifier with a HEPA filter to reduce indoor air pollution during fire season. For tobacco smokers, quitting smoking or taking it outside can help minimize skin irritation.
Smoke from fires, whether from wildfires or indoor sources like fireplaces and tobacco, can irritate the skin and aggravate eczema. Smoke contains particulate matter and chemicals that can cause inflammation and disrupt the skin barrier.
If you live in an area prone to wildfires, consider investing in an air purifier with a HEPA filter to reduce indoor air pollution during fire season. For tobacco smokers, quitting smoking or taking it outside can help minimize skin irritation.
Indoor air quality can also impact eczema.
Common indoor air pollutants, such as volatile organic compounds (VOCs) from paint, furniture, and cleaning products, can irritate the skin and worsen eczema symptoms. To improve indoor air quality, consider using low-VOC paint and furniture, as well as natural, fragrance-free cleaning products.
Regularly dust and vacuum your home to reduce the presence of allergens and irritants. Additionally, ensure proper ventilation by opening windows when possible and using exhaust fans in the kitchen and bathroom.
Fine particles, smoke, and aromas from cooking can also contribute to indoor air pollution and aggravate eczema symptoms. To minimize the impact of cooking on air quality, use an exhaust fan while cooking, clean up grease and food particles promptly, and avoid burning food.
Mold spores can cause allergic reactions and worsen eczema symptoms.(WAN 2022) To prevent mold growth in your home, maintain a humidity level below 60%, fix water leaks promptly, and clean visible mold with a mild detergent and water.
If you suspect mold in hidden areas, such as behind walls or under flooring, consult a professional for assessment and remediation.
Animal dander from pets like cats, dogs, and horses can cause allergies which result in contact or atopic eczema symptoms. The severity can vary between individuals. Some pet breeds have been specifically developed to be less allergenic, but it's essential to consider possible allergies when selecting a pet.
Pet allergens, particularly from dogs, can trigger eczema flare-ups in some individuals. Dog allergens are present in pet dander, saliva, and urine, and can be spread throughout the home on surfaces and in the air. It is important to note that no dog breed is completely hypoallergenic, although some breeds may produce fewer allergens than others.
If you have a dog allergy and eczema, consider the following steps to reduce your exposure to allergens:
Bath and groom your dog regularly to reduce dander and hair shedding.
Vacuum your home frequently using a vacuum cleaner with a HEPA filter.
Keep your dog out of your bedroom and off upholstered furniture.
Wash your hands after handling your pet and avoid touching your face.
If possible, have a non-allergic family member take care of the pet's grooming and cleaning tasks.
Like dogs, cats can also trigger eczema flare-ups in some individuals due to allergens found in their dander, saliva, and urine. Cat allergens tend to be smaller and more potent than dog allergens, and can remain airborne for longer periods of time.
If you have a cat allergy and eczema, consider the following steps to reduce your exposure to allergens:
Choose a cat breed that produces fewer allergens, if possible.
Bathe and groom your cat regularly (if tolerated by the cat) to reduce dander and hair shedding.
Vacuum your home frequently using a vacuum cleaner with a HEPA filter.
Keep your cat out of your bedroom and off upholstered furniture.
Wash your hands after handling your pet and avoid touching your face.
If possible, have a non-allergic family member take care of the pet's grooming and cleaning tasks.
Certain clothing materials can irritate the skin and contribute to eczema flare-ups. Synthetic fabrics like polyester, nylon, and rayon can cause friction and trap moisture against the skin, leading to irritation.
Opt for natural, breathable fabrics like cotton, bamboo, and silk, which are gentler on the skin and help regulate body temperature.
Traditional wool has larger diameter fibers that can irritate the skin, making it itchy. Modern super or ultra-fine merino wool can provide a smoother alternative.
Bacterial, viral, and fungal infections can exacerbate eczema by causing skin inflammation and compromising the skin barrier. Practice good hygiene by washing your hands regularly, avoiding close contact with sick individuals, and keeping any cuts or abrasions clean and covered to reduce the risk of infection.
Moderate sun exposure can be beneficial for eczema, as UV rays have anti-inflammatory properties that can help reduce symptoms. Ultraviolet (UV) light can be beneficial for the skin barrier boosting Vitamin D production in the skin, an essential component of immune function.(VAH 2008) Atopic eczema has been linked to lower vitamin D levels and specific genes which are involved in the vitamin D pathways.(WAN 2014)
However, overexposure to the sun can lead to sunburn, skin damage, and a worsening of symptoms, so it's essential to balance sun exposure with sun protection.
Aim for 10-15 minutes of sun exposure daily, preferably during the early morning or late afternoon when the sun's rays are less intense. Always wear sunscreen and protective clothing when spending extended periods outdoors.
Since eczema triggers vary from person to person, it's important to identify and avoid the specific environmental factors that worsen your symptoms.
Look for general trends: Changes in seasons or life circumstances, as well as alterations in your choice of soaps or other personal care products, can provide clues about potential triggers.
Listen to your body: Pay attention to how your skin reacts in different environments or situations.
Track your skin condition and potential triggers: Recording flare-ups and possible environmental factors can help you uncover your specific triggers. See the our tracking page for tips.
A strong skin barrier is your first line of defense against the environment. Unfortunately, in eczema sufferers, their skin barrier is naturally weak. Luckily there are solutions to supplement your skin barrier. Take a look at our moisturizer page for details.
Minimize your exposure to irritants by making changes to your home environment, such as using allergy-proof bedding, opting for natural cleaning products, and maintaining optimal humidity levels. Additionally, wear non-irritating clothing and use gentle, fragrance-free skincare products.
See the trigger avoidance page to learn about mitigating these triggers and improving the skin symptoms and improved quality of life.
If you're struggling to manage your eczema, consult with a health practitioner for personalized advice and treatment options. They can help identify specific triggers and develop a tailored treatment plan to address your unique needs.
Eczema is a complex condition influenced by a combination of genetic and environmental factors. By understanding and managing common environmental triggers, such as chemicals, temperature, humidity, smoke, pollution, pet allergens, and other irritants, you can help reduce flare-ups and maintain healthier skin.
Living with eczema can be challenging, but by taking a proactive approach to managing your triggers and maintaining a healthy skin barrier, you can improve your overall quality of life. Stay informed about the latest eczema research and treatment options, and work closely with your dermatologist or allergist to develop a personalized management plan.
We understand that each person's experience with eczema is unique, and we would love to hear about your personal journey. Please share your experiences, tips, and insights in the comments section below. By learning from one another, we can build a supportive community and help others navigate the challenges of living with eczema.
Learn how to identify the different types of eczema
Discover the treatments that work for the eczema type
There are three pillars to healthy skin: a functional skin barrier, calm immune system and a safe environment. If any one of these pillars is disrupted, this can lead to inflamed skin, known as dermatitis or eczema.
There are different types of eczema but they are all characterized by areas of inflamed, itchy and dry skin. The different types of eczema can have different triggers and underlying issues with skin barrier strength and immune reaction. Identifying which type of eczema is present can help determine the best course of action to heal quickly and to prevent new flares.
This article steps through the different types of eczema, exploring the typical symptoms and triggers.
Atopic dermatitis eczema, also known simply as atopic eczema (and often what people refer to as "eczema"), is the most common form of eczema, affecting around 10-20% of children and 1-3% of adults worldwide. This chronic inflammatory skin condition is characterized by periods of flare-ups and remissions, and is often associated with other atopic conditions like asthma and hay fever.(CHA 2006)
The symptoms of atopic dermatitis can vary greatly from one individual to another, and may also change over time. Mild symptoms include small patches of dry, itchy and cracked skin. In moderate to severe symptoms, the skin can become inflamed and subsequently change color. For more, check out our article on the symptoms of eczema.
With the skin inflamed, it is even easier for triggers to pass through the barrier and perpetuate the flare. We cover more details on the lifecycle of a flare is our article on the stages of a flare.
Atopic dermatitis patients typically have a genetic predisposition for a weakened skin barrier, and as a result they are more susceptible to triggers.(BRO 2017) A deficiency in long chain ceramides is gerenally part of the weakened skin barrier of those with atopic eczema. The weakened skin barrier and increased inflammation tends to lead to drier skin and an imbalanced microbiome.(JAN 2012)
Atopic eczema tends to form on certain parts of the body that undergo a lot of movement or have thinner skin, including, but not limited to, the knee and elbow creases and around the neck and ankles. Atopic eczema will often appear symmetrically on the body i.e. if one hand is affected, it is likely that the other hand will also be affected. These areas can be dry and itchy and the symptoms can be significantly worse after exposure to the individual’s triggers.
In severe cases, the eczema can spread across the whole body and cause extreme discomfort. In babies, it often forms on the neck and scalp, the nappy region is normally unaffected.(CHA 2006)
For a comprehensive overview of the treatment options for atopic dermatitis eczema, please visit our article on treatment.
Contact eczema, also known as contact dermatitis. This is a type of eczema that occurs when the skin comes into contact with certain substances that cause irritation or trigger an allergic reaction.
It was estimated that contact eczema affects around 15-20% of the population at some point in their lives, making it a relatively common skin condition.
Irritants cause physical damage to the skin. When in contact, there is no response from the immune system. Examples of irritants are: soaps, detergents, solvents and acid/alkaline solutions.
Symptoms can range from mild dryness to severe cracked and inflamed skin. It is most commonly found on the hands since the hands come into contact with more substances more regularly.
Allergic contact eczema is less common than the irritant form. The immune system reacts to the skin coming into contact with specific allergens.
Even small amounts of the allergen can cause a severe reaction with red itchy inflammation, dry skin, hives and blistering. Mild cases can appear with scaling of the skin and mild redness.
Both types of contact eczema result in redness and inflammation of the skin followed by dryness with itchiness throughout. The inflammation can affect the skin color where lighter skin can appear more red and darker skin can appear darker, more purple or grey.(NHS)
In some cases, little raised red lumps can appear in the affected site or the skin can thicken. The triggers and appearance of contact eczema can be similar to atopic dermatitis however, there are differing characteristics.
Contact eczema primarily affects only the area of skin which has come into contact with the trigger. Allergic contact eczema can spread beyond this area but it may not be symmetrical, like atopic eczema often is.(CHA 2006)
The primary goal of contact eczema treatment is to identify and avoid the irritant or allergen causing the reaction. In addition, various topical and oral medications may be prescribed to reduce inflammation and relieve itching.
“Seborrheic” means greasy or oily, and this type of eczema generally forms in regions of skin with high natural grease (sebum) production. A fairly common type of eczema with around 50% of the population having a non-inflammatory form of Seborrheic eczema. Generally, this type of eczema is mild and rarely leads to serious complications.(WHO 2017)
In children, it primarily affect the scalps and creases. For babies, this is also called “cradle cap”, where the head crusts up with yellow greasy scales. It can develop around the nose, forehead, eyebrows, behind the ears in nappy areas and armpits. In these areas, it appears as red, inflamed and glistening, and sometimes oozing dries into crusting.
In adults, the condition can affect any age and gender however it is most common in men and in young to middle-aged adults. It can start as dandruff on the scalp before spreading to the face and neck. Commonly affected areas are: forehead, ears, eyebrows, eyelids and folds alongside the nose. Here, the skin appears yellowed with small flakes of skin and occasional crusting. Other areas which can be affected include the back, armpits, groin or under breasts.
The exact cause of seborrheic eczema is not well understood, but it is believed to involve a combination of genetic and environmental factors.
A common contributing factor is an overgrowth of the yeast Malassezia, which is naturally present on the skin but can cause inflammation in susceptible individuals. Other risk factors include stress, cold weather, and certain medical conditions, such as HIV and Parkinson's disease.
Treatment for seborrheic eczema focuses on managing symptoms and controlling the growth of Malassezia yeast. This may involve the use of medicated shampoos, topical antifungal creams, and corticosteroids to reduce inflammation and itching.(CHA 2006)
It is important to work with a healthcare professional to develop an individualized treatment plan.
Nummular eczema, also known as discoid eczema, is a less common form of eczema characterized by round or oval-shaped patches of irritated skin. This condition affects both men and women, with a higher prevalence in middle-aged and older adults.
The exact prevalence of nummular eczema is unclear, but it was estimated to account for approximately 2% of all eczema cases.
The main symptoms of discoid eczema are disk-like patches around an inch in diameter (25 mm). The patches are itchy, red and bumpy and most commonly found on the legs and arms.
In severe cases, the skin can become very inflamed with oozing and crusting.(NHS) As the problematic area heals, the skin dries over and become scaly.
While the exact cause of nummular eczema remains unknown, it is thought to be triggered by a combination of genetic and environmental factors.
Common risk factors include dry skin, skin injuries, and exposure to irritants. Individuals with a history of atopic conditions may also be at an increased risk of developing nummular eczema.
Treatment is similar to atopic eczema but the trigger of discoid eczema is unclear.(MCW 2022) The patches might clean completely only to return time and time again.(CHA 2006) Therefore treatment for nummular eczema is focused on managing symptoms and preventing flare-ups. This may involve the use of topical corticosteroids, moisturizers, and antihistamines.
In more severe cases, healthcare professionals may prescribe oral medications or other therapies.
Dyshidrotic eczema, also known as pompholyx eczema, is a type of eczema that is characterised by clear-fluid blisters on the hands and/or feet.(NHS) This relatively rare condition accounts for approximately 5-20% of all hand dermatitis cases and affects both men and women, with a higher prevalence in individuals aged 20-40 years.
For most affected (80%), the eczema forms on their hands and not on their feet.
The characteristic symptoms of dyshidrotic eczema include small, fluid-filled blisters that can be intensely itchy and painful. Their size can range from a few mm to a few cm and are often densely packed.
The affected skin is extremely itchy. The blisters can take 2 to 3 weeks to clear where the skin will appear red, scaly and often cracked.
The symptoms can return within a few weeks or months and this can repeat for months or years.(CHA 2006)
The cause is not often known, but atopic dermatitis, exposure to contact allergens and/or irritants, hyperhidrosis, smoking, exposure to ultraviolet light, and intravenous immunoglobulin use or mycosis (disease from fungal infection) can be considered as suspects for its occurrence.(SAR 2020)(NHS) Some cases seem to be spontaneous with no apparent trigger.(GUI 2017)
Treatment for dyshidrotic eczema focuses on managing symptoms and preventing flare-ups. This may include the use of topical corticosteroids, cold compresses, and antihistamines.
In more severe cases, healthcare professionals may prescribe oral medications or other therapies.
Asteatotic eczema is also known as “eczema craquelé” or “winter eczema”, It is a type of eczema that primarily affects older adults, particularly those over the age of 60.
This condition is characterized by dry, cracked, and scaly skin, and is more common during the winter months when the air is drier.
The affected skin is rough, scaly, reddish, sore and itchy. The scales form a criss-cross pattern, similar to a dried river bed. Commonly affected areas include: thighs, arms, stomach and back. It’s uncommon to have blistering with this type of eczema. Symptoms can last for weeks to months.(SPE 2022)
Asteatotic eczema is primarily caused by a reduction in the skin's natural oils, leading to increased water loss and dryness. This can be exacerbated by factors such as low humidity, harsh soaps, and frequent bathing.
The primary goal of asteatotic eczema treatment is to restore and maintain the skin's moisture levels. This may involve the use of gentle cleansers, moisturizers, and topical corticosteroids to reduce inflammation and itching.
Life-style changes can improve the skin health and it often responds well to milk-treatment.(CHA 2006) It is important to work with a healthcare professional to develop an individualized treatment plan.
Gravitational eczema is also known as “stasis” or “varicose eczema”. This condition is the result of fluid building up in the legs and subsequently affects the skin of the lower legs. The veins are essential for pumping blood back up to the heart.
If this system is not working properly, perhaps due to age, blood clots or being overweight, the pressure can cause fluid to collect in the skin.
Ankle may swell, and skin can weep or ooze. The skin looks shiny, discoloured and itchy and eventually can become leathery and thickened. On lighter skin, it can appear red whereas darker skins can appear darker or more purple or grey.(NHS)
Blotches of brown can indicate that blood has also leaked into the skin and this is often found on the inside of the ankles. This condition can spread up the legs if it is not controlled.
The symptoms will persist until the cause of the increased pressure is released.(CHA 2006)
Gravitational eczema is primarily caused by poor blood flow and increased pressure in the veins of the lower legs. This leads to fluid leakage into the surrounding tissues, resulting in inflammation and eczema.
Risk factors for gravitational eczema include obesity, sedentary lifestyle, and a history of circulatory problems.
Treatment for gravitational eczema aims to improve circulation in the affected areas and manage the symptoms of eczema. This may involve the use of compression stockings, elevation of the legs, and topical corticosteroids to reduce inflammation and itching.
In some cases, additional treatments may be required to address the underlying circulatory issues.
Once you have identified which type of eczema you have, it is possible to identify your personal triggers and learn what is necessary to help your skin heal. For more information about potential triggers, see the triggers page. To learn how your lifestyle and subsequently your immune system affect your skin health in the section on immune control. There are various treatments available for eczema, learn more in the treatment section.
Eczema is a chronic skin condition with different stages: acute, subacute, and chronic, each requiring specific treatments.
Long-term eczema management involves understanding unique skin needs, avoiding triggers, maintaining skin barrier, monitoring progress, and staying committed to treatment.
Eczema is a chronic skin condition characterized by periodic acute flares, marked by red, itchy, and inflamed skin. The severity and duration of an acute eczema flare are influenced by three main factors:
In this post, we will explore the various stages of an atopic dermatitis flare, how they are defined, and what treatments may be suitable for each stage.
Atopic eczema, or atopic dermatitis, is a dynamic condition that can evolve through different stages. These stages are defined by the primary mechanisms at play and can be used to tailor treatments to address specific symptoms.
We will discuss the characteristics of acute, subacute, and chronic eczema, including what you can expect and what actions you should consider taking at each stage.
The beginning stages of an eczema flare may be subtle, but early identification is crucial to prevent the condition from progressing further. Signs and symptoms in the early stages of eczema can include:
Dry, flaky skin
Small bumps or papules
Mild itching and redness
These early symptoms can be easily mistaken for other skin conditions or simply dry skin. They typically occur shortly after exposure to a trigger and are indicative of a histamine and Th2 immune response.(BEI 2012)
The first few days of a flare we call the “early flare”. You could think of this as your moment of “sixth sense” where you think a flare might be coming, all the way to where you are starting to think of a doctor’s visit a few days later.
