Can’t Identify Your Eczema Triggers? These Factors Might Be Contributing

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

Some of the potential benefits of using herbs and supplements for eczema include:

• They may help reduce inflammation, which is a key factor in eczema flare-ups. For example, fish oil, turmeric, and zinc are known to have anti-inflammatory effects.
• They may help soothe itching, which can be very distressing and lead to scratching and skin damage. For example, chamomile, aloe vera gel, and calendula cream are reported to have anti-itch properties.
• They may help promote wound healing and prevent infections, which can complicate eczema. 

Some of the potential risks of using herbs and supplements for eczema include:

• They may cause allergic reactions or skin irritation, especially if the person has sensitive skin or is allergic to any of the ingredients. For example, some people may experience contact dermatitis from topical applications of chamomile or evening primrose oil.
• They may interact with medications or other supplements, which could affect their effectiveness or safety. For example, fish oil may increase the risk of bleeding if taken with blood thinners, and turmeric may lower blood sugar levels if taken with diabetes medications.
• They may not be regulated or tested for quality, purity, or safety by the Food and Drug Administration (FDA) or other authorities. This means that some products may contain contaminants, additives, or incorrect dosages of the active ingredients.

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:

• Bisphenol A (BPA) is a chemical used to make polycarbonate plastics and epoxy resins, which are found in many food and beverage containers, such as water bottles, cans and baby bottles. BPA can leach into the food or drink and enter your body. BPA has been linked to reproductive disorders, diabetes, obesity and cardiovascular disease.
• Phthalates are chemicals used to make plastics more flexible and durable, such as PVC pipes, vinyl flooring, shower curtains and toys. They are also used as solvents or fragrances in cosmetics, detergents, nail polish and perfumes. Phthalates can enter your body through ingestion, inhalation or skin contact. Phthalates have been associated with reproductive abnormalities, asthma, allergies and obesity.
• Parabens are preservatives used to prevent microbial growth in cosmetics and personal care products, such as shampoo, lotion, deodorant and makeup. Parabens can be absorbed through the skin and act as weak estrogen mimics in the body. Parabens have been implicated in breast cancer, infertility and thyroid dysfunction.
• Triclosan is an antibacterial agent used in some soaps, toothpastes, mouthwashes and cleaning products. Triclosan can disrupt the thyroid hormone function and affect the immune system.

While it may be impossible to avoid EDCs completely, there are some steps you can take to reduce your exposure and protect your health:

• Choose glass, stainless steel or ceramic containers for food and drinks instead of plastic ones. Avoid heating food or beverages in plastic containers or using them for acidic or fatty foods that can leach more chemicals.
• Look for products that are labeled as BPA-free, phthalate-free or paraben-free. Read the ingredients list carefully and avoid products that contain these chemicals or their abbreviations (such as DEHP for diethylhexyl phthalate) .
• Opt for natural or organic cosmetics and personal care products that do not contain synthetic fragrances, colors or preservatives. You can also make your own products using simple ingredients like coconut oil, baking soda, vinegar and essential oils.
• Wash your hands frequently with plain soap and water instead of antibacterial products that contain triclosan. Avoid using triclosan-containing products around children or pregnant women.
• Eat organic fruits and vegetables whenever possible to avoid pesticide residues. Wash and peel non-organic produce before eating. Choose organic or hormone-free meat and dairy products to avoid exposure to hormones or antibiotics given to animals.
• Filter your tap water to remove contaminants like chlorine, fluoride, lead and other chemicals that can affect your hormones. Use a reverse osmosis system or a carbon filter for best results.

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.

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.

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:

• Brush your teeth twice a day with a soft-bristled toothbrush and fluoride toothpaste to remove plaque and bacteria from your teeth and gums.
• Floss your teeth once a day to remove food particles and bacteria from between your teeth and gums.
• Rinse your mouth with water or mouthwash after eating or drinking to wash away any residue that can cause cavities or gum disease.
• Visit your dentist regularly for check-ups and cleanings to detect and treat any dental issues before they become serious.
• Avoid smoking, alcohol, sugary drinks, and acidic foods that can damage your teeth and gums and affect your oral microbiome.
• Consider using natural or organic oral care products that do not contain harsh chemicals, artificial flavors, or colors that can irritate your skin or mouth.
• Consult with your dentist about any dental procedures or materials that may affect your eczema symptoms or allergies.

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:

• Pay attention to any signs or symptoms of dental issues, such as tooth pain, sensitivity, discoloration, bad breath, bleeding gums, swelling, pus, fever, or headache.
• Ask your dentist to perform a comprehensive oral examination and take X-rays to detect any hidden dental issues that may not be visible to the naked eye.
• Ask your dentist to test you for any allergies or sensitivities to dental materials or metals that may be causing an adverse reaction in your skin or body.
• Ask your dentist to remove any dental materials or metals that may be causing an allergic reaction.