Eczema Triggers: Identifying What Causes Flare-Ups

Eczema is a chronic skin condition that affects an estimated 10-20% of children and up to 10% of adults worldwide. Characterized by inflamed, itchy, and often painful skin, eczema can significantly impact quality of life, disrupting sleep, productivity, and emotional well-being. 

Eczema flares – periods when symptoms worsen – are often triggered by environmental, dietary, or stress-related factors. Identifying and managing these triggers is indispensable to long-term control and remission of symptoms. Therefore, trigger avoidance is one of the foundational strategies for effective eczema management, helping to prevent the cycle of inflammation and discomfort.

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Understanding Eczema Triggers

Eczema refers to several subtypes of eczematous skin conditions, many of which are related to allergies. 

The most common type of eczema is atopic dermatitis: 

• "Atopy" refers to the tendency to promote exaggerated allergic immune responses 
• "Dermatitis" means inflammation of the skin

Eczema is a multifactorial condition caused by a combination of immune system dysfunction, genetic predisposition, and exposure to environmental and emotional triggers. People with eczema have hypersensitive immune systems that overreact to minor environmental irritants or allergens. When exposed to these triggers, the immune system mistakenly identifies them as harmful invaders and responds by promoting inflammation. This inflammation manifests as the classic symptoms of eczema: redness, itching, and skin swelling. (9) 

Genetics also plays a significant role in eczema. People with a family history of eczema, asthma, or allergies are more likely to develop the condition. Mutations in the filaggrin (FLG) gene lead to a weakened skin barrier. Even in the absence of these mutations, the characteristic immune system dysregulation of eczema suppresses filaggrin production. Reductions in the filaggrin protein weaken the skin's barrier, allowing allergens and irritants to penetrate more easily and exacerbate eczema symptoms. 

Common Eczema Triggers

A variety of well-documented factors can trigger eczema flares. We'll discuss these in more detail, but it's important to recognize that eczema triggers are not universal: what causes one person's eczema to flare may differ from another's. 

Environmental Irritants

Exposure to environmental irritants can perpetuate skin barrier dysfunction and inflammation. Patients with eczema have lower thresholds for environmental chemicals ubiquitous in everyday life, including: 

• Soaps
• Detergents
• Cleaning products
• Skincare products
• Fragrances
• Air pollution
• Tobacco smoke

Allergens

Th2 skewing is a term used to describe an imbalance in the immune system that is often seen in people with eczema and allergies. In a healthy immune system, different parts work together to protect the body from harmful things like germs. But in people with eczema and allergies, the immune system has an imbalance that makes it react strongly to ordinarily harmless things, like dust, pollen, or certain foods. Exposure to these allergens stimulates inflammatory allergic immune responses, exacerbating eczema symptoms. 

Eczema can exhibit seasonal patterns when triggered by environmental allergens, depending on the specific allergens and their seasonal prevalence. Common environmental triggers of eczema include: 

• Dust mites
• Pollen
• Pet dander
• Mold

Food allergies affect one-third of children with moderate-to-severe atopic dermatitis. More than 90% of food allergies in children with atopic dermatitis are caused by:

• Tree nuts
• Chicken egg
• Wheat
• Peanuts
• Milk
• Soy
• Fish (31) 

Contact dermatitis is a type of eczema that occurs when the skin comes into direct contact with an allergen or irritant, triggering a localized immune response that results in skin rash and inflammation. In the United States, poison ivy is the most common cause of contact dermatitis, but nickel and fragrances are other common culprits.

Climate and Weather Conditions

Climate and weather conditions can significantly affect eczema, often in complex ways. Some studies suggest that warmer temperatures might be associated with less severe eczema by reducing the need for indoor heating and potentially increasing ultraviolet (UV) exposure. However, other research indicates that high temperatures cause sweating, which can irritate the skin and worsen eczema. (30) 

Humidity also impacts eczema differently: higher humidity can help prevent skin dryness but might increase sweating. Conversely, low humidity can worsen eczema by increasing skin dryness and reducing essential skin proteins like filaggrin. (30) 

Stress and Emotional Factors 

Emotional and physical stress triggers the body's stress response and release of stress hormones, like cortisol. Over 30% of people with atopic skin diseases have emotional disorders, like anxiety and depression, which have been associated with elevated cortisol levels. In large amounts, cortisol can contribute to immune dysregulation and increase systemic inflammation.