Treatment in the early flare stage should focus on reducing or removing the trigger and calming additional inflammation. A symptom journal can help identify the trigger. Treatment options to consider in the early flare stage include:
Antihistamines to reduce itching and swelling
Trigger avoidance and management
Dietary adjustments diet and nutrition
Topical steroids to reduce inflammation, prescription strengths may be used in more severe cases
In the mid-flare stage, if triggers have been removed (which may be hard to do), the flare is now being driven largely by skin barrier “weakness” and the immune system itself.
All of the above treatment options still apply. Consider adding the following in the mid flare stage:
Phototherapy - specifically UV-A1 (BEI 2012)
Topical calcineurin (TC) inhibitors for control
The subacute stage, also known as the "healing stage," occurs as the skin begins to heal. Symptoms in this stage include itching, dryness, scaliness, thickening of the skin, and cracking or weeping. The skin is less red and inflamed compared to the acute stage but may still experience occasional flares meaning the healing is not necessarily linear.
Treatment during the subacute stage focuses on moisturizing dry skin and facilitating the healing of the skin barrier. This can be achieved through:
Continued use of moisturizers
Topical steroids, potentially weaning off their use
Maintenance phase of TC inhibitors
Soothing baths, wet wraps, washing and other symptom management
Trigger avoidance and lifestyle adjustments
Continued use of antihistamines
Escalations in treatment to more systemic immunomodulatory medication may be considered for severe and enduring cases. See the ‘medical treatments’ in the immune control part of treatments and discuss this with your doctors if you think this is applicable for you.
If a flare persists for an extended period of time, it can enter the chronic stage where a feedback loop occurs and the flare persists. Symptoms include thickened, scaly skin, discoloration, and persistent itching and dryness. This stage takes months to establish and can be caused by ongoing triggers, genetic susceptibility, or constant scratching.
Chronic eczema requires a different treatment approach to acute and subacute eczema, focusing on identifying the changes necessary to break the cycle of symptoms while maintaining daily skin care. Chronic eczema can lead to a heightened Th1 immune response, with a delayed hypersensitivity.(BEI 2012) Treatment should involve:
Review of trigger avoidance with careful investigation into stress, outstanding lifestyle changes, environment, allergies and intolerances and food
Support healthy gut through proportionate review of diet and nutrition
Consistent moisturizing
Increased potency topical steroids
Continued use of TC inhibitors
Microbiome support
Phototherapy, ideally NB UV-B
For moderate and severe cases which do not respond to first-line treatments, escalating to systemic immunomodulatory medication will be necessary. The objective is to interrupt the inflammatory processes which are preventing the skin from healing. Some options include:
In certain circumstances, oral steroids
Healing from an eczema flare is a journey that progresses through various stages. As you move through your treatment plan, you'll notice a reduction in eczema symptoms and eventually, a decline in their frequency. It is important to remember that triggers and skin barrier weakness may continue to cause symptoms or flare-ups over time. Healing is rarely linear so there you may experience two steps forward, one step back and so on.
As you progress through the healing stages, you'll notice the following changes:
Inflammation subsides and heat reduces
Dryness can increase briefly following a period of inflammation
Dryness diminishes as the skin repairs itself
Itchiness calms down
Thickened skin lightens and loosens
Discoloration can lessen
Throughout the healing process, it's crucial to address the symptoms present at each stage. Once your skin has healed, you may find that it becomes more resilient to triggers, allowing you to reintroduce certain foods or activities into your lifestyle without causing a flare-up. For example, if a leaky gut had led to certain foods triggering your eczema. Once the gut has healed, the triggering foods may not be so problematic any more.
The above walked you through an eczema flare in stages. However, for most people eczema is a lifelong balancing act between their environment, their skin barrier strength, and their immune system function.
The best flare management is avoiding a flare all together. After your flare subsides, think about how to avoid triggers, build a stronger skin barrier, and keep a balanced immune system by:
Understanding your skin's unique needs and characteristics
Identifying and avoiding triggers that exacerbate your eczema
Find suitable moisturizers to build your skin barrier
Monitor your progress and adjust your treatment plan as needed tracking
Be patient and stay committed to managing your eczema in the long term
We encourage you to explore our website to learn more about eczema and find the resources and support needed to manage this complex skin condition effectively.
Remember, you are not alone in this battle, and there is help available to guide you every step of the way.
Share your experiences with us! Tell us what has and hasn’t worked for you. What did we miss in this article that you've found personally impactful? Your insights can help others better understand and manage their eczema.
Exercise can reduce eczema symptoms by decreasing inflammation and stress.
To exercise comfortably with eczema, stay hydrated, apply moisturizer, wear breathable clothes, and avoid allergens.
Eczema can have a debilitating impact on every aspect of an individual’s life. Everyday activities, including exercise, can become uncomfortable or even aggravate eczema symptoms. Despite these challenges, exercise plays a crucial role for both physical and mental health: boosting the immune system, reducing inflammation, and elevating mood. It is important to continue to exercise even when suffering from eczema.
This article will explore the relationship between eczema and exercise, discussing the benefits, considerations, and best practices to incorporate exercise into your eczema management plan.
Regular exercise offers numerous health benefits including:
These benefits are especially valuable for individuals with eczema, as stress and mental health challenges can aggravate the condition.
Exercise has been shown to reduce the anxiety, depression, and social withdrawal, common in those with eczema, by increasing blood circulation to the brain, improving self-efficacy, encouraging social interaction, and providing a healthy distraction
As a result, exercise can be an effective way to mitigate the mental health effects of living with eczema.(SHA 2018)(BOR 2021)
Moreover, research has demonstrated that exercise can attenuate Th2-mediated inflammatory responses, which are often elevated in individuals with eczema.(SIL 2015) By reducing Th2 responses, exercise can potentially decrease sensitivity to allergens.
Exercise intensity is also a factor: moderate exercise has been linked to reduced cortisol levels (a stress marker), while high-intensity exercise can initially increase cortisol levels but eventually lead to overall stress reduction.(HIL 2008)(BOR 2021) If stress is impacting your eczema, moderate exercise can be used to reduce stress-levels immediately and high-intensity exercise can improve one’s resilience to stressful situations over the long-run.
Furthermore, exercise has been reported to reduce specific IgE counts for individuals with dietary allergies. A reduction in IgE levels could lower a person’s sensitivity to an allergen.
However, it is essential to note that IgE levels for environmental allergens might increase after exercise due to increased ventilation and exposure.(ALD 2010) Therefore, efforts should be made to minimize exposure to allergens during physical activity.
As discussed in the Stress and Mental Health section, there are significant mental health implications from living with eczema. Exercise increases blood circulation to the brain, improves self-efficacy, encourages social interaction and provides a healthy distraction.
Consequently, exercise has also been shown to reduce anxiety, depression and social withdrawal and therefore, exercise can be used to boost mental wellbeing and combat the mental side effects of eczema.(SHA 2018)
In the Allergy Test section, the concept of an imbalanced immune response is highlighted as a marker for allergic conditions. Exercise has been shown to attenuate Th2-mediated inflammatory responses and therefore reduce the severity of allergy experienced by an individual.(SIL 2015)
The intensity of exercise is important: moderate intensity exercise has been shown to reduce cortisol, the marker for stress, whereas high intensity exercise increases cortisol levels.(HIL 2008)
An individual's allergies can also play a part in how beneficial exercise is: those with dietary allergies can expect a reduction in the IgE count following exercise (see Allergy Tests section to learn more about IgE), by as much as 50%. This could suggest a reduction in allergy severity. On the other hand, an individual with airborne allergens, such as dust or pollen, can expect an increase in IgE following exercise.
This could be due to increased ventilation increasing the exposure and therefore efforts should be made to avoid exercising in the presence of known allergens.(ALD 2010)
While exercise offers numerous benefits, it can also cause discomfort and complications for those with eczema. It's vital to understand one's limits and develop a personalized approach to exercise to maximize the physical and mental health benefits it can provide.
Below are some tips for making your favorite activity more comfortable, and some suggestions on new activities to try.
Here are some considerations when exercising with eczema:
The suitability of various sports and exercises for individuals with eczema can vary. Here are some examples and their typical pros and cons:
Sport |
Pros |
Cons |
Walking |
Accessible Sociable Minimal equipment required Can walk in nature |
Could increase exposure to environmental triggers |
Jogging/running |
Accessible Sociable Minimal equipment required Can run in nature |
Could increase exposure to environmental triggers Higher intensities increase cortisol in the short-term Sweating could irritate skin |
Cycling |
Accessible Sociable Can cycle in nature |
Wind can be drying Could increase exposure to environmental triggers Sweating could irritate skin |
Swimming |
Water can be cooling on skin Sociable Can swim in nature |
Drying of skin Chemicals in water can irritate skin |
High intensity interval training |
Improve resilience to stress Time efficient |
Increases cortisol in the short-term |
Weightlifting/gym |
Controlled environment (temperature and air quality) Can be less sweaty Sociable |
Could be costly |
Yoga |
Accessible Sociable Focus on mind-body connection |
|
Indoor court sports |
Sociable Controlled environment (temperature and air quality) |
Can be sweaty |
Outdoor team sports |
Sociable |
Can be sweaty Exposure to environmental triggers Mud and dirt increase infection risk |
To effectively incorporate exercise into an eczema management plan, it is essential to:
Try some of the tips and best practices discussed earlier and share your tips and experiences for exercising with eczema below!
Seek guidance from healthcare professionals as needed to ensure a safe and effective exercise regimen.
Ultimately, exercise can help to alleviate some of the burden of living with eczema and contribute to a more balanced, healthier life. By understanding the relationship between eczema and exercise, recognizing potential complications, and following best practices, individuals with eczema can experience improved physical and mental health.
Please share what has worked and hasn’t worked for you. We are in this together and together we are stronger.
Distinguishing skin infections from eczema symptoms can be challenging and misdiagnosis can delay healing.
Elevated levels of S. aureus on the skin are common in eczema sufferers but do not necessarily indicate infection.
Eczema is a common skin condition that affects people of all ages. Manifesting as patches of dry, itchy, and inflamed skin, eczema can significantly impact a person's quality of life.
Skin infections can be a significant concern for those who suffer from eczema as they are more common for individuals with eczema and they can make eczema symptoms worse. (Mind)(BYR 2018)
Additionally, they can sometimes be hard to distinguish from some standard eczema symptoms and treating eczematous skin for infections when there is none present can be costly and even slow the healing process.
In this article, we will discuss the symptoms of skin infections, their impact on eczema, and how to prevent and treat them to help you better manage your eczema symptoms.
Before we delve deeper into the specifics of eczema infections, it is vital to understand the critical role that your skin's microbiome plays in maintaining your skin health.
The skin microbiome refers to the community of microorganisms, including bacteria, fungi, and viruses, that reside on the surface of our skin.(SEN 2016) This might sound alarming, but the presence of these microorganisms is entirely normal and, in fact, beneficial for our skin health.
The key functions of a healthy skin microbiome include:
Infection resistance
Skin barrier strength
Modulation of immune responses
Promotion of skin homeostasis
Wound healing
We dive deep into how the microbiome helps those with eczema heal their flares here. Suffice to say though, given the above list, keeping the microbiome healthy is important to those with eczema.
An infection occurs when “pathogenic” microorganisms overwhelm the skin’s native microbiome and invade the body's tissues causing damage to the cells of the body.(ALY 1996)
While people with eczema often have elevated levels of S. aureus on their skin, and their flares will have even higher levels of S. aureus, it is not an infection simply by being elevated.(LUS 2021)
Below we give you some tools for identifying if you have an infection and some tips on what you can do about it.
It is important to always follow your doctor’s advice.
When an infection takes hold in an area of skin affected by eczema, the symptoms can be quite noticeable. The skin might become more red and swollen than usual, and it may feel warm or hot to the touch.
You may also notice pus-filled blisters or a yellowish crust forming on the skin's surface. Infected skin can also be very tender or painful, and you may experience a fever or flu-like symptoms.
In general, the symptoms of a skin infection include:
Hot, red, and sore skin
Weepy/yellowish crust
Puss
Swollen skin
Folliculitis (red, pus-filled dots around hair follicles)
Tender, swollen glands in the neck, groin, and/or armpits
While eczema can cause symptoms such as redness, dryness, and itching, an infection generally exacerbates these symptoms and introduces new ones. Non-infected eczema won't typically cause fever or flu-like symptoms, and it's less likely to result in extreme redness, warmth, or tenderness of the skin.
Eczema infections refer to the occurrence of a secondary infection—bacterial, viral, or fungal—in the skin already affected by eczema. Eczematous skin has a weakened skin barrier, leaving it more vulnerable to infection. Scratching and certain treatments, such as topical steroids, can further weaken the skin.
Eczema does not make individuals more susceptible to infections with resistant strains of bacteria.(HUA 2009)
General symptoms of infected eczema include a new itch, warmth, fever, be painful to touch, increased scaling, fluid in the area, and swelling.
If you notice your eczema symptoms worsening dramatically, or if you start experiencing fever, fatigue, or increased pain in your skin, these could be signs of an infection. If you suspect an infection, it's crucial to seek medical help immediately to prevent the infection from spreading or worsening your eczema.
It is generally better to err on the side of caution when it comes to infections, as untreated skin infections can lead to more serious complications.
Infected weeping eczema, also known as wet or vesicular eczema, is a type of eczema infection where the skin becomes moist and oozes fluid. This usually happens when bacteria infect an area of skin affected by eczema.
The weeping, combined with the itchiness of eczema, can make this type of infection particularly uncomfortable. Moreover, the fluid can spread bacteria to other areas of the skin, leading to further infections.
Infections can significantly worsen the symptoms of eczema, making management of the condition more challenging. They can intensify itching and inflammation, leading to increased discomfort and distress. The presence of an infection can also trigger a more severe eczema flare-up.
Moreover, infections can disrupt the skin's barrier function even further, making the skin more susceptible to future infections and causing a vicious cycle of eczema flare-ups and infections.
To prevent infected eczema, prioritize avoiding contamination, proper washing techniques, and maintaining a healthy immune system. Supporting a robust skin barrier is also crucial.
Maintaining cleanliness is crucial in managing eczema, but it is equally important to do it right. Regular washing, even during severe eczema flare-ups, can help remove irritants and allergens that may trigger symptoms. However, it's essential to use gentle, non-irritating soaps to preserve the skin's natural acidity and prevent further damage.
For an in-depth understanding of the best practices for washing with eczema, refer to our dedicated article on washing when you have eczema. This resource provides comprehensive guidelines to help you maintain skin cleanliness without exacerbating your eczema symptoms.
Eczema is intrinsically linked to a higher risk of skin infections due to several reasons. The impaired skin barrier function, a characteristic of eczema, allows easier penetration by pathogens.
The constant itching and scratching associated with eczema can also lead to open sores, providing an entry point for bacteria, fungi, and viruses.
We offer some tips to avoid scratching in our non-medical treatments article.
A healthy skin microbiome and a robust skin barrier are critical in managing eczema and preventing infections. Achieving this requires a diligent skincare routine that supports a healthy microbiome, including the use of fresh, high-quality skincare products. Out-of-date products can harbor harmful bacteria that disrupt the skin's natural balance.
Furthermore, consider using products that restore long chain ceramides, which are often lacking in individuals with eczema. These substances play a key role in maintaining the skin's barrier function.
For a comprehensive guide on how to select and use moisturizers to support a healthy skin barrier, refer to our detailed moisturizers for eczema article.
Supporting your immune system is essential in managing eczema and preventing infections. A balanced, nutritious diet is a cornerstone of a strong immune system. Check out our comprehensive article on diet and nutrition to learn more about the best foods for boosting immunity in the context of eczema.
Stress can also negatively impact your immune system, making stress management techniques crucial. To understand how to manage stress effectively, refer to our insightful article on mental health.
Additionally, regular exercise can promote a healthy immune system and overall wellbeing. While exercising with eczema can present unique challenges, our dedicated article on exercising with eczema offers useful tips to help you maintain an active lifestyle while managing your skin condition.
When dealing with infected eczema, seeking professional medical advice is paramount. If you suspect an infection, consult with your healthcare provider promptly.
Ensure you follow their prescribed treatment plan meticulously, taking all medications as scheduled. It is important to clean the infected area thoroughly yet gently, to remove any potential irritants or pathogens.
After cleaning, keep the area dry and consider using a protective dressing to prevent further irritation or infection. Your healthcare provider will guide you through this process to ensure the best outcome.
Dealing with skin infections and eczema symptoms involves recognizing the symptoms of infection, understanding the impact on eczema, and learning how to prevent and treat infections. By following the advice and techniques outlined in this article, you can manage your eczema more effectively. For more information on related topics, explore articles on visiting doctors, washing techniques, and using topical steroids.
While eczema can be a difficult condition to live with, remember that you're not alone, and help is available. Never hesitate to seek medical advice if you're experiencing concerning symptoms or if your eczema becomes difficult to manage. With the right knowledge, support, and treatment, you can effectively manage eczema and maintain healthy skin.
Share your experiences with us! Tell us what has and hasn’t worked for you. What did we miss in this article that you've found personally impactful? Your insights can help others better understand and manage their eczema.
Antihistamines, often used for their anti-inflammatory purpose, are useful when the body overproduces histamines or their breakdown is faulty.
Histamines can be controlled through medication or diet. Success will vary based on the local environment, stage of eczema, and individual characteristics.
Eczema is a chronic skin condition that affects millions of people worldwide. Eczema flares have symptoms like itchiness, redness, and inflammation.
Antihistamines are among the many available tools that can help with the symptoms of eczema.(THA 2018)
Success with any one tool can vary by person, making sorting through all the options a challenge.
To accelerate finding the right treatment for you, this article aims to provide a comprehensive overview of antihistamines, explaining what they are, how they work, their different types, usage, benefits, and potential side effects.
Histamines are crucial compounds produced by the body that serve various functions, including:
Initiating an immune response
Neurotransmission including alertness, and possibly memory processing
Regulating stomach acid levels
When immune cells in your body identify a foreign invader they are sensitive to, they release histamine. Histamine then dilates nearby blood vessels and lowers blood pressure, allowing more white blood cells and specific proteins to enter the area and attack the foreign invader, promoting healing.
As a result, the affected area becomes inflamed—red, hot, swollen, and itchy.
When this inflammation occurs in the nasal area, it leads to the three classic allergy symptoms:
Both a runny nose and swelling in the nasal tissue (congestion) are considered "on-target" effects because they facilitate the entry of white blood cells into the area to combat the detected foreign invader.
There are several reasons why someone might want to use antihistamines for their main, anti-inflammatory purpose:
Antihistamines are medications specifically formulated to counteract the effects of histamine. They function by blocking histamine receptors on target cells, thereby reducing the body's reaction to histamine release.
Antihistamines are available in various forms, including oral and topical treatments, and can be acquired either over the counter or with a prescription.
There are four known histamine receptors in the body that can be targeted to block histamine activity: H1, H2, H3, and H4. Currently, only experimental medications do target H2 and H4 receptors and H3 receptors are typically used in treating brain disorders.
The majority of familiar antihistamines work through the H1 pathway to block histamine action. H1-antihistamines can be applied topically (to the skin, nose, or eyes) or administered orally (systemically), depending on the specific condition being treated.
First-generation H1 antihistamines have the ability to cross the blood-brain barrier, which often results in drowsiness.(NHS)
Some common examples of these include:
Brompheniramine (Dimetapp, Dimetane)
Chlorpheniramine (Chlor-Trimeton)
Dimenhydrinate (Dramamine, Gravol) – a combination of diphenhydramine and 8-chlorotheophylline
Diphenhydramine (Benadryl)
Doxylamine (Unisom)
Interestingly, the originally off-target effect of drowsiness has now become a primary use for these medications, with many sleep aids incorporating one of these drugs. There are questions around the quality of sleep that is gained from use of these drugs however.(WOL 2016)
For managing allergic conditions and atopic dermatitis, second-generation antihistamines are preferred.(RAN 2018)
The newer class of second-generation H1 antihistamines does not easily penetrate the blood-brain barrier, making them less likely to cause sedation. However, individual reactions, concomitant medications, and dosage may still increase the likelihood of experiencing sedative effects.
Examples of second-generation drugs include:
Cetirizine (Zyrtec)
Fexofenadine (Allegra)
Levocetirizine (Xyzal)
Loratadine (Alavert, Claritin)
Oral antihistamines, available in pill or liquid form, are absorbed into the bloodstream and provide systemic relief for symptoms throughout the body. Generally, they can be purchased over the counter or obtained with a prescription, and come in various formulations, such as first- and second-generation antihistamines. The latter usually cause less drowsiness and have fewer side effects.
Topical antihistamines are applied directly to the affected skin areas in the form of creams or ointments. They offer localized relief for itching and inflammation.
If the side effects of oral antihistamines are not tolerable, topical antihistamines might be a more suitable option. Topical antihistamines can also be used in conjunction with oral antihistamines if there is a specific inflamed skin area that oral antihistamines do not adequately address.
Many foods contain histamines or chemically similar molecules, which can trigger reactions when consumed in large enough quantities.(FIS 2012) Increasing evidence suggests that low-histamine diets can help reduce eczema symptoms, though there is still some debate about what constitutes a low-histamine diet.(COM 2020)(SAN 2021)
Histamine is primarily broken down by two enzymes: diamine oxidase (DAO) and histamine-N-methyltransferase (HNMT).
The small intestine naturally expresses DAO to protect us (the DAO produced by the small intestine also helps break down our body's own histamine production).
Individuals with naturally low DAO expression may be more susceptible to stronger reactions from a diet high in histamines.
Fermented foods and beverages naturally contain small amounts of histamine due to similar conversions performed by fermenting bacteria or yeasts. For instance, sake contains histamine in the 20–40 mg/L range, while wine may have 2–10 mg/L.
Certain fruits and vegetables, such as eggplants, spinach, and citrus fruits, can also be high in histamine.(SAN 2021)
Consuming amine-rich foods, alcohol, nicotine, and certain heavy metals can further inhibit the body's ability to detoxify histamines.(FIS 2012)(COM 2020)
Some bacteria are capable of producing histamine while in the gut. Be mindful of whether any probiotics you are taking contain histamine-producing strains and consult with a doctor for proper guidance.
When considering a low-histamine diet, it is crucial to maintain a balanced diet.
Instead of merely excluding specific ingredients, replace them with lower-histamine alternatives that provide similar nutritional content.
Before starting a low-histamine diet, consult a healthcare provider or a registered dietitian to ensure your nutritional needs are met.
When using antihistamines, it is essential to be aware of the precautions, risks, and potential side effects.
Drowsiness: Some antihistamines, especially first-generation ones, can cause drowsiness. Use caution when driving or operating machinery.(NHS)
Dry mouth, nose, or throat: Antihistamines may cause dryness, which can be relieved with sugar-free candy or gum, ice chips, or drinking water.
Drug interactions: Antihistamines may interact with other medications, so inform your healthcare provider about all the medicines you're taking.
For children, pregnant or breastfeeding women, and older adults, it's important to consult a healthcare provider before using antihistamines, as specific formulations may be more appropriate or safer for these populations.
Antihistamines show potential in treating certain eczema symptoms. Our review of the latest research has identified several areas where antihistamines may be beneficial.
We delve into more detail below, providing the information you need to develop the right plan with your doctor.
However, if you're pressed for time, here are our baseline recommendations (always consult with a doctor):
During the early stages of a flare, when you first experience that tingling sensation, consider incorporating fexofenadine (Allegra) into your treatment plan.
As the flare stabilizes, using a low dose of fexofenadine (Allegra) may aid in skin barrier repair.
If hives develop during a flare, or the flare seems to be spreading, consider using fexofenadine (Allegra) if possible.
Histamine is a primary driver of itch during the early stages of an eczema flare.(OET 2017) When the body detects a trigger, histamine is released, activating an itch pathway associated with it. You might experience a "sixth sense" that a flare is imminent; this could be due to the histamine release activating the itch pathway.
However, during the mid- to late-stages of a flare, the majority of itch seems to be driven by a pathway that histamine does not affect.(OET 2017) An overproduction of killer T-cells and the release of interleukin 4 (IL-4) activate a separate itch pathway. Immune modulators may be more effective at alleviating itch during these mid- to late-stages of the flare.(YOS 2019)
In warmer and moist climates like those in South Asia, the mid- and late-stage itch might still be driven by histamine or at least be alleviated by antihistamines.(TAY 2021) Second-generation antihistamines have shown effectiveness in reducing itch and improving sleep in these warmer and wetter climates.(TAY 2021)
However, in temperate climates, as the flare stabilizes, there is little evidence that antihistamines effectively reduce itch.(LEG 2021)
Among second-generation antihistamines, fexofenadine is the preferred choice due to its superior skin penetration.(TAY 2021)
During the mid-stages of a flare, the skin barrier is further weakened due to immune activity.(LEG 2021) The barrier is more porous, even broken, allowing triggers to penetrate more easily and cause new inflammation, including hives.
Focusing on skin barrier repair and trigger removal should be the primary strategies to prevent flare growth. However, antihistamines can help reduce hives and minimize the response to new triggers, offering relief in these situations.
There is evidence suggesting that antihistamines may also contribute to skin repair during the mid- and late-stages of a flare by blocking the H1 receptor.(TAY 2021) Blocking the H1 receptor could promote the production of filaggrin and other skin barrier repair components, helping to rebuild the skin barrier and potentially shortening the duration of a flare.
Living with eczema can be challenging, and we understand the impact it can have on your daily life.
While long-term management of eczema should focus on preventing triggers, strengthening the skin barrier, and managing the overall immune system, antihistamines and an antihistamine diet offer a potentially effective way to manage some eczema symptoms during the early stages of a flare and help control hives and support skin repair during the mid- to late-stages of a flare.
Always consult your healthcare provider before starting or modifying your treatment.
Remember, you're not alone in this journey, and we're here to help. If you need further guidance or support, feel free to reach out to us at any time. Together, we can work towards better control of your eczema and an improved quality of life.
The unpredictability of eczema drives stress, impacting the immune system and exacerbating symptoms.
The interconnection between mental and physical health means that improving mental health can significantly improve eczema symptoms.
The physical symptoms of eczema can vary in severity and can impact on all aspects of an individual’s life. Mild symptoms can be uncomfortable and lead to undesirable changes in the skins appearance.
Severe symptoms can be totally overwhelming, debilitating and extremely distressing to live with. The sufferer’s quality of life is affected and there are significant mental health implications.(NHS)(KIM 2011)(FIS 2012)(DAV 2011)
This page explores how mental health can be affected and how one can mitigate these negative effects.
The physical symptoms of eczema, including dry and scaly skin, inflammation, itchiness, thickened skin, blisters, color changes, and ooze and crusting, can change the way we behave and act. If the symptoms persist long enough, the structure of the brain can change to match our new reality.(BAE 2011)
Dry, thickened, or scaly skin, for instance, can feel rough to touch and be touched.
Itchiness can vary from mildly uncomfortable to totally overwhelming, distracting from daily tasks and draining mental energy. It can result in feeling fidgety and restless and also negatively impact on sleep.
Inflammation can be hot and tender to touch and uncomfortable with high temperatures, affecting the clothes the sufferer wears, how they wash, and their level of discomfort in a warm environment.
Blisters, often occurring on feet and hands, are sensitive and uncomfortable. In severe cases, they can be so large and painful that the sufferer cannot put shoes on or wear certain clothes. It can be problematic getting the blisters wet, which affects what the sufferer can do with the affected regions.
Ooze and crusty skin can get on clothes and bedding, and it feels very uncomfortable and unpleasant. It can affect the clothes worn and increase the frequency of washing the skin and the body.
In essence, eczema symptoms can become all-encompassing, affecting every aspect of life. This includes sleep quality, attentiveness, work productivity, relationships, clothing options, and the ability to comfortably engage in exercise.
All of these factors can take a toll on mental health, reinforcing the need to address both physical and psychological aspects of eczema to break the cycle of distress and improve overall well-being.
There are significant psychological impacts from living with severe eczema and poor skin health. Constant discomfort from dryness, itchiness, inflammation, blistering, sensitive skin and hyper awareness to very negative sensations is exhausting.
Treatments can bring their own side effects: burning skin, wrinkles, slimy skin, rosacea and drowsiness to name a few. Expensive and time consuming treatment can add burden to normal life. These factors can increase stress levels and ultimately contribute towards burnout. (SMI 2022)
Color changes on the skin, dry flakiness and wrinkles all negatively affect how the skin looks and lead to reduced self-worth and social anxiety. Eczema can flare immediately and take a long time to heal. The fear of sometimes unavoidable and invisible triggers results in a fear of causing a flare-up.
Even triggers that can be avoided require near-constant awareness and attention which can lead to an anxiety of missing something. Even the presence of air-borne allergens can increase anxiety levels.(CAS 2018)
Living with eczema can be isolating, painful and overwhelming. It comes as no surprise then that having eczema increases the chances of developing depression and anxiety.(SCH 2020)(YAN 2017)
Depression is a normal reaction to grief which is a normal reaction to loss.(SMI 2022) In the context of eczema, this could be the loss of comfort, freedoms of feeling healthy, relationships and identity.
Typical characteristics include a loss of interest and enjoyment in ordinary things and experiences, feeling flat and unmotivated. An individual is 14% more likely to suffer from depression if they suffer from atopic eczema compared to the average.(SCH 2020)
Anxiety can be a natural response to risks and threats to your daily life (SMI 2022) and an anxious disorder is characterized by excessive fear, anxiousness or avoidance of perceived threats.(WHO 2017)
In the context of eczema, this could be the fear of triggering the symptoms to worsen, skin flaring up or avoidance of social situations due to a fear of what people may say or how they may react to your condition. An individual suffering from atopic eczema is 17% more likely to suffer from an anxiety disorder when compared to the general population.
In more severe cases of eczema, the likelihood of developing an anxious disorder increases to 26%. (SCH 2020)
As discussed in our article on the effects of stress on eczema, anxiety itself can lead to increased itch. (MIS 2018)(GAR 2013) Demotivation from depression can result in the individual struggling to implement their treatment effectively and suffer more as a consequence.
This can lead to a vicious cycle where the eczema symptoms lead to emotional stress, depression and anxiety which result in worse eczema symptoms. Therefore it is critical to look after one’s mental wellbeing to help recover from eczema.
Improving eczema symptoms can result in improved anxiety and depression metrics, as shown by one study where Dupilumab has been shown to boost mental wellbeing and quality of life within 2 weeks of initiating treatment. (COR 2020)
The mind-body connection is strong. Eczema can impact on your mental wellbeing and in return your mental wellbeing can impact on your skin health. Therefore it is important to treat your mental health as seriously as the physical symptoms of eczema.
It’s natural to experience bad feelings, especially when there is a justified reason, such as poor health. Listen to what your feelings are saying and do only what you feel you can do.
Keep talking to your family and friends following the techniques listed on this site and time will help to heal you. Stoic Philosophy can provide grounding as it teaches the development of self-control and fortitude as a means of overcoming destructive emotions, check out this podcast to learn more.(CHA 2021)
Mindfulness is a practice of pausing when we notice unwanted feelings, taking a moment to identify the feeling, and then think on what may have triggered that feeling.(CHA 2021) By identifying your feelings, you can pinpoint the potential stress triggers and work on finding solutions.(MON 2016)
Super simple right? You are stressed out, panicking, and the advice is: just will your way out of it.
We have been there and, no, it is not that simple. And no, we do not expect you to change right away.
But it is possible and we do believe in you.
Like most other things, it is a matter of practice. Meditation can help build your mindfulness muscles so that when you are faced with a crisis, you will have the strength to take a pause and find the trigger.
Similar to dealing with eczema and discussed in our article on the effects of stress on eczema, there are three steps to managing your mental wellbeing: awareness, triggers and treatment. To build self-awareness, take time to check in to how you feel in the present by practicing mindfulness.(MON 2016)
The potential triggers of depression and anxiety in the context of eczema have already been discussed earlier in this page. Take some time to explore how your feelings could indicate what the trigger is.(CHA 2021) This can help to target your treatment.
Mindfulness technique
Take time out - give yourself a moment to collect your thoughts, practice mindfulness and be present
If you find yourself in a bad place, take some time to recognize what emotions you are feeling and understand the cause.(CHA 2021)
Given the circumstances, it’s likely that your skin has something to do with it. Perhaps it is a recent flare up or an unknown trigger.
Meditation can improve the brain’s resilience to stress and anxiety inducing situations, and help us identify triggering negative thoughts that lead to a physical reaction, which lead to more negative thoughts (aka, “spiraling”).
Movies may have portrayed meditation as sitting, saying “om”, and being irritated when the youthful applicant interrupts. However practical meditation is the act of training the higher order brain functions responsible for awareness, concentration, and decision making.
It is about being a better you.
Often meditators will think on their core values and think about how they can manifest outcomes related to those core values. For example, a meditating parent might think of a core value like, “I want my children to have success”.
They would then ask themselves what success is and then think on the events of the previous day. With no agenda to those thoughts, they simply watch the movie of the previous day. They would acknowledge any thoughts which arise and let them move on.
Often, insights will come forth that are important to act on. If you have ever experienced a key insight while walking the dog or taking a shower, the effect is similar. And you have now trained your brain for this - during non-meditation periods, your brain will be better able to notice your thoughts and change them and change the outcomes.
To meditate, many people sit on the floor with legs crossed (just like in the movies) but you can just as easily lie down. The position you choose is up to you, but the key is to limit outside stimulus like movement and sounds.
Notice how you are sitting, how you are feeling and your breathing. Remember to be kind to your thoughts. Do this for a set amount of time and gently arouse yourself again once the time is up.
If you are struggling with solo meditation, there are various sources of guided meditation.
Quality relationships fulfill fundamental human needs and boost happiness.(CHA 2021)(SMI 2022) Talking to close family and friends can be a therapeutic activity. There is a psychological effect where your thoughts will have more emotional effect when kept inside. Once you put the thoughts into words, often the challenges of those thoughts will seem smaller.
One of the keys to success here is to try to limit the expression of the thoughts to the facts of the thoughts, and limit the emotional expression of them. By doing so with a companion, you have the opportunity to associate new feelings with those thoughts.
Your friends and family want to help. Give them a chance!
Working out or engaging in physical activities can release feel-good endorphins that improve your mood and it can protect you long-term from new challenges.(CHA 2020)(SMI 2021) Check out some of our tips on exercising with eczema.
Combine this with exercising socially and in nature to compound the benefits. Being in nature can induce the feeling of awe which can help to put things into perspective.(SMI 2021)
Once you have acknowledged your negative feelings and explored the potential triggers, it can be helpful to try to move on from the negatives. Instead, focus your energy on what solutions are accessible and achievable. Ask yourself: “What can I do about this?”
Here are some examples:
"I feel fidgety and frustrated that my skin is so uncomfortable and I’m scared that I might be allergic to something I’m eating." Perhaps it is time to take some allergy tests to investigate allergies as a trigger. Or perhaps it is time to start a food diary to compare skin symptoms to diet (see our tracking resources for how)
"I feel overwhelmed: my skin is awful, work is busy and I can’t find my eczema cream." Perhaps getting organized, cleaning up and sorting my medications out will help to declutter my mind and I’ll find the creams I need. Or perhaps it’s time to take some sick-leave from work and rest
"I feel flat and sad, my eczema has stopped me being able to go swimming which is a big part of my identity." Perhaps it is time to meditate, perhaps I should write down three things that I can still do and I am grateful for.
When you know what is causing the feelings, ask yourself: "What can I do about it?"
Perhaps it’s time to implement a more drastic change in diet. Perhaps it’s the motivation you need to start tracking your symptoms and triggers to to narrow in on your condition.
Breathing is perhaps the most accessible and powerful tool to reduce anxiety and stress. It can be done wherever you are and makes a difference within a minute.
When you are anxious, muscles tense up, your breaths are shallow and your breathing rate increases. By doing this, your body is poised to deal with the threat that you are fearful of.
Mind and body are connected: if your body is ready to fight or flight, your mind will follow and thoughts of fight or flight will dominate.
But the reverse is true as well: if you force yourself to breathe in a relaxed way, you can calm your mind down.(SMI 2021) To do so, breathe in through your nose deeply from your stomach, hold your breath for a moment and slowly exhale out the mouth.
Counting can give yourself something to focus on and maintain the right tempo. Some popular breathing counting methods include:
When you are unwell, your body is working harder to deal with the condition as well as complete daily tasks. Rest is important to let your body and mind recover.
Try to get the right amount of sleep for you, aiming for 8 hours each night, but adjusting to what is the right amount for you.
This can be challenging with the skin symptoms and effects on mental health. You may need to give yourself more time in bed or nap during the day.
Avoid having caffeine after midday and minimize screen time in the hour or two before bed.(RC)(CHA 2021) Try to establish a calm routine prior to sleep. Many people have told us that incorporating meditation prior to sleeping has helped.
Check out the other treatments section to see if there are any tools to help reduce scratching.
When you are unwell, your body is working harder to deal with the condition as well as complete daily tasks. Rest is important to let your body and mind recover.
Try to get the right amount of sleep for you, aiming for 8 hours each night.
A healthy diet can impact your mental well-being.(CHA 2021) Maintaining a balanced diet rich in vegetables and avoiding foods that trigger eczema can improve your gut health and mood. A healthy gut boosts immune function and mood.
See the [diet and nutrition] page to learn more about eating the right foods for eczema and the [food] page for what foods to avoid.
A method to reduce anxiety is Progressive Muscle Relaxation Therapy. This is where you step through different muscle groups of your body, tensing them in turn and focussing on the sensation of relaxation afterwards.
This has been shown to be beneficial for eczema.(BAE 2011) This helps to build awareness of the “tense anxious” feeling and subsequently anxiety. Check out this video for a tutorial: Progressive Muscle Relaxation Training.
The links between mental health and eczema are profound, creating a cycle that can be difficult to break. Poor mental health can exacerbate eczema symptoms, while the physical and emotional impacts of eczema can negatively affect mental health.
This can manifest in the form of depression, anxiety, and low self-esteem, which can further worsen eczema symptoms.
We understand how challenging living with eczema can be, and we're here to support you. Breaking the cycle and improving both your mental health and eczema is possible through a range of approaches such as mindfulness, meditation, talking, exercise, being solution-oriented, focusing on your breath, getting adequate rest, maintaining a healthy diet, and practicing progressive muscle relaxation therapy.
Don't hesitate to reach out to a healthcare professional to discuss your eczema and mental health concerns. A doctor or specialist can provide tailored guidance and support to help you manage your condition effectively. Visit our doctors page to find the right healthcare professional for you.
Remember, you don't have to go through this journey alone. If you need help or someone to talk to, feel free to reach out to us. We're here to support you in overcoming the challenges of eczema and achieving a healthier state of mind and body.
There are multiple ways to manage eczema symptoms without the use of medical therapies.
Alternative treatments can supplement conventional therapies such as medications and moisturizers which may not be suitable for all.
Eczema, affecting millions of individuals globally, is a recurring skin condition typified by red, itchy, and inflamed skin outbreaks. The degree and length of these flare-ups are influenced by three key factors:
While conventional remedies like topical steroids and moisturizers are often the go-to treatments, they may not always be suitable for all skin types, or potent enough to fully manage the condition. This is where alternative eczema treatments come in.
These therapies tackle the condition from the standpoint of the three core factors listed above, offering an array of strategies beyond the first-line treatments.
Alternative and complementary therapies for eczema are designed to address the three main pillars of the condition: immune system response, trigger control, and skin barrier strength.
The immune system is multifaceted, and there are several alternative ways to calm and control it:
Dietary Changes: As eczema is linked to inflammation, an anti-inflammatory diet rich in fruits, vegetables, and omega-3 fatty acids could be beneficial.
Mind-Body Techniques: Mindfulness, yoga, and stress management techniques can reduce the psychological stress that often exacerbates eczema flare-ups.
Acupuncture and Traditional Chinese Medicine (TCM): In TCM, eczema is viewed as an imbalance of the body's energy or "Qi". Acupuncture aims to restore this balance, potentially alleviating symptoms.
Homeopathy: A holistic system of medicine, homeopathy uses minute doses of natural substances to stimulate the body's self-healing mechanism.
Biofeedback and Hypnosis: These approaches work by helping individuals gain control over physiological responses to stress, potentially reducing the severity of eczema symptoms.
Exercise: Regular physical activity can help manage stress and boost the immune system, possibly reducing eczema flare-ups.
You can find more details about some of these options in our articles on Diet, Mental Health, and Exercise.
Managing triggers that can induce or worsen a flare is crucial. The primary approach is to identify the trigger either through an allergy test or tracking symptoms.
It can take some time for those approaches to find and eliminate the trigger. A few alternative and complementary strategies to consider are:
Vacuuming: Regular vacuuming can help reduce dust mites, a common trigger for many people with eczema. Use a vacuum with a HEPA filter for the best results.
Maintaining Humidity: Dry air can aggravate eczema symptoms. Using a humidifier to maintain an optimal humidity level in your home can help keep your skin hydrated and less susceptible to flare-ups.
Washing: How and when you wash can influence your eczema. Avoid hot baths or showers and harsh soaps, which can strip your skin of its natural oils. Opt for lukewarm water and mild, fragrance-free cleansers instead.
Skin care ingredients: Many skincare products contain ingredients that can irritate sensitive, eczema-prone skin. Always read the label and select products with fewer allergens. Avoid products with fragrances, dyes, and harsh chemicals.
Aroma removal: Scented products such as air fresheners, candles, or perfumes can trigger eczema flare-ups in some individuals. Opt for fragrance-free products and keep your indoor environment well-ventilated to minimize exposure to potentially irritating aromas.
For a deeper exploration of these topics, please read our articles on allergies and intolerances, washing, avoiding triggers, triggers you may not have thought of, and how to find the best moisturizers for your eczema. They provide valuable insights and practical tips that can make a real difference in your journey towards better eczema management.
In individuals with eczema, the skin barrier function is often compromised. This barrier, composed of lipids and proteins, protects the skin from environmental irritants and allergens while retaining moisture.
When this barrier is disrupted, the skin becomes more permeable to irritants, leading to inflammation and eczema symptoms.
Alternative treatments can aid in either restoring a healthy skin barrier or offering supplementary protection while your skin barrier recuperates.
In the next section, we will delve deeper into complementary skin barrier therapies for eczema.
Regular application of moisturizers is the common first step in both helping the skin barrier strengthen and providing an additional layer of barrier between your skin and the triggers in the world.
In our article on moisturizers we dive deep into how to identify if the product hydrates to reduce cracking and create a protective layer on the skin's surface or if it helps the skin barrier repair and strengthen.
Several complementary and alternative therapies can help bolster your moisturizer and your skin barrier while you are healing.
The materials you wear can aggravate the skin and cause eczema to flare up. Opting for soothing materials which do not harbor triggers can help the skin recover. Materials with finer fibers are more soothing, such as cotton silk or merino wool.(JAR 2020)
Clothing can act as a "second skin," offering additional protection from environmental triggers and harmful UV rays, and preventing excessive scratching.
Another consideration for clothing is the temperature. Wearing breathable materials and layering can protect against extreme temperature changes, as overheating can lead to sweating and exacerbation of eczema symptoms.(CAS 2006)
Scratching can damage the skin barrier, leading to increased permeability and worsening eczema symptoms. Your fingernails also harbor dirt and microorganisms that, when scratching, can find their way below the skin barrier to induce flaring.
It can be so difficult to eliminate scratching completely, especially while asleep. A simple lifestyle change which can reduce the damage to the skin is maintaining short fingernails. Cut them every week or more often if your nails grow fast. File the cut edge to soften it and further reduce scratching damage.
Consider wearing cotton gloves at night to prevent unconscious scratching during sleep.
Another method to reduce the damage from scratching is to learn to recognize the scratching motions sooner. Scratching can become so habitual that eczema sufferers are not even aware they are doing it.
By practicing self-awareness, mindfulness and focussing on being present, it is possible to become aware of the scratching sooner and therefore reduce the amount of scratching taking place.
Sometimes, someone may be totally aware that they are scratching but feel powerless and unable to stop. The desire to scratch can outweigh the motivation to stop scratching.
Perhaps the individual has suffered from intense itches for a long duration of time, they are feeling mentally fatigued and out of control. Perhaps the individual is feeling helpless and hopeless.
There are some tools to help from behavioral therapy:
Find a mantra or other trigger. For example, you could repeat “I am in control” or snap a rubberband on your wrist to trigger your brain to focus elsewhere.
Focus on doing something else with your hands.
Remember 50% less scratching is a win. Trying to eradicate all scratching can lead to guilt for that one time you scratched your skin. You may even feel: “well I’m scratching now, I’ve failed so I may as well carry on”. The healthier perspective is to aim for minimal scratching so catching yourself scratching is an opportunity to catch yourself and reduce scratching rather than a failure.
This technique involves applying a moisturizer to the affected area, covering it with a wet bandage, and then wrapping a dry bandage over the top. Wet wraps can provide intense, targeted hydration and have a cooling effect, which can be particularly soothing during a flare-up.
To make a wet wrap for a particular patch of skin, follow these steps:
Clean the affected area
Apply moisturizer
Dampen a clean bandage and wrap it around the affected, be careful not to wrap too tight
Wrap the damp bandage with a dry bandage
Leave the wrap on for several hours
The damp cloth cools the skin whilst trapping the moisturizer and water in, allowing the skin to hydrate.(FIS 2012)(CAS 2006)
Be careful to avoid making the following mistakes, do not:
Apply topical steroids before wrapping a patch of eczema, this will increase the dose absorbed.
Wrap infected skin.
Wrapping broken skin or scabs
Use dirty bandages or wraps
The inflammatory process initiates the healing process for damaged tissue. During an allergic reaction, there is no actual damage and the inflammation is an over reaction of the immune system.
As described in the symptoms page, when eczema is inflamed, it feels warm and there is increased blood flow to the area. Therefore, by reducing the inflammation present, the severity of the reaction can be calmed down.
The cooling effect of an ice pack held against the skin constricts the blood vessels and subsequently the histamine levels in-situ depreciate. This limits the severity of the allergic reaction and reduces itchiness and damage to the area.(LIU 2018)
Interestingly, menthol stimulates cooling sensation without actually reducing the temperature and has still been shown to reduce itching. (BRO 1995)
The exploration of alternative eczema treatments opens up a world of possibilities for managing this complex condition. From mindfulness techniques to maintaining a healthy skin barrier to wearing the right clothes for your situation, these approaches offer hope for those seeking solutions beyond traditional treatments.
However, remember that these alternative and complementary therapies should be used judiciously and in consultation with a healthcare provider. The ultimate goal is to find a combination of treatments that work best for you, helping you lead a comfortable and fulfilling life.
Share your experiences with us! Tell us what has and hasn’t worked for you. What did we miss in this article that you've found personally impactful? Your insights can help others better understand and manage their eczema.
Topical steroids mimic natural cortisol to suppress the immune response, temporarily reducing itchiness and irritation.
Topical steroids can help manage acute flare symptoms but are not a cure for eczema and come with significant risks.
Eczema is a chronic skin condition characterized by periodic acute flares, marked by red, itchy, and inflamed skin. The severity and duration of an acute eczema flare are influenced by three main factors:
Immune system sensitivity
Trigger intensity
Skin barrier strength
Among the multitude of treatment options, topical steroids can be used in the management of the symptoms such as itching, redness, and irritation, related to an acute flare. Topical steroids do not eliminate triggers, and can sometimes weaken the skin barrier further and therefore are effective only during acute flares for the temporary management of symptoms.(FUK 2014)
Here we provide a comprehensive understanding of topical steroids for eczema treatment, explaining their mechanism of action, types, usage, benefits, and potential risks, such as Topical Steroid Addiction and Withdrawal. With a deeper understanding of topical steroids we hope to empower you to make informed decisions about your skin health journey.
Topical steroids, also known as corticosteroids or glucocorticosteroids, are medications that are applied directly to the skin to reduce the symptoms of itchiness and irritation related to inflammation during an acute flare.(HAJ 2015)(CAS 2006)
The skin is tightly tied to the immune system. It signals the body when a trigger is present through molecules like histamine, which will induce an immune reaction. It also signals when the invader is no longer present by expressing cortisol. Cortisol lowers inflammation, essentially telling the immune system that it can take a break.
Topical steroids work by mimicking cortisol to suppress the immune response and therefore the downstream symptoms associated with an immune response such as itchiness, redness, and irritation.
Topical steroids offer a number of benefits for individuals dealing with eczema. By providing localized treatment, they reduce the systemic risks associated with immune suppression, providing targeted symptom relief and reducing inflammation. This is particularly beneficial for individuals whose eczema is characterized by an overactive immune response to a trigger on the skin.
However, it is important to understand that while topical steroids can help manage symptoms during an acute flare, they are potentially disturbing the natural inflammatory process, and they are not a long-term cure for eczema. Their primary role is to control inflammation and provide symptomatic relief.
A weakened skin barrier, or an excess of triggers in the environment, are critical concerns that need to be addressed in tandem to any symptom relief.
For long-term management of eczema, topical steroids should be used as part of a comprehensive treatment plan that may include other medications, lifestyle modifications, and strategies to avoid triggers.
Topical steroids can play a role in managing symptoms of eczema such as itching and redness. When used judiciously and as needed, they can provide a welcome break from the discomfort of a flare-up.
However, while these steroids help manage symptoms, it is important to concurrently consider your skin's barrier function and possible triggers. These factors must be addressed alongside any steroid usage to achieve effective resolution of a flare and long-term control of eczema.
In some individuals with eczema, an overactive immune system can exacerbate the condition.
A strong immune reaction in a flare can further weaken the skin barrier and allow additional triggers through, thus sustaining a flare. In those cases, steroids can allow a temporary reduction of immune activity and a window of time for the skin to repair.
And for individuals with chronic eczema, topical steroids can effectively disrupt the itch-scratch cycle, also helping the skin barrier repair and the flare to resolve.
However, inflammation is not itself a marker of an overactive immune system; it can also be a natural response to a weakened skin barrier or strong environmental triggers. Monitor your symptoms using our tracking tools to identify potential triggers and prioritize maintaining a robust skin barrier. This approach can lower the amount of topical steroids required and manage eczema in a more comprehensive and health-conscious manner.
Moreover, topical steroids can be used in combination with other treatments, such as TC inhibitors, JAK inhibitors, or monoclonal antibodies. For instance, when used alongside Dupilumab, an effective monoclonal antibody therapy, it was observed to yield high overall effectiveness.(SED 2022) This combined approach not only lowers the overall dosage of steroids required but also provides a more targeted method to manage "overactive" immune responses.
While topical steroids offer benefits in managing eczema, they also carry significant potential risks and side effects.
While these drugs are sold over-the-counter, do not be fooled: they artificially lower your immune response and that should not be undertaken lightly.
Risks and side effects may include:
Topical Steroid Addiction and Withdrawal - Topical steroids are replacing the natural cortisol release from the skin and body. This can cause a lowered natural release of cortisol, which can develop into a dependency in some people. Please see our Topical Steroid Withdrawal page for more information. Each individual will have different sensitivities to these effects - some research indicates up to 12% of people will have a high sensitivity to topical steroids.
Other Systemic Side Effects - In rare cases, topical steroids can be absorbed into the bloodstream and cause systemic side effects such as weight gain, rounding of the face, thinning of bones, clouding of the eye lens, increased blood sugar levels or blood in the urine, and high blood pressure.
Increased Risk of Infection - Topical steroids can suppress the immune response in the skin, making it more susceptible to infections.
Thinning of the Skin - Topical steroids can lead to skin thinning or atrophy.
Allergic Reactions and Skin Irritations - In some cases, the skin may react negatively to the steroid or other components of the medication, causing itching, burning, or irritation.
Stretch Marks and Changes in Skin Appearance - Long-term use of topical steroids may lead to stretch marks, changes in skin color, and altered hair growth patterns.
To reduce chances of side effects, be mindful of how much topical steroids you use and when. See the tracking page for tools to do this effectively.
The above risks and potential side effects may be scary. However, many people tolerate topical steroids well when they are carefully used as directed.
Doctors are trained on and use manuals which tell them the order in which treatments should be deployed. These manuals are developed over many years of research and study, and remember the doctor motto is “do no harm”. So they will largely follow the manual on the order of treatments. If it is your first time talking to a primary care physician or a dermatologist about your symptom concerns, they are likely to offer topical steroids as the place to start.
If you are uncomfortable with that, your best bet is to share specific reasons why you personally cannot use steroids. Saying that you are uncomfortable with the risks, or read about TSW online, may not move them as they also have that information, and other treatments also come with serious costs or risks.
There are several reasons you could offer to a physician to help them work their way down the treatment list and consider other treatments. Some reasons could include:
If any of these conditions or factors are present, the physician might consider other options such as topical calcineurin inhibitors, emollients, or other systemic treatments.
You could also talk to the doctor about a regular follow-up schedule and actually schedule multiple appointments with the physician as evidence of your commitment to treatment. One reason a doctor may insist on steroids is that the manual says they are the first line treatment and regarded as safe. From their perspective if the patient goes home and they never see the patient again, topical steroids are the safest option.
This is especially true in the emergency room or urgent care departments - they are concerned that they cannot follow up. If you demonstrate a willingness to meet regularly to talk about side effects and treatment progression, they may be willing to move to other treatments knowing they can follow your progress.
Always remember, it is important to have an open and honest discussion with your healthcare provider about your symptoms, concerns, and any potential side effects you might be worried about.
Our page on talking to doctors goes into detail on how to track your treatment so you can show them your personal reaction and work together to find the right treatment plan.
Topical steroids for eczema come in a range of strengths and formulations, each designed to address different levels of disease severity and affected body areas. They are typically categorized into four classes, from mild to very potent forming a ladder of escalation if lower potency steroids are not sufficient.
The different formulations—ointments, creams, lotions, and gels—serve various purposes. Ointments are usually more potent because of their occlusive nature, making them suitable for very dry, lichenified areas.(NHS)
Creams are less occlusive and may be more suitable for acute or weepy eczema. Lotions and gels are best for hairy areas or when minimal residue is desired, like on the scalp or face.
The strength and formulation of topical steroid to use depends on several factors, including the severity of eczema, the age of the person, the body area to be treated, and the presence of any other skin conditions.
It's crucial to consult with a healthcare provider to determine the appropriate type of topical steroid for your situation.
Over-the-counter (OTC) topical steroids are available without a prescription and can provide a convenient and cost-effective way to manage mild to moderate eczema symptoms. The most common OTC topical steroid is hydrocortisone, which typically comes in a 1% concentration.