Skin Trauma

Physical irritation to the skin, possibly caused by scratching, rubbing from tight or rough clothing, over-bathing, and bug bites, can worsen eczema (18, 35). 

The "itch-scratch cycle" is a common obstacle people living with eczema must try to overcome. Intense itching is a hallmark symptom of eczema, leading many people to scratch the affected skin. Unfortunately, scratching will further disrupt the skin's barrier and cause more inflammation. 

Hormonal Changes

Hormones are chemical messengers produced by glands in the body that regulate various physiological processes, including the immune system and skin health. During certain life stages, it is normal to experience hormonal fluctuations. These changes often mark changes in eczema symptoms. For example, children may notice improvement/resolution in eczema during puberty, which is correlated to hormonal surges and increased sebum production. Women often notice worsening eczema symptoms during pregnancy or at specific points during their menstrual cycle when estrogen and progesterone levels are changing. 

Infections

People with eczema often have reduced levels of β-defensins, proteins that play a crucial role in protecting the skin from infectious agents. The decreased presence of these antimicrobial peptides makes the skin more vulnerable to colonization and infection by opportunistic pathogens, such as Staphylococcus aureus and Candida albicans. (9) 

How to Identify Your Personal Eczema Triggers

Given the critical role that personal triggers play in influencing eczema severity and disease outcomes, identifying these triggers is essential for effective eczema management and flare prevention. Various methods can help you do this.

Keeping a detailed diary of eczema symptoms and flare-ups is a widely recommended approach. This method helps in recognizing correlations between eczema flare-ups and specific factors to identify disease patterns and potential triggers. Patients who keep records of their symptoms tend to have improved quality of life and reduced disease severity. 

‍Elimination diets remain the gold standard for diagnosing food sensitivities, which are IgG-mediated immune responses to food proteins (and different from food allergies). Children with eczema are more likely to have food sensitivities, particularly to dairy, gluten, and eggs, than those without (24). An elimination diet involves removing specific foods from the diet to determine if they are contributing to eczema flare-ups. A general elimination diet that successfully removes triggering foods can reduce the severity of atopic dermatitis by up to 70%.

Allergy testing includes blood tests and skin prick tests. Skin testing is the gold standard for diagnosing allergies; however, elevated blood IgE levels are the most consistent laboratory finding in eczema patients, measured in approximately 80% of cases. 

Examples of serum allergy panels available for order through Rupa Health include:

• IgE Allergy Explorer by Diagnostic Solutions
• Environmental Allergy Test (88 Antigen IgE) by Infinite Allergy Labs
• IgE Food Antibodies by Genova Diagnostics

Creating a Trigger Management Plan

Identifying personal eczema triggers empowers you with the knowledge necessary to create an individualized trigger management plan:

Avoid Food and Environmental Triggers

Eliminate identified food allergies and sensitivities from the diet. Keep a diet diary to help track which foods you consume and how they affect your skin. Working with a nutritionist or dietician can help ensure you avoid triggering foods while meeting your nutritional needs. 

To reduce environmental allergen load, use air purifiers, keep windows closed during high pollen seasons, and wash bedding regularly in hot water. Ensure any pets in the household are kept clean, and consider keeping them out of bedrooms. (26) 

Avoiding Chemicals and Irritants in Skincare Products

Choose skincare products labeled as hypoallergenic, fragrance-free, and free from harsh chemicals. Common irritants include alcohol, artificial colors, and sodium lauryl sulfate.

The Environmental Working Group's (EWG) Skin Deep database is a valuable resource for individuals with eczema because it provides comprehensive information on the safety and ingredients of a wide range of personal care products.

Managing Stress  

You may not always be able to avoid stress, but you can utilize stress-relieving practices to keep it from getting too overwhelming: 

• Stimulate the parasympathetic nervous system by practicing mind-body therapies, such as meditation, yoga, or acupuncture
• Supplement with ashwagandha or other adaptogenic herbs to reduce cortisol and inflammation
• Prioritize getting enough quality sleep

Preventive Tips for Reducing Flare-Ups

Unlocking radiant skin involves more than just addressing surface-level symptoms; it requires a