There are several benefits of OTC steroid creams for eczema. Firstly, they provide a degree of convenience, as they can be purchased from local drugstores without needing a doctor's prescription. Secondly, they are usually less expensive than prescription options, making them more accessible to a larger number of people. Lastly, OTC topical steroids are often sufficient for treating mild eczema symptoms, providing relief without the need for stronger, prescription-strength options.
Despite these advantages, it is important to note that even OTC topical steroids come with significant risks and potential side-effects. They should be used sparingly, not for prolonged periods, and never on sensitive areas like the face or groin unless specifically advised by a healthcare professional.
It is always a good idea to consult with a healthcare provider to determine the most suitable treatment for your specific condition and needs.
Prescription topical steroids come in various strengths and formulations, and they tend to be more potent than over-the-counter versions.
Prescription topical steroids may be recommended when:
Some commonly prescribed topical steroids for severe eczema include betamethasone dipropionate, mometasone furoate, and clobetasol propionate, among others. These steroids are potent to very potent.
However, due to their strength, these medications should be used under the guidance of a healthcare provider to avoid potential side effects. A specific regimen will be provided, which will specify how much to apply, how often to use it, and how long the treatment course should last.
This regimen should be followed carefully to ensure optimal treatment results and minimize the risk of side effects.
Always follow your healthcare provider's specific instructions as the application protocol can vary based on the severity of your condition and the area affected.
Here are some general rules to consider along with your healthcare provider’s instructions:
While topical steroids can be effective for treating eczema symptoms and allowing a window for the skin barrier to heal, it is crucial to remember that they do not cure eczema or address the underlying causes. They are intended to manage symptoms and improve quality of life as part of a comprehensive treatment plan.
Long-term management should include the identification and elimination of triggers and a strengthening of the skin barrier.
An essential aspect of eczema management is working closely with your healthcare provider to develop a tailored treatment plan that considers your specific needs and circumstances. This collaborative approach ensures that the most appropriate treatments are selected and any potential risks or side effects are monitored closely.
Remember that each individual's experience with eczema and response to treatments will differ. It may take some trial and error to determine which combination of therapies works best for you. Maintaining open communication with your healthcare provider is crucial for adjusting your treatment plan as needed.
Understanding the varying symptoms of eczema can be crucial for effective management.
The symptoms of eczema can be both visible and hidden. There are the most obvious: red, itchy, dry, skin. And the less obvious: a weaker skin barrier, lower vitamin D synthesis, and psychological distress.
Eczema is a chronic skin condition characterized by periodic acute flares, marked by red, itchy, and inflamed skin. The severity and duration of an acute eczema flare are influenced by three main factors:
Understanding and identifying the various symptoms of eczema is essential for proper management and timely intervention.
In this blog post, we will explore the common symptoms across different types of eczema and provide guidance on when to seek professional help.
Eczema symptoms may vary depending on the specific type of eczema, but certain signs are shared among most forms. Recognizing these common symptoms can help you determine if you may be experiencing eczema.
Typical eczema symptoms include:
Dry, scaly skin
Inflammation
Itchiness
Thickened skin
Blisters
Color changes
Ooze and crusting
The specific symptoms can give clues as to the cause of the eczema, so understanding the signs on your body is crucial to managing your condition. We will explore each symptom in more detail below.
Healthy skin is supple and smooth with no breaks in the surface. Whereas, individuals with eczema often have dry, flaky, and/or scaly skin. Dry skin is less flexible and elastic, so it cracks easily under movement increasing the permeability of the skin to new triggers, making the skin sensitive and easy to agitate.
Mildly dry skin can feel rough, while severely dry skin can have deep fissures and dead skin flaking off. In some cases, the skin can appear scaly with a number of large, thickened flakes on the affected area.
Inflammation is part of the body's defense mechanism, indicating that the immune system is actively trying to remove damaged cells and/or fight infection.(PAH 2022) Inflammation in eczematous skin is caused by the activity of the immune system reacting to a trigger.
The skin can feel warm to touch, itchy and in some instances swollen. In people with lighter skin, the inflammation may appear red. For those with darker skin, the inflammation may appear more purple or gray.(CAS 2016) For both, the inflamed areas may feel warm, itchy, or swollen. The inflammation results from the immune system reacting to a trigger, such as an allergen, irritant, or emotional stressor.
An itch is defined as an “unpleasant sensation that leads to the need to scratch”.(MIS 2018) There are four sources of itches as defined by medicine: neurogenic, neuropathic, psychogenic and pruritoceptive.
Pruritoceptive itches are generated in the skin as a reaction to inflammation or skin damage and subsequently is the predominant source of itch for eczema sufferers.(TIV 2009)
During the initial phase of an eczema flare, histamines are a key component to pruritoceptive itches. In the mid- and late-stage flare, itch is often driven by IL-4 production (which antihistamines are not effective in relieving).(GAR 2013)
Itching can be the most unpleasant and debilitating symptom of eczema. The severity can range from mild and acute, to totally continuous and overwhelming. The resulting scratching can damage the skin and result in increased intensity of itchiness.
Emotional stress from eczema can contribute towards a psychogenic itch and itch sensitization can occur where itchiness can increase and be triggered more easily.
Heavy scratching or rubbing of the skin can lead to thickened skin.(TIV 2019) This is also known as secondary lichenification.(ABO 2022) Thickened skin can appear to have exaggerated skin markings and feel leathery. The skin will remain thickened whilst the scratching or rubbing continues.
Blisters are clear-fluid sacks on the skin. They can be found in three types of eczema: pompholyx, contact and discoid. In pompholyx eczema where they appear primarily on hands and feet.(CHA 2006)
In contact eczema, small blisters can appear anywhere on the body, often in the area of skin which was in contact with the trigger.(CHA 2016) It can also indicate an allergen was present rather than an irritant. In discoid eczema, small blisters can appear within the discoid patch.(CHA 2006)
The color of your skin can change if you have eczema. The change in color depends on the initial color of the skin and the type of eczema present. For people with darker skin, patches of eczema might look darker or lighter than the original shade.(CHA 2006)
Patches of dry skin can have higher cell turnover and therefore can cause a dappled effect on tanned skin, where the eczema patches appear paler. For people with lighter skin, inflammation appears pink or red whereas it can appear gray or purple on darker skin.
Scratching skin can change the tone of skin color, darker or paler, and the skin eventually returns to the normal coloring when the scratching is under control.(CHA 2006) With seborrheic eczema, the affected skin can appear yellowed.
Inflamed skin can release a clear or yellowish fluid from the surface. Serum, the fluid-component of blood, can leak dilated blood vessels found in inflamed tissue.
The leakage can lead to swelling and ooze from the skin.(MHJ) As the fluid dries on the surface of the skin, it leaves behind yellow or orange crusting. Oozing and crusting can be experienced with any type of eczema but it is unlikely in asteatotic.
Oozing of puss-colored or foul-smelling fluid can be a sign of infection, a complication from a compromised skin barrier.
While many symptoms are common across various types of eczema, each type may have unique characteristics and manifestations. Understanding these differences can help with proper diagnosis and management.
See the table to understand what symptoms are typical of which types of eczema. See our article on the types of eczema to learn more.
Types of Eczema Vs Symptoms |
Dry Scaly |
Itchy |
Inflamed skin |
Thickened skin |
Blisters |
Color change |
Oozy & Crusty |
Y |
Y |
Y |
Y |
Y |
|||
Y |
Y |
Y |
Y |
Y |
Y |
Y |
|
Y |
rarely |
Y |
Y |
Y |
|||
Y |
Y |
Y |
Y |
Y |
|||
Y |
Y |
Y |
Y |
Y |
|||
Y |
Y |
Y |
|||||
Y |
Y |
Y |
Y |
Table mapping the symptoms experienced to each of the types of eczema.
Atopic dermatitis, the most common form of eczema, can present differently depending on the individual's age. In infants, it often appears as red, scaly patches on the cheeks, forehead, and scalp.
In children, the rash typically occurs in the creases of the elbows and knees, while in adults, it may be more widespread and involve the hands, feet, and neck. Atopic dermatitis is characterized by intense itching, and scratching can lead to skin infections and scarring.
Contact eczema is triggered by direct contact with an irritant or allergen, which leads to inflammation and irritation of the skin. There are two types: irritant contact dermatitis and allergic contact dermatitis. Symptoms for both types can include redness, itching, burning, stinging, and swelling at the site of contact.
In more severe cases, the skin may develop blisters, oozing, or crusting. Allergic contact dermatitis symptoms may take longer to appear (up to 48 hours) and can last for several weeks, while irritant contact dermatitis symptoms usually appear more quickly (within minutes to hours) and resolve within a few days, provided the irritant is removed.
Seborrheic eczema is characterized by red, inflamed skin with yellowish, greasy, and flaky scales. It commonly affects areas of the body with a high concentration of oil-producing (sebaceous) glands, such as the scalp, face, and upper chest.
Symptoms can include dandruff, itching, redness, and scaling on the scalp, as well as red patches with yellowish scales around the nose, ears, eyebrows, and eyelids. In severe cases, seborrheic eczema can cause hair loss.
Nummular eczema, also known as discoid eczema, is characterized by round or oval patches of inflamed skin. These patches can be pink, red, or brown and may have a scaly, crusty appearance.
Nummular eczema can occur on any part of the body, but it is most commonly found on the lower legs, arms, and trunk. This type of eczema can be triggered by factors such as dry skin, insect bites, or skin injuries.
Dyshidrotic eczema is a distinct form of eczema that primarily affects the hands and feet. It is characterized by small, intensely itchy blisters filled with clear fluid. These blisters may eventually rupture, leading to oozing, crusting, and peeling skin.
Triggers for dyshidrotic eczema may include stress, exposure to certain metals, or contact with irritants. Severe cases can lead to painful fissures and an increased risk of infection.
Asteatotic eczema, sometimes referred to as xerotic eczema or eczema craquelé, is characterized by dry, cracked skin that resembles a cracked porcelain or parched riverbed. This type of eczema typically affects older adults and is most common on the lower legs, though it can also occur on the arms and trunk.
Asteatotic eczema can be caused by factors such as cold weather, low humidity, and excessive use of soaps or hot water, which strip the skin of its natural oils.
Gravitational eczema is caused by poor circulation, typically affecting the lower legs and ankles. The weakened blood flow results in increased pressure in the veins, leading to fluid buildup and skin changes. Symptoms can include swelling, redness, itching, aching or heaviness in the legs, skin darkening (hyperpigmentation), and skin that feels hard or tight. In advanced cases, the skin may break down, resulting in open sores or ulcers.
Eczema not only affects an individual's skin but can also lead to a range of complications that impact their overall health and well-being.(KIM 2011) These complications can include infections, social implications, and effects on mental well-being.
Eczema can weaken the skin's natural barrier, making it more susceptible to bacterial, viral, and fungal infections. Scratching the affected area can also introduce bacteria from the nails into the broken skin, further increasing the risk of infection.
Common infections associated with eczema include impetigo, cellulitis, and herpes simplex. To prevent infections, it is crucial to maintain proper skincare, avoid scratching, and seek medical attention if signs of infection are present, such as increased redness, warmth, pain, or pus.
The visible symptoms of eczema, such as redness, scaling, and oozing, can lead to social stigma and self-consciousness. This can be particularly challenging for children and adolescents, who may feel embarrassed, isolated, or bullied because of their skin condition. It is essential to provide support and understanding to individuals with eczema, encouraging them to seek appropriate treatment and engage in activities that promote self-esteem and resilience.
Living with eczema can take a significant toll on mental well-being. The constant itch-scratch cycle, time consuming skin routines, , fear of triggers, sleep disturbances, and appearance concerns can lead to increased stress, anxiety, and depression. In children, poor sleep could disrupt development and has been linked to various other health conditions.(RAM 2019)
The result can be emotional burnout, low self-worth, depression, anxiety and chronic stress. See the stress and mental health pages for more on this subject.
As mentioned in the intro: eczema is a balancing act between skin barrier strength, the immune system, and triggers. The intensity of a trigger can dictate the intensity of an acute flare. Many triggers can be managed and even removed from the local environment, lowering the burden on the skin barrier and calming the immune system.
For a more detailed discussion on eczema triggers, as well as information on how to identify and manage them, please visit our dedicated triggers page. By understanding and addressing your specific triggers, you can minimize flare-ups and better manage your eczema symptoms.
Eczema is a balancing act between skin barrier strength, immune system activity, and trigger intensity. There are treatments and preventative measures that can be effectively used across all three areas.
For an overview of how these treatments work together please see our Treatment Page. Or for more information on each of these areas please see:
Please note that it is essential to consult a healthcare provider or dermatologist before starting any new medical treatment to ensure it is safe and appropriate for your specific needs.
Understanding your symptoms is crucial for several reasons, including proper diagnosis, effective treatment, and prevention of complications. Recognizing the specific symptoms of your eczema can help you and your healthcare provider determine the most appropriate course of action for managing your condition.
By understanding your symptoms, you can:
Identify your eczema type: Different types of eczema have unique symptoms and triggers. Knowing the specific type of eczema you have can help you tailor your treatment and prevention strategies.
Monitor your condition: Being familiar with your symptoms allows you to track changes in your eczema, identify triggers, and evaluate the effectiveness of your treatment plan.
Prevent complications: Understanding your symptoms helps you take necessary precautions to minimize the risk of infections, social implications, and mental health concerns associated with eczema.
Seek timely medical care: Recognizing when your symptoms worsen or become unmanageable enables you to seek medical help promptly, ensuring better management of your condition and preventing potential complications.
Share your experiences with us! Tell us what has and hasn’t worked for you. What did we miss in this article that you've found personally impactful? Your insights can help others better understand and manage their eczema.
Topical steroids are a common treatment for eczema, but can lead to a condition known as topical steroid withdrawal (TSW) or steroid addiction.
Preventing TSW involves understanding the proper use of topical steroids, avoiding self-treatment with over-the-counter topical steroids, and regular check-ups with healthcare providers.
Eczema is a chronic skin condition characterized by periodic acute flares, marked by red, itchy, and inflamed skin. The severity and duration of an acute eczema flare are influenced by three main factors:
Immune system sensitivity
Trigger intensity
Skin barrier strength
A common first-line treatment for an acute eczema flare is the use of topical steroids. One potential complication associated with the use of topical steroids for eczema is a phenomenon known as topical steroid withdrawal (TSW), also referred to as steroid addiction.
For individuals dealing with eczema, understanding the risk of TSW and how to identify its symptoms is crucial. Mismanagement of TSW can exacerbate eczema symptoms and complicate the treatment process, potentially damaging the patient-doctor relationship and causing unnecessary distress.
Topical steroid withdrawal (TSW) is a condition that occurs when the skin reacts adversely to the discontinuation or reduction of topical corticosteroids (topical steroids). TSW has been divided into two subtypes with distinct clinical presentations: erythematous edematous and papulopustular.
The symptoms of TSW can vary depending on the subtype, but may include:
Erythema (redness)
Swelling (edema)
Burning or stinging sensation
Itching
Papules or pustules
Skin dryness or desquamation (peeling)
Oozing or crusting
TSW shares symptoms with several other dermatological conditions, making it essential to consider alternative diagnoses, such as:
Atopic dermatitis (eczema)
Contact dermatitis
Rosacea
Seborrheic dermatitis
Diagnosing TSW can be challenging, as its symptoms often overlap with those of the underlying dermatological condition, such as eczema. A thorough patient history and clinical examination are crucial in determining the presence of TSW. Factors that may suggest TSW include:
Worsening of symptoms after topical steroids discontinuation or reduction
Reliance on increasingly potent topical steroids to achieve symptom control
A history of prolonged or frequent topical steroids use
Distinguishing TSW from eczema flare-ups can be challenging, as the symptoms can appear similar. However, some key differences may help identify TSW:
TSW symptoms typically worsen after discontinuing or reducing topical steroids use, while eczema flare-ups may occur independently.
The intensity and pattern of symptoms may differ between TSW and eczema flare-ups.
Consulting with a dermatologist, an eczema specialist, or your primary physician can help in differentiating between TSW and eczema flare-ups, enabling the development of an appropriate treatment plan.
Although the exact mechanism of TSW is not fully understood, several theories have been proposed to explain how topical steroids use can lead to withdrawal symptoms.
Topical corticosteroids can lead to skin atrophy, including thinning of the skin and impaired functioning of the skin's own cortisol production. This could result in a decreased ability to regulate inflammation naturally, potentially leading to dependency on increasingly higher doses of topical corticosteroids to manage symptoms effectively.
However, topical corticosteroids when used as minimally, for short periods of time to manage an acute flare, are generally safe and effective for most people.
There may be a genetic risk as well. Research indicates that up to 12% of the population are particularly susceptible to atrophy of their natural cortisol production, making them very sensitive to the use of topical steroids.
Certain factors may increase an individual's risk of developing TSW, including:
When topical steroids use is discontinued or reduced, the immune system may react to the sudden absence of the immunosuppressive action of topical steroids. This can lead to a rebound inflammatory response, in which the production of cytokines and the activity of immune cells are increased.
This heightened immune response can exacerbate skin inflammation and result in the redness, burning, and itching associated with TSW.
If you suspect TSW, it is essential to consult with a dermatologist for a proper evaluation and diagnosis. They can help differentiate TSW from eczema flare-ups and develop an appropriate treatment plan tailored to your specific needs.
To prevent TSW, your dermatologist may recommend gradually tapering off the use of topical steroids instead of stopping abruptly. This approach allows the skin to adjust to the reduction of medication and reduces the risk of triggering withdrawal symptoms.
Continue to manage your eczema! Explore treatment alternatives, some of which can help both eczema flares and TSW.
Open communication between patients and healthcare providers is crucial for successful TSW management. Patients should feel comfortable discussing their concerns about topical steroids usage and TSW with their healthcare provider, while healthcare providers should actively listen and address these concerns with empathy.
It is important to note that some dermatologists may not be well-equipped to deal with topical steroid withdrawal, as they typically receive little training in this area. In some cases, dermatologists may only be aware of the viral media coverage of topical steroid addiction and may deny that you have this condition. In such cases, see our doctors page which provides some tips on working with healthcare professionals and referral resources.
Active listening, acknowledgement, and validatation of patient symptoms, experiences, and concerns related to topical steroids use and TSW by healthcare professionals are essential to building trust and a collaborative relationship.
If you find that your concerns are being dismissed or ignored, sending brief, written correspondence after a visit can be helpful prior to deterioration of the professional relationship and/or a negative impact on treatment adherence or outcomes.
An example approach could be writing:
“Thank you for seeing me today. I appreciated our discussion about topical steroid withdrawal and know that it may be difficult to get the full picture during a brief visit. I believe TSW is contributing to my ongoing symptoms (e.g., X, Y, Z). Attached is a brief, overall summary with specific details regarding my symptoms. After review, if you agree that TSW is a diagnostic consideration, I would be very interested in discussing next steps with you and would be glad to discuss in a follow up appointment as needed. If not, it would be helpful for me to know your reasons or to be referred to an eczema specialist as these symptoms are significantly affecting my quality-of-life. Hopeful we can work together to find an effective solution and let me know if additional information would be helpful. Thank you for partnering with me on my health care.”
Check out our section on tracking symptoms to learn how to log your symptoms and treatments in details to support your letter.
It is important to understand that while topical steroids can help manage symptoms during an acute flare, they are not a long-term cure for eczema. Their primary role is to control inflammation and provide symptomatic relief.
A weakened skin barrier, or an excess of triggers in the environment, are critical concerns that need to be addressed in tandem and can minimize use of topical steroids.
Understanding the proper use of topical steroids and potential risks associated with overuse can help patients make informed decisions about their treatment. Healthcare providers should ensure patients receive comprehensive education on the appropriate application, potential side effects, and the importance of following the prescribed treatment plan.
Using the lowest effective potency of topical steroids can minimize the risk of TSW. Healthcare providers should carefully consider the appropriate topical steroids strength for each patient and re-evaluate the necessity of high-potency topical steroids both initially and on a periodic basis if possible.
Patients should avoid self-treating with over-the-counter topical steroids or using topical steroids without the guidance of a healthcare professional. Such practices increase the risk of inappropriate topical steroids use, which can contribute to the development of TSW.
Regular check-ups with healthcare providers allow for ongoing evaluation of treatment effectiveness, adjustments to the treatment plan as needed, and early identification of potential TSW. Patients should report any concerns or adverse effects related to topical steroids use during these appointments.
To facilitate communicating with your doctor, we recommend using a symptom and treatment tracking tool like we provide on our tracking eczema page. Offering evidence of symptoms and treatment use can facilitate a dialog with your doctor around treatment alternatives.
Topical steroid withdrawal (TSW) is a significant concern for patients with eczema and other dermatological conditions who rely on topical corticosteroids (topical steroids) for managing their symptoms. Understanding the signs and symptoms of TSW, as well as the underlying mechanisms, can help both patients and healthcare providers make informed decisions regarding treatment plans.
Proper patient education, open communication, and a strong doctor-patient relationship are crucial for successful TSW management. By following prescribed treatment plans, using the lowest effective potency of topical steroids, and avoiding self-treatment with over-the-counter topical steroids, patients can minimize the risk of developing TSW.
Long-term management should include the identification and elimination of triggers and a strengthening of the skin barrier.
Share your experiences with us! Tell us what has and hasn’t worked for you. What did we miss in this article that you've found personally impactful? Your insights can help others better understand and manage their eczema.
Certain foods can trigger eczema symptoms by impacting the immune system and skin health.
Once a dietary factor is recognized as a factor in eczema, adjustments can be made to manage symptoms.
Eczema is a chronic skin condition characterized by periodic acute flares, marked by red, itchy, and inflamed skin. The severity and duration of an acute eczema flare are influenced by three main factors:
While there are many things that affect these factors, research has shown that diet can play a significant role in all three factors.
In this blog post, we will explore the connection between eczema and diet in detail, including which foods can trigger eczema symptoms, how to tell if your eczema is diet-driven, and what an eczema-friendly diet looks like.
By the end of this post, you'll have a better understanding of how your diet can impact your eczema and what you can do to manage it effectively.
Research has shown that certain foods and drinks can trigger eczema symptoms by affecting various aspects of the body's immune system and skin health. Understanding the mechanisms can help to identify what is going on and therefore what dietary changes need to be implemented.
When someone has a weak skin barrier and an allergy to certain foods, consuming these foods can trigger eczema flare-ups. The body perceives the allergen as a threat and reacts by releasing histamine and other inflammatory molecules.
If the inflammatory response is strong enough, it becomes systemic and travels to the skin, where a weakened skin barrier is affected, resulting in itching, redness, and inflammation. For more information, see our article on allergies.
The gut lining is the interface between your body and the foods you eat. It must absorb the nutrients you rely on for survival while preventing toxic substances and pathogens from entering the body.
Leaky gut occurs when the intestinal tract is damaged, allowing undesirable matter to enter the body.(IMU 2020) This can trigger an immune response that becomes systemic, and combined with a weakened skin barrier, an eczema flare can occur.(APA 2023)(CLA 2016)(HHP)(FIS 2012)
Processed foods and drinks often contain artificial ingredients and preservatives that can be harmful to the body. These chemicals can trigger an immune response, leading to eczema flare-ups.
Preservatives such as nitrates and sulfites are used in foods to prevent microbial growth and extend their shelf life. They can induce dermatitis and hives, among several other health conditions.(VAL 2012)
The liver plays a vital role in filtering toxins from the body, but when it becomes overburdened with toxins, it can't function properly. This can lead to inflammation and other health problems, including eczema.
Fat metabolism plays a crucial role in maintaining skin health, and any disruption in this process can contribute to skin issues, including eczema.
High levels of omega-6 fats in the blood have been linked to the onset of eczema.(FIS 2012) Modern western diets tend to be rich in omega-6 fats, which are commonly found in vegetable oils, processed foods, and some nuts and seeds. On the other hand, these diets are often lacking in omega-3 fats, which are found in fatty fish, flaxseeds, and walnuts. Omega-3 fats have anti-inflammatory properties, which can help counteract the pro-inflammatory effects of omega-6 fats.
Trans fats, found in some processed foods and partially hydrogenated oils, are another type of fat that can negatively affect eczema. These highly reactive fats can interfere with enzymes in the body, disrupting the healthy balance of essential fatty acids and contributing to inflammation. Limiting or eliminating trans fats from your diet can help improve eczema symptoms and overall skin health.
Additionally, a high intake of saturated fats can influence hormone levels, which can, in turn, lead to eczema flare-ups. Saturated fats are typically found in animal products such as meat, butter, and full-fat dairy, as well as some plant-based oils like coconut oil and palm oil. Reducing saturated fat intake and opting for healthier sources of fats, such as olive oil, avocados, and nuts, can contribute to better hormone balance and improved eczema management.
Certain foods and drinks have been identified as common triggers for eczema symptoms. In part, that is because an allergy or intolerance to that food is associated with the mutations in the body that lead to a weak skin barrier.
It's important to note that not all individuals with eczema will have the same food triggers, and some may not have any food triggers at all. However, by identifying and avoiding potential food triggers, individuals can reduce the frequency and severity of eczema flare-ups.
Dairy products, such as milk, cheese, and yogurt, contain lactose which more than 40% of eczema sufferers are sensitive to.(FIS 2012) If an individual is iron deficient, dairy has been shown to damage the gut lining and contribute towards leaky gut.(FIS 2012)
However, consumption of dairy products such as milk, yogurt and kefir (a fermented yogurt) has been shown to improve the gut microbiome.(ASL 2020) If there is no sensitivity to dairy, it can be beneficial to consume dairy products.
Some fermented foods can be high in histamines.(FIS 2012) In the body, histamines lead to itchiness and redness among other things.
Gluten is a protein found in grains such as wheat, barley, and rye. For some people, gluten can trigger an immune response and lead to eczema symptoms. In others, consumption of glutenous foods increases gut permeability.(KHO 2020)
Sugar, when contained within a fiber matrix (like a raw apple), is not in itself bad. Processed foods, or refined products like apple sauce or juice, contain “free sugar” which is outside a fiber matrix.
Sugar when consumed outside of fiber is associated with inflammation and liver disease.(KHO 2020)(MA 2022)
Sugar can also break down collagen, one of the building blocks of healthy skin.
Additionally, sugar and artificial sweeteners can disrupt gut health and contribute to the growth of harmful bacteria leading to systemic inflammation.
Other common food allergens, such as eggs, soy, and nuts, can trigger eczema symptoms in some individuals. Nightshade vegetables, such as tomatoes and eggplants, and spicy foods may also trigger eczema symptoms. Brewers yeast has been shown to flare eczema.(FIS 2012)
Highly Acidifying foods |
Highly acidic foods disrupt your bodies pH. Excess acid is excreted through skin, lungs and kidneys. |
Fermented foods |
Increases chemical load – has been shown to worsen eczema symptoms |
Nitrates |
Eczema sufferers can be sensitive to dietary nitrates – used as a preservative |
MSG |
Promotes liver inflammation and has been shown to worsen eczema symptoms |
Histamine |
A chemical which is produce by the body during an allergic reaction is also naturally available in the diet – See Antihistamine section for more. |
Brewer’s Yeast |
Has been shown to worsen eczema symptoms |
Food Additives |
Preservatives, artificial coloring, artificial sweeteners |
(FIS 2012)(COM 2020)
Dietary sulfites have been shown to induce dermatitis and hives, among several other health conditions.(VAL 2012)
For more information, check out our allergies and intolerances page.
Alcohol consumption can have a negative impact on eczema symptoms due to its dehydrating effects on the body, influence on blood vessels, and its potential to damage the gut lining. Furthermore, alcohol can cause liver stress and interact with other dietary factors to exacerbate eczema symptoms.
When alcohol is consumed, it can lead to dehydration, which can worsen eczema symptoms. Adequate hydration is crucial for maintaining healthy skin, and dehydration can result in dry, itchy, and irritated skin. Additionally, alcohol can cause blood vessels to dilate, leading to flushing and skin irritation. To minimize these effects, it's important to drink plenty of water and stay well-hydrated, especially when consuming alcohol.
Alcohol consumption can damage the gut lining, contributing to leaky gut syndrome. As the gut lining becomes more permeable, it allows undesirable substances to enter the bloodstream, triggering an immune response and exacerbating eczema symptoms. Furthermore, since alcohol is a fermented product, it can contain high concentrations of histamines, which can be problematic for individuals with histamine intolerance. To protect gut health, consider reducing alcohol intake and focusing on a diet rich in gut-friendly foods, such as probiotics and fiber.
Alcohol is essentially a toxin, and its consumption puts stress on the liver as it works to metabolize and eliminate it from the body. Some individuals have an intolerance to alcohol, making it even more difficult for their bodies to process it and putting additional stress on the liver.
When alcohol is consumed alongside processed foods, the liver becomes overstressed, leading to a stronger inflammatory response and exacerbation of eczema symptoms. To reduce liver stress, consider limiting alcohol consumption and avoiding processed foods.
Individuals with eczema often experience a weakened skin barrier, which can result in increased transepidermal water loss (TEWL). This water loss can contribute to dry, itchy, and irritated skin, which can exacerbate eczema symptoms.
Repairing the skin barrier requires moisture. Adequate water intake can support the skin's natural repair processes and promote overall skin health.
Determining whether your eczema is diet-driven can be a challenging task. However, by utilizing specific tools and techniques, you can identify if certain foods may be contributing to your symptoms.
Here are some strategies to help you determine if your eczema is influenced by your diet:
Keeping a food journal can help you track which foods you consume and when eczema symptoms occur. This can help you identify potential food triggers that may be exacerbating your symptoms.
Generally, symptoms increasing may be related to the food consumed up to 48 hours prior.
If you suspect that you may have a food allergy, allergy testing can help you determine which foods you should avoid. Allergy testing can be done through blood tests, skin tests, or elimination diets.
An elimination diet involves removing potential food triggers from your diet for a period of time, then gradually reintroducing them one by one to determine which ones are causing eczema symptoms.
From recognizing foods that can trigger flare-ups to incorporating foods that can help soothe symptoms, the role of diet in eczema management cannot be overstated. Remember, everyone's body is unique, and what works for one person might not work for another.
Please take a look at our diet and nutrition page for how to leverage diet in alleviating eczema symptoms.
It is crucial to remember that eczema is a multifactorial condition. Diet is just one of the many factors that can contribute to its development and exacerbation.
We encourage you to explore other factors and treatments by engaging with our other content, as a comprehensive approach is key to effectively managing this complex skin condition.
Share your experiences with us! Tell us what has and hasn’t worked for you. What did we miss in this article that you've found personally impactful? Your insights can help others better understand and manage their eczema.
Phototherapy uses UV light to reduce eczema's inflammation and itching; it works well with other treatments.
Many forms of phototherapy exist; each type has unique efficacies, mechanisms, and safety profiles.
Phototherapy, also known as light therapy, is a treatment for eczema that involves exposing the skin to ultraviolet (UV) light. This type of therapy has been used since 1970s and has shown to be effective in reducing inflammation and itching associated with eczema, and can be used in combination with other treatments such as topical creams and ointments.(PÉR 2015)
In this blog post, we will explore the different types of phototherapy available for treating eczema, including narrowband UVB, UVA1, and PUVA. We will also discuss the benefits and risks of phototherapy, as well as the latest research on the topic.
By the end of this post, you will have a better understanding of how phototherapy can be used to treat eczema and whether it may be a suitable treatment option for you.
In the context of eczema, the use of phototherapy has evolved significantly over the past decades. With the advent of technologies that can generate specific and controlled wavelengths of UV light, phototherapy has become a mainstream treatment option for eczema patients who don't respond well to traditional therapies or seek a systemic treatment with fewer side effects.
However, as with any therapeutic approach, it is essential to understand the nuances of phototherapy, including the different types, their effectiveness, and potential risks.
Visible light refers to the part of the electromagnetic spectrum that we can see. UV light is just beyond visible light with a wavelength between 10 and 400 nanometers.
Research indicates that different wavelengths within the UV part of the spectrum have different potential actions on the skin and therefore different risks and benefits. For example, UV-A wavelengths (315-400 nm) can suppress the immune system and is associated with skin aging. UV-B wavelengths (280-315 nm) may help with reducing inflammation and itching but are more associated with sunburn.
There are various forms of light therapy for eczema, each utilizing different parts of the UV spectrum. The common types include:
Broadband UV-B (BB UV-B)
Narrowband UV-B (NB UV-B)
Broadband UV-A (UV-A)
Psoralen plus UVA (PUVA)
Long-wave UV-A (UV-A1)
UV-AB
Excimer Laser (EL) Therapy
Heliotherapy
Tanning Beds
UV exposure can have impacts on skin health. High doses of UV can have nasty side effects so it is important to understand what is beneficial and where the risks lie.
Here, we delve into each type, examining their efficacy, mechanism of action, and safety profiles.
280-315 nm wavelength
The earliest form of phototherapy, uses a wide spectrum of UV-B light. Studies suggest that UV-B has an immunosuppressing effect on the skin by inducing the release of immunosuppressive cytokines and inhibiting antigen presentation.(BEI 2012) UV-B is less penetrating than UV-A, so the energy is absorbed more by the outer layers of the epidermis.(PAT 2015)
Broadband UV-B was used more in the past before narrowband UV-B was developed. There are more significant side effects in using broadband UV-B. Risks to the patient include skin damage, increased risk of skin cancer, and potential side effects such as redness, itching, and blistering.
311 nm peak wavelength
Narrowband UV-B, also known as TL-01, has replaced most of the use of BB UV-B therapy since the same benefits can be obtained with lower risks and significantly less redness.(PAT 2015) Since the effects are so quick, lower doses of light can used lowering the risk of skin cancer and longer-term potential side effects.(PAT 2015) To date, no studies have found a direct link from NB UV-B phototherapy to skin cancer.
One of the ways NB UV-B appears to work is through apoptosis (cell death) which was induced in epidermal T lymphocytes which can calm the Th1 immune response. In some eczema patients, especially those with chronic eczema, the Th cell response is often heightened.(PAT 2015)
In a study, NB UV-B therapy was provided to a group of eczema sufferers in 2 sessions a week for 12 weeks. The conclusions found: 90% experienced a decrease in itchiness, 71% had improved sleep and 65% had a decrease in topical steroids through the course.(PER 2015)
NB UV-B can be made available at home, reducing the burden on the patient for comparable therapeutic results.(DER 2013)
315-400 nm wavelength
UV-A radiation has an immunomodulatory effect by acting on the Langerhans cells of the skin.(PAT 2015) UV-A light can penetrate more deeply for a similar amount of light than UV-B, increasing the risk of skin damage or cancer. Similar to Broadband UV-B treatments, UV-A treatments have therefore become less popular since the development of UV-A1, which is more targeted.
Treatment with this wavelength of light can cause side effects which are usually mild and go away on their own, redness, itching and dry skin. The heat of the light can irritate the skin.
315-400 nm wavelength
Since UV-A radiation can result in skin damage and increased risk of cancer, the application of psoralen can be used to reduce the overall dose of UV-A. This treatment is called PUVA or photochemotherapy. The psoralen can be applied topically or taken orally and it increases the sensitivity of the skin to the light by increasing the rate of T-cell death.(PAT 2015)
Still, the risks of skin damage and cancer remain to a degree. One study found that long-term systematic use resulted in an increased risk of skin malignancies. After 25 years, more than half of the patients with more than 400 treatments had developed one or more cancerous cells in the squamous layer; of the patients with more than 200 treatments, at least one cancerous cell formed in the basal layer.(BEI 2012)
When proper eye protection is used, PUVA does not put patients at risk of cataracts.
340-400 nm wavelength
UV-A1 therapy uses a specific part of the UV-A spectrum, reducing the overall UV-A the skin is exposed to during treatment by 90% versus UV-A.
Since the heat of the light can cause skin irritations, a cold-light option can be available where the infra-red part of the spectrum is filtered out and cool air is blown over the skin.
In one study, patients were given 5 sessions of cold-light UV-A1 for 3 weeks with a check up 4 weeks after the course had finished. SCORAD is a measure of area and severity for atopic eczema. The results showed a significant improvement in SCORAD over the three weeks and the benefits were still present 4 weeks after treatment:(PER 2015)
Baseline mean SCORAD - 71.7
Week 3, after treatment - 23.3
Week 7, after 4 weeks - 24.9
Treatment times can range from 10 minutes to 1 hour per session.(PAT 2015) Side effects can include burning of the skin, redness and itchiness but this is lower than reported for UV-A, especially when using a cold-light.
280-400 nm wavelength
Since there are different benefits for UV-A and UV-B therapies, one option is to combine the treatment. UV-AB was commonly used in the past because the clinical results were better than either of the therapies on their own.(PAT 2015)
The combined treatment is used less now that UV-A1 and Narrowband UV-B have been developed, as the combined benefits also come with increased risk of side effects such as burning, itching and dryness.
308 nm wavelength
Another specific type of phototherapy uses a xenon chloride excimer laser (EL). The wavelength of the light is very close to the NB UV-B therapy (308 nm) and research indicates that EL could be at least as effective or superior.(BAR 2021)
The studies indicate that EL may be an effective treatment for the itchy forms of atopic eczema however as of 2021, the European and US guidelines do not recommend the use of EC due to a lack of quality trials.(BRE 2010)(BAR 2021)
Sunlight is UV-A, UV-B and UV-C.
Controlled exposure to natural sunlight, known as Heliotherapy, may be an effective treatment option, especially for mild to moderate eczema cases.
However, it is important to note that excessive sun exposure can cause skin damage and increase the risk of skin cancer. Therefore, it is important to use caution when using natural sunlight exposure as a form of phototherapy.
Tanning beds use UV-A and UV-B, 280-400 nm
Tanning beds have not been designed to deliver eczema treatment. Sunbeds emission spectra are similar in the UV-B range but can reach 10 to 15 times higher in the UV-A range.(GER 2002). The broadband nature of the tanning bed can result in more significant side effects when compared to NB UV-B or UV-A1.
The risks associated with tanning beds including skin aging and increased risk of skin cancer, far outweigh potential eczema relief. Leading healthcare professionals to advise against their use for this purpose.
Traditional eczema management primarily relies on topical treatments such as moisturizers and steroids, complemented by lifestyle changes. Despite their widespread use, these remedies carry inherent risks and may not always effectively address severe or persistent eczema. Enter phototherapy, a light therapy for eczema that provides a novel approach by targeting specific immune responses in the skin.
UV-A and UV-B light, key components of phototherapy, offer therapeutic benefits like reduced itching, inflammation control, and immunomodulation. Studies suggest that patients with moderate to severe eczema can experience significant improvement in skin symptoms, sleep quality, and overall quality of life within the first three weeks of phototherapy.(NHS)(TIV 2009)(PAT 2015)(BEI 2012)(PER 2015)
Furthermore, UV exposure can enhance serum vitamin D levels and promote gut microbiome diversity, contributing to overall health.(PES 2021)
While phototherapy has its own side effects, one notable advantage over other severe eczema treatments, such as oral immunosuppressive drugs, is its localized action. By focusing treatment on affected areas, phototherapy minimizes exposure to the rest of the body, mitigating the risk of systemic side effects.
Common side effects of phototherapy include photodamage, xerosis (dry skin), erythema (skin redness), actinic keratosis (rough, scaly patches), sunburn, and skin tenderness.(PAT 2015) UV light can harm the microbiome, a critical player in managing inflammation.(BEI 2012)
Phototherapy can be costly and time consuming since a course often requires clinical presence multiple times a week for 12 weeks. There is also a reasonable proportion of patients who do not respond.(BEI 2012)
However, it is crucial to note that while phototherapy presents significant advantages, it does not negate the importance of conventional treatments.
In many cases, a combination of therapies tailored to individual needs proves to be the most effective approach. As always, any treatment plan should be discussed and overseen by a healthcare provider to ensure it's safe and effective for the patient's specific needs.
Phototherapy can be used to treat both acute and chronic atopic eczema. It is recommended for children and adults after the failure of: emollient use, topical steroids, TC inhibitors and lifestyle changes such as environmental trigger management.(SID 2014) UV-A1 is considered the preferred modality for acute sufferers whereas NB UV-B is preferred for chronic eczema sufferers.(PAT 2015)
In the cases where clinical application of UV therapies are not available or accessible, home kits are available for UV-A, NB UV-B and BB UV-B.(DER 2013) Heliotherapy is an alternative which can be effective with tolerable risks.
As always, suitability for this treatment should be evaluated by a medical professional on an individual basis, taking into account the patient's specific condition, treatment history, and overall health status.
While phototherapy offers promising benefits in managing eczema, it is essential to consider the safety measures and precautions associated with these treatments. Understanding the potential risks can help you make an informed decision and ensure you're taking the necessary steps to protect your health during treatment.
As a first step, it is important to know that not all forms of phototherapy are appropriate for everyone. Certain types of phototherapy may not be recommended for individuals with specific medical conditions, such as lupus or a history of skin cancer. If you have a history of liver disease, phototherapy may increase certain medication levels in your blood. Always discuss your medical history with your healthcare provider to ensure phototherapy is a safe option for you.
If you are pregnant or nursing, you will need to take extra precautions. NB UVB and BB UVB are considered safe for use in pregnant women, but can increase the risk for melasma (darker patches of skin on the face) and also deplete folic acid, a key vitamin in preventing neural tube defects.
Phototherapy can also make your skin more sensitive to sunlight. This means you may be more susceptible to sunburn while undergoing treatment. Protecting your skin by applying a broad-spectrum sunscreen of at least SPF 30-50, wearing protective clothing, and limiting sun exposure during peak hours can help mitigate this risk.
Certain medications can increase sensitivity to UV light, leading to a heightened risk of burns or other side effects. If you're taking any medications, ensure you discuss this with your healthcare provider before starting phototherapy.
Phototherapy, particularly treatments involving UV-A light, can accelerate skin aging and increase the risk of skin cancer over the long term. Regular skin examinations to detect any early signs of skin damage or skin cancer are crucial when undergoing long-term phototherapy treatment.
Finally, eye protection is essential during phototherapy sessions to protect your eyes from UV light exposure. Wearing special goggles designed to block UV light is typically recommended.
Remember, the best approach to phototherapy is a proactive one. Stay informed, take precautions, and always maintain open communication with your healthcare provider to ensure you're receiving the most beneficial and safest treatment for your eczema.
Phototherapy presents a promising treatment avenue for eczema, a skin condition that can often be challenging to manage. With the potential to reduce inflammation, alleviate itching, and improve overall skin health, light therapy for eczema is certainly worth considering.
However, as we've discussed, phototherapy is not a one-size-fits-all solution. Its effectiveness can vary from person to person, and there are important safety considerations and precautions to take into account. Different types of phototherapy, each with unique strengths and risks, offer various options for individualized treatment.
Remember, managing eczema often involves a journey of trial and error, patience, and perseverance. Exploring different treatment options, staying informed, and maintaining open dialogue with your healthcare provider are key steps toward finding relief. Phototherapy for eczema is a potential step on that journey, offering light at the end of the tunnel for many eczema patients.
Check the treatments section to learn more about other available therapies.
Immunosuppressants reduce immune system activity, aiding in controlling inflammation in stubborn eczema.
Immunosuppressants manage the symptoms of a flare but are not a long-term eczema cure. Accompanying efforts to strengthen the skin barrier and remove triggers are recommended.
Eczema is a chronic skin condition characterized by periodic acute flares, marked by red, itchy, and inflamed skin. The severity and duration of an acute eczema flare are influenced by three main factors:
Immune system sensitivity
Trigger intensity
Skin barrier strength
Long-term eczema management rests on strengthening the skin barrier and eliminating triggers. During an acute flare though, sometimes an extreme immune reaction can create significant symptoms and sustain the flare by attacking the skin barrier even when no triggers are present.
When more conventional treatments for inflammation relief, such as topical steroids and phototherapy, fail to provide enough suppression of the immune reaction relief, immunosuppressants may offer a viable alternative.
In this article, we will explore the role of immunosuppressants in treating the immune-related symptoms of an eczema flare, how they work, and the benefits and risks associated with their use.
Immunosuppressants are medications that reduce immune system activity, consequently reducing inflammation and symptoms related to inflammation. Examples of immunosuppressants used for eczema include cyclosporine, azathioprine, methotrexate, mycophenolate mofetil, and interferon gamma.
These medications are typically reserved for refractory (“resistant”) atopic eczema flares, a severe form of eczema flare characterized by increased levels of total serum IgE and positive skin tests to allergens such as dust mites, molds, and food.
While immunosuppressants can help manage symptoms during an acute flare, they are potentially disturbing the natural inflammatory process, and they are not a long-term cure for eczema. Their primary role is to control inflammation and provide symptomatic relief.
A weakened skin barrier, or an excess of triggers in the environment, are critical concerns that need to be addressed in tandem to any symptom relief.
Cyclosporine is a treatment option that has proven effective for patients with atopic eczema, including those who do not respond well to conventional topical treatments.(SID 2014)(TSU 2012)
Discovered in the 1970s, cyclosporine A (CSA) suppresses T cells and interleukin-2 production, which play a crucial role in the immune response. By inhibiting these cells, cyclosporine helps reduce inflammation and alleviate eczema symptoms.(SID 2014)
Cyclosporine has been shown to significantly reduce the severity and extent of eczema symptoms. Patients treated with CSA experienced a 55% decrease in total body severity assessment (TBSA) and a 40% reduction in the rule-of-nines area assessment (RoNAA), which measures the extent of the disease.(SID 2014) In a systematic review, cyclosporine was recommended as the first-line, short-term systemic treatment for atopic eczema due to its consistent efficacy in improving clinical signs.(ROE 2013)
Despite its benefits, cyclosporine is not without risks. Potential adverse effects include infection, nephrotoxicity, hypertension, tremor, hypertrichosis, headache, gingival hyperplasia, and increased risk of skin cancer and lymphoma. Patients receiving CSA should be closely monitored for these potential consequences, which may occur regardless of the daily dosage used.(SID 2014)
Azathioprine is another systemic agent recommended for treating refractory atopic dermatitis.(SID 2014)
As a purine analog, azathioprine inhibits DNA production, preferentially affecting cells with high proliferation rates like B cells and T cells during inflammatory disease states.(SID 2014)
Patients treated with azathioprine reported significant improvement in their dermatitis. After 12 weeks of treatment, the azathioprine group experienced a 37% improvement, compared to a 20% improvement with placebo.(SID 2014) In another study, azathioprine-treated patients saw a 26% reduction in their SASSAD (Six Area, Six Sign Atopic Dermatitis) score, while the placebo group only experienced a 3% reduction.(SID 2014)
While azathioprine can be beneficial, it may also cause side effects such as nausea, vomiting, bloating, anorexia, cramping, headache, hypersensitivity reactions, elevated liver enzymes, and leukopenia.(SID 2014) These side effects can lead to patient dissatisfaction and non-compliance with treatment.
Methotrexate is another systemic agent recommended for the treatment of refractory atopic dermatitis, with folate supplementation advised during treatment.(SID 2014)
Methotrexate is an antifolate metabolite that blocks the synthesis of DNA, RNA, and purines, negatively affecting T-cell function.(SID 2014)
Methotrexate has demonstrated efficacy in reducing eczema symptoms, with a 52% reduction in disease activity via SASSAD scoring. After 24 weeks of treatment and 12 weeks of follow-up, the mean disease activity remained 34% below baseline making Methotrexate's efficacy comparable to that of azathioprine.(SID 2014)
Methotrexate may cause nausea and other gastrointestinal symptoms, which may make oral administration challenging. Severe adverse effects, such as bone marrow suppression and pulmonary fibrosis, can occur, though bone marrow suppression is often reversible upon dose reduction or discontinuation.
Methotrexate has also been associated with an increased risk of skin cancer and lymphoma. Pulmonary fibrosis may occur with short or long-term use of the medication, making it unsuitable for patients with pulmonary diseases.
Mycophenolate mofetil is an alternative, variably effective therapy for refractory atopic dermatitis.(SID 2014)
Mycophenolate mofetil (MMF) is an immunosuppressant that inhibits the purine biosynthesis pathway of cells by blocking inosine monophosphate dehydrogenase. MMF selectively affects B-cells and T-cells, as other cells have purine scavenger mechanisms that compensate for this blockage, giving this medication a unique mechanism of action to treat inflammatory disorders.(SID 2014)
A study of 20 adult patients with moderate to severe AD treated with MMF found that 85% reported disease improvement within the first month, and 50% achieved disease clearance, allowing them to discontinue the medication.(SID 2014)
The initial response to MMF may be delayed, and common side effects include nausea, vomiting, and abdominal cramping. Rarely, hematologic (anemia, leukopenia, thrombocytopenia) and genitourinary (urgency, frequency, dysuria) symptoms have been reported.(SID 2014)
Interferon gamma is a moderately and variably effective alternative therapy for refractory AD in adults and children who have not responded to other systemic therapies or phototherapy.(SID 2014)
Interferon gamma (IFN-G) is a cytokine with a principal role in the innate and adaptive immune system cascade. It enhances natural killer cell production and increases macrophage oxidation, functioning as a biologic response modifier.
A study comparing 38 topic dermatitis patients receiving daily subcutaneous injections of IFN-G to 40 patients receiving placebo injections over 12 weeks found statistically significant improvements in IFN-G treated patients regarding erythema (p=0.035), excoriations and erosions (p=0.045), and conjunctivitis (p<0.002).(SID 2014)
Interferon gamma treatment may cause constitutional side effects such as fatigue, fever, nausea, vomiting, and myalgia.(SID 2014)
To determine whether immunosuppressants are the right treatment option for your eczema, consult with a healthcare professional who can evaluate your specific needs and medical history. Each immunosuppressant drug has its unique benefits and risks, so it is essential to thoroughly discuss these options with your doctor before making a decision.
Long-term management of eczema should include the identification and elimination of triggers and a strengthening of the skin barrier.
Check out our articles on moisturizing, avoiding triggers, controlling your immune system through diet and stress management.
Share your experiences with us! Tell us what has and hasn’t worked for you. What did we miss in this article that you've found personally impactful? Your insights can help others better understand and manage their eczema.
Monoclonal Antibodies (mAbs) offer targeted relief of acute eczema flare symptoms by moderating the immune response.
They can be a powerful tool when combined with systemic immune tools, skin barrier strengthening, and trigger avoidance.
Monoclonal antibodies have emerged as a promising and innovative treatment for eczema, providing significant relief during an acute flare.
Eczema is a chronic skin condition characterized by periodic acute flares, marked by red, itchy, and inflamed skin. The severity and duration of an acute eczema flare are influenced by three main factors:
In this article, we'll explore how monoclonal antibodies, such as Dupilumab (Dupixent), Tralokinumab (Adtralza or Adbry), and Lebrikizumab, work to modulate the immune response to alleviate the symptoms of an acute flare.
Monoclonal antibodies work well in people with an overactive immune system to help them regulate the inflammatory response, but they are not a cure for eczema. Long-term management of eczema should include the elimination of triggers and a strengthening of the skin barrier as well as natural systemic immune modulation like mental health and exercise.
Monoclonal antibodies (mAbs) are lab-engineered molecules designed to act like naturally occurring antibodies in the body. Just as the immune system creates antibodies to identify and neutralize foreign substances such as bacteria and viruses, monoclonal antibodies can be designed to target specific antigens, which are the unique proteins. Each monoclonal antibody is made to bind to a single antigen, which is why they are termed 'monoclonal.'
Once a monoclonal antibody binds to its target antigen, it can neutralize the activity of the agent. The precision with which monoclonal antibodies work allows them to be powerful tools in disease treatment with minimal impact on healthy cells and tissues.
Some atopic eczema patients have a dysregulation of their immune system which causes an increased number of type T2 helper cells (Th2 cells) to be produced in response to allergens or other triggers. The Th2 cells release proinflammatory cytokines, such as interleukin-4 (IL-4) and interleukin-13 (IL-13). As discussed in the [immune control] page, these cytokines play a central role in the development of atopic eczema by contributing to IgE production, histamine release, and factors that impair the skin barrier from repairing itself.(CHI 2020)
The impairing of the skin barrier repair causes the flare to persist and to be more susceptible to new triggers entering the skin. At the same time, the increased cytokines induce increased symptoms, like itchiness, which can increase stress levels and scratching, further stimulating the immune system and trigger entry.
Dupilumab is a monoclonal antibody that targets and inhibits IL-4 and IL-13, while Tralokinumab, and Lebrikizumab inhibit only IL-13.(SED 2022)(ROS 2019) By interrupting the signaling of these proinflammatory cytokines, these treatments can effectively reduce the symptoms of a dysregulated immune system around an acute eczema flare.
Monoclonal antibody treatments are administered via injection, with specific protocols for each drug. Dupilumab, for example, can be self-administered or given by a caregiver after proper training. For patients over 12 years old, one injection is given every two weeks, while 6 to 11-year-olds receive one injection every four weeks. The medication is available in pre-filled syringes or pens and must be stored in the refrigerator.(NES)
Similarly, Tralokinumab is administered through injections every two weeks. The first dose consists of four injections, followed by two injections every two weeks thereafter.(NES)
Lebrikizumab, which is pending FDA approval, will also be given as an injectable treatment.
Monoclonal antibodies have shown significant potential in treating eczema, with the possibility of long-term positive outcomes.
Benefits include:
Traditional eczema flare treatments often involve the use of topical corticosteroids or calcineurin inhibitors, which can effectively reduce inflammation and itchiness. However, they do not always control the disease in more severe cases and are more broad immune suppressor, leading to more side effects with long-term use.
Despite their promising therapeutic potential, monoclonal antibodies are not without their challenges. Side effects can occur, and these may range from mild to severe, such as:
There have been low rates of adverse events from phase 2 and 3 studies and therefore no reason to suspend use.(FER 2020)
Ultimately, monoclonal antibodies work by modulating the immune response, and this can increase susceptibility to certain infections and dysregulate the immune system.
At the root of eczema though, is a weakened skin barrier due to mutations in the body’s ability to build and repair the skin barrier. For long-term management of eczema, immune modulators should be used as part of a comprehensive treatment plan that may include skin barrier strengthening tools and strategies to avoid triggers.
Blepharitis is a condition that can cause conjunctivitis and is often caused by an overgrowth of staphylococcus or dysfunction of the meibomian glands. These glands, located at the base of the eyelashes, lubricate the eyes, but if they become capped for too long, they can die off, leading to lifelong dry eyes.
Therefore, it is important to use warm compresses and eyelid manipulations to loosen the caps. Eye drops can also be used to alleviate dryness, itchiness, and prevent infections.(OPT)
One of the more common side effects of dupilumab treatment is the worsening of face and neck eczema. Due to the thinness of the skin in these areas, topical calcineurin inhibitors are a preferable treatment over topical steroids, which are not recommended for use on the face.
If you have seborrheic eczema, it is important to discuss the use of antifungal shampoos with your doctor, such as ketoconazole (Nizoral) or maximum strength Selsun Blue. Zinc shampoos like DHS Zinc Shampoo 2% are also useful for treating seborrheic eczema (dandruff) by healing the scalp and normalizing epithelial keratinization, sebum production or both.
Coconut oil has antimicrobial properties which can be beneficial.(LIN 2018) In addition, supporting the microbiome in the affected areas can also help improve the condition of the skin.
Monoclonal antibodies represent a highly targeted approach in the management of eczema flares. By targeting specific proteins that drive the inflammation characteristic of certain people with eczema, monoclonal antibodies offer a targeted, effective treatment strategy. They have shown considerable promise in alleviating symptoms, improving skin health, and enhancing the quality of life for individuals with moderate to severe eczema.
Currently, these treatments are mainly accessible to those with severe eczema, trial patients, or individuals who can afford the cost.
As monoclonal antibody treatments require medical intervention for administration, it is crucial to discuss your options with a healthcare professional, such as a dermatologist, before deciding if this treatment is the right choice for you.
We understand that navigating the world of eczema treatments can be complex, and you may have further questions or concerns about monoclonal antibodies. Please feel free to reach out to us for more information. We are committed to helping you better understand your treatment options and empowering you to make informed decisions about your health.
Allergies occur when the immune system misidentifies a harmless substance (allergen) as a pathogen and attacks it.
Intolerances result from the body's inability to properly process certain substances.
Both can cause eczema flares. Learn how to identify which allergies and intolerances may be affecting your eczema.
Eczema is a chronic skin condition characterized by periodic acute flares, marked by red, itchy, and inflamed skin. It is believed to be caused by a combination of genetic, environmental, and immunological factors.
The severity and duration of an acute flare is a product of three main factors:
Skin barrier strength: affecting the permeability of the skin, how strong it is and how quickly it can heal
Immune system sensitivity: affecting the aggressiveness of the immune system, how quickly it reacts, and how quickly it shuts down a reaction
Triggers: something the body has an immune reaction to
In this article, we will delve into the role that allergies and intolerances play in eczema and provide insights into managing these aspects of your health to better control your eczema flares.
The immune system is a complex and sophisticated system that is designed to defend the body against foreign substances and dispose of pathogens to keep you alive and healthy.
In some cases, the immune system has falsely learned that a harmless substance is a pathogen and attacks it with vigor.(DAV 2011) This unnecessary response is called an allergy and the generally harmless substance is called an allergen.(ALL 2023)
Allergic reactions can be classified into four main types, based on the immune response involved. These are known as Type I, Type II, Type III, and Type IV hypersensitivity reactions.
Type I and Type IV reactions are involved in eczema. Type I reactions are felt almost immediately while Type IV reactions are delayed, making it more difficult to track down the trigger.
Allergies and intolerances can trigger and exacerbate eczema symptoms, with the severity of these symptoms varying between individuals. The intensity and duration of an eczema flare-up are influenced by three main factors:
Skin barrier strength
Immune system activation
The amount of environmental triggers present
A weakened skin barrier allows lower amounts of an allergen to trigger a flare-up and for flare-ups to be more intense of an equal amount of allergen. The flare-up lasts longer with a weaker skin barrier due to the skin's slower repair process compared to someone with a stronger skin barrier.
Similarly, an overactive immune system intensifies a flare-up and prolongs its duration, even when the allergen amount is the same as that in someone without an overactive immune system. Understanding these factors helps to manage eczema symptoms more effectively.
Allergies occur when the body reacts inappropriately to generally harmless substances. These reactions are learned and, as a result, differ from one person to another.
The following sections contain potential allergens to which some individuals might react, while others may not. Nonetheless, if you are attempting to identify your trigger, these common allergens are a good starting point for devising a plan to assess your personal sensitivity.
Some common environmental allergens include:
Dust mites: Microscopic organisms that live in household dust.
Pollen: Fine powdery grains released by plants for reproduction.
Mold: Fungi that release spores into the air.
Pet dander: Tiny particles of skin and hair from pets.
Household cleaning agents, including laundry detergents and fabric softeners, contain ingredients intended to break down and separate organic molecules. These same ingredients can also act as potential allergens or irritants for individuals with sensitive skin or eczema. For instance:
Being aware of these potential sources of allergens can help minimize the risk of eczema flare-ups.
Your nose reacts to (e.g “smells”) scents in the world. Those scents are made up of volatile organic compounds.
Volatile organic compounds are natural or synthetic ingredients that may trigger an allergic reaction or irritate the skin.
In particular, fragrance chemicals such as limonene, linalool, and geraniol are known to cause skin reactions in sensitive individuals.
Look for fragrances in cleaning products and personal care products and be mindful of scents emanating from sources like barbecues, candles, and cooking, as they may contain irritants that aggravate eczema symptoms.
Where there is water, there is microbial growth, which can lead to allergic reactions or infections. As a result, manufacturers typically add preservatives to slow down or halt microbial growth.
Traditional preservatives, such as sugar, alcohol, and salt, require relatively high concentrations in the final product to be effective. However, scientists have discovered preservatives that function in smaller quantities, allowing for a higher proportion of functional ingredients in the end product.
Individuals may develop sensitivities to these preservatives.
Formaldehyde, methylisothiazolinone (MI), and parabens, are preservatives that can cause skin irritation, inflammation, and allergic contact dermatitis. They may also cause cross-reactivity with other chemically similar substances.
Colorants, comprising synthetic dyes and pigments, are often added to personal care and household products to enhance their visual appeal. However, some individuals may have sensitivities to these colorants, leading to skin reactions or allergic responses.
Examples of synthetic colorants known to cause allergic reactions include P-phenylenediamine (PPD) found in hair dyes and disperse dyes used in textiles. In addition, though less common, natural colorants such as henna or annatto can also provoke allergic reactions in some people.
Certain foods are well-known culprits for triggering allergies including:
Dairy
Nuts (especially peanuts)
Soy
Shellfish
The effects of these allergens on individuals can vary, depending on factors such as seasonality, environment, and genetic predisposition.
A weakened skin barrier may allow dietary allergens to penetrate the skin, initiating a direct reaction on the skin surface.
Minimizing eczema symptoms often involves identifying any allergies that may be contributing to your flare-ups. You can take the following steps to pinpoint potential allergens:
By identifying and managing your exposure to allergens, you can better control your eczema symptoms and reduce the frequency and severity of flare-ups.
Eczema symptoms are a product of:
The amount of environmental triggers present
Skin barrier strength
Immune system activation
By addressing each these three factors, you can better manage your eczema symptoms. Here are some steps to consider:
Maintain a clean environment: Regularly clean your living space to reduce the presence of allergens like dust mites, pet dander, and mold. This may involve frequent vacuuming, dusting, and using air purifiers to improve indoor air quality.
Use hypoallergenic products: Opt for skincare products, laundry detergents, and household cleaners that are free of your known allergens or formulated specifically for sensitive skin.
Adjust your diet: Based on allergy and intolerance testing results, modify your diet to avoid trigger foods. Work with a registered dietitian or nutritionist to create a balanced diet that supports your overall health while eliminating allergens.
Intolerances, also known as non-allergic hypersensitivities, are adverse reactions to specific substances or ingredients that occur without the involvement of the immune system. In contrast, allergies are immune-mediated reactions to substances that are typically harmless for most people. While both intolerances and allergies can lead to uncomfortable symptoms, their underlying causes and mechanisms differ.
Intolerances typically result from the body's inability to properly digest, absorb, or process a particular substance. Common examples include lactose intolerance, where an individual lacks the enzyme lactase to break down lactose found in dairy products, or gluten sensitivity, where the body has difficulty processing gluten found in wheat and other grains.
Intolerances can cause a range of gastrointestinal symptoms, such as bloating, gas, and diarrhea, but may also result in skin issues like eczema flare-ups in some individuals.
Intolerances can exacerbate eczema symptoms by causing additional inflammation in the body and, at times, directly affecting the skin. When the immune system is activated due to an intolerance, it can amplify the skin's reaction to a trigger, even if the trigger level was previously tolerable without causing a flare-up. This heightened sensitivity can lead to more frequent or severe eczema flare-ups.
The severity and specific symptoms of eczema can vary from person to person, depending on each individual's sensitivity to particular intolerances. In some cases, managing intolerances through dietary and lifestyle changes can significantly improve eczema symptoms, while others may require additional treatment or intervention to achieve optimal results.
Common intolerances that can contribute to eczema include:
Lactose intolerance: Occurs when the body lacks sufficient lactase, the enzyme required to break down lactose, a sugar found in dairy products. This can lead to gastrointestinal symptoms and increased immune activity.
Gluten intolerance: A sensitivity to gluten, a protein found in wheat, barley, and rye. For some individuals, consuming gluten can cause gastrointestinal symptoms increased immune activity.
While intolerances are generally associated with digestion, a weak skin barrier can allow substances to pass through the skin and into the body, where they can act as irritants.
Preparing food, even if not consumed, can cause someone with an intolerance to experience an eczema flare.
Some people with eczema may be intolerant or sensitive to specific fabrics, such as wool or synthetic materials. These fabrics can cause friction or irritation on the skin, leading to discomfort and potentially triggering or worsening eczema symptoms. Opting for soft, breathable, and natural fabrics like cotton can help reduce irritation and promote overall skin health for individuals with eczema.
Diagnosing and managing intolerances typically involves the following steps:
Keep a food diary: Record everything you eat and any symptoms experienced to help identify potential triggers.
Elimination diet: Remove the suspected trigger food from your diet for a period of time (usually 2-4 weeks) and monitor your symptoms. If symptoms improve, the trigger food may be reintroduced to see if they return.
Consult a healthcare professional: If you suspect an intolerance, consult with a healthcare professional for guidance on diagnosis and management.
Managing intolerances involves avoiding or limiting intake of the offending substances, which can help reduce eczema flare-ups and improve overall skin health.
Effectively managing your intolerances can play a crucial role in controlling eczema symptoms and improving your overall skin health. Here are some strategies to help you navigate through the challenges posed by intolerances and maintain healthier skin:
By identifying and managing your intolerances, you can take a proactive approach to reduce eczema flare-ups and improve your overall skin health.
Genetics plays a significant role in the development of eczema and an individual's susceptibility to allergies and intolerances. Research has shown that eczema is strongly linked to genetic factors, particularly the loss-of-function mutations in the filaggrin gene. Filaggrin is a crucial protein for maintaining the skin's barrier function, and a deficiency can lead to a compromised skin barrier, making it more susceptible to allergens and irritants.
In addition to genetic predisposition to eczema, some individuals may inherit a genetic predisposition to allergies and intolerances. Allergic diseases like asthma, hay fever, and food allergies tend to run in families, suggesting a strong genetic component.
The term "atopic triad" refers to the combination of three related allergic conditions: eczema, allergic rhinitis (hay fever), and asthma. Many individuals with eczema also suffer from one or both of these other conditions, highlighting the interconnected nature of these diseases.
Research suggests that the genetic factors that contribute to eczema may also play a role in the development of other atopic conditions.
Managing eczema in the context of the atopic triad may require a more holistic approach to treatment, taking into consideration the potential impact of other atopic conditions on eczema symptoms and the need for a coordinated management plan.
Given the complex nature of eczema and its relationship with allergies and intolerances, it is crucial to develop a comprehensive management plan that addresses all contributing factors. This may involve:
Regular visits with a healthcare professional: Consulting with a dermatologist, allergist, or primary care physician to monitor your eczema symptoms, discuss treatment options, and adjust your management plan as needed.
Collaboration with other specialists: Depending on your specific needs, you may benefit from working with other healthcare professionals, such as a dietitian or a mental health professional, to address various aspects of your eczema management.
Personalized treatment: Tailoring your treatment plan to your specific triggers, allergies, and intolerances, as well as other factors that contribute to your eczema, will help optimize symptom control.
Continual education: Staying informed about the latest research and treatments in eczema management can help you make the best decisions for your skin health.
In summary, allergies and intolerances can play a significant role in eczema, impacting both the frequency and severity of flare-ups. Identifying and managing these triggers through allergy and intolerance testing can help you tailor your lifestyle for better eczema symptom control.
It is crucial to remember that eczema is a multifactorial condition, and allergies and intolerances are just some of the many factors that can contribute to its development and exacerbation.
We encourage you to explore other factors and treatments by engaging with our other content, as a comprehensive approach is key to effectively managing this complex skin condition.
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Janus Kinase inhibitors (JAK inhibitors) offer temporary relief for the symptoms associated with acute flares, but do not repair the skin barrier or block triggers.
JAK inhibitors are most effective for patients with an overactive immune system.
Eczema is a chronic skin condition characterized by periodic acute flares, marked by red, itchy, and inflamed skin. The severity and duration of an acute eczema flare are influenced by three main factors:
For eczema sufferers, managing the symptoms of acute flares can feel like a constant battle. In the ceaseless quest for more effective solutions, scientific and medical research has led us to Janus Kinase inhibitors, commonly known as JAK inhibitors. JAK inhibitors offer various ways to address the symptoms of an acute flare.
JAK inhibitors do not eliminate triggers nor do they directly repair the skin barrier and therefore are effective only during acute flares for the temporary management of symptoms related to inflammation.
In this blog post, we will discuss JAK inhibitors, how they work, their potential benefits and challenges, and whether they might be a suitable treatment option for you.
To understand what a JAK inhibitor is and how it works, it is important to first understand a little bit about the role of Janus Kinase (JAK) proteins in our bodies.
JAKs are a family of enzymes that play a crucial role in the signaling process for the body's immune response. They activate certain types of immune cells and inflammatory processes.
Some atopic dermatitis sufferers may have a genetic mutation which causes the body to “overreact” during a flare. A JAK inhibitor, therefore, is a type of drug designed to impede these enzymes, effectively dampening the immune response in a way where the immune system is not able to property balance itself during a flare.
JAK inhibitors are classified into types based on which JAK enzymes they inhibit. One type that has shown promise in the treatment of eczema flares in certain people is the JAK1 inhibitor. These specifically target and inhibit the activity of JAK1, an enzyme that plays a vital role in the immune response and inflammation pathways.
JAK inhibitors, including JAK1 inhibitors, represent a unique and targeted approach to treating eczema. By focusing on a key player in the immune response and inflammation, these drugs offer a potential new way to control eczema symptoms more effectively for the right patients.
Examples of JAK inhibitor medications include baricitinib, opzelura, ruxolitinib, tofacitinib, and momelotinib. Approved JAK inhibitors in the United States include abrocitinib (Cibinqo), upadacitinib (Rinvoq), and ruxolitinib (Opzelura). Other JAK inhibitors, such as baricitinib (approved in Europe as Olumiant), tofacitinib, gusacitinib, and momelotinib, are at different stages of development.
To understand how JAK inhibitors work, we need to look at the role of cytokines in our immune system. Think of cytokines as messengers that help cells communicate and orchestrate the immune response, as discussed in understanding immune control for eczema.
When these messengers bind to receptors on target cells, they trigger the JAK-STAT pathway, a signaling system that regulates gene expression and helps the cell take action.(YAM 2004)
In certain eczema sufferers, an imbalance in Th2 cells leads to an overproduction of pro-inflammatory cytokines. These cytokines are responsible for many of the symptoms associated with eczema, such as inflammation, itching, and skin barrier dysfunction.
JAK inhibitors work by blocking cytokines from binding to the Janus kinase receptors, thus reducing inflammation and improving eczema symptoms.(TRA 2021)
JAK inhibitors come in oral and topical forms, allowing for different methods of application. Depending on the specific JAK inhibitor used, it may be taken orally once or twice a day.(TRA 2021) Topical JAK inhibitors can be applied directly to affected skin areas, often in combination with topical steroids for improved efficacy without compromising the safety profile.(SED 2022)(REI 2020)
JAK inhibitors offer several advantages, including their non-steroidal nature, significant improvement in the area and severity of eczema coverage, rapid itch relief, and overall enhancements in quality of life.
Studies have shown that abrocitinib and upadacitinib can be particularly effective in achieving rapid symptom relief for moderate to severe eczema flares, even outperforming Dupilumab in some metrics.(SED 2022)(TRA 2021) See monoclonal antibodies for more on Dupilumab.
Topical JAK inhibitors, such as delgocitinib, have also shown promising results, with significant reductions in eczema flare severity and itchiness observed within hours of application, no systemic side effects and overall moderate efficacy.(TRA 2021)(HOS 2018)
While JAK inhibitors hold promise, they also have some limitations. The FDA has approved the medication with a ‘black box warning’, highlighting there is a high uncertainty about the potential risks of using these medications. Additional limitations include cost, long-term effects, and limited real-world knowledge of their safety and efficacy.
Some common, less serious side effects of JAK inhibitors include nausea, indigestion, diarrhea, and headaches. As an immunosuppressant, there is a higher risk of infections, including in the upper respiratory tract.(TRA 2021) However, the black box warning indicates that JAK inhibitors may increase the risk of infection, cancer, cardiovascular disease, heart attack, stroke, and blood clots. Moreover, they can trigger a drop in platelet, red blood cell, and white blood cell counts.(KEY 2022)
JAK inhibitors may also cause higher cholesterol levels, but more significant side effects can be screened for by identifying risk factors beforehand.(SAM 2023)
Ultimately, it is important to understand that while JAK inhibitors can help manage symptoms during an acute flare, they are best used for people with an overactive immune system, and they are not a long-term cure for eczema. Their primary role is to control inflammation and provide symptomatic relief.
A weakened skin barrier, or an excess of triggers in the environment, are critical concerns that need to be addressed in tandem to any symptom relief for long-term management of eczema.
JAK inhibitors represent a promising advancement in eczema treatment, but it's essential to consult with a medical professional before considering them as an option; see the doctors page for more tips on how to approach this. Although these medications have shown potential in clinical trials, more information and research are needed to fully understand their long-term implications.
JAK inhibitors offer a new treatment avenue for eczema sufferers, particularly those with an overactive immune system in the area where JAK inhibitors function. However, they are not a cure. Long-term management should include the identification and elimination of triggers and a strengthening of the skin barrier.
For more medical treatment options, see the pages for immunosuppressants, phototherapy, monoclonal antibodies, and TC Inhibitors.
Seek proper medical advice to determine if JAK inhibitors are the right choice for you.
Share your experiences with us! Tell us what has and hasn’t worked for you. What did we miss in this article that you've found personally impactful? Your insights can help others better understand and manage their eczema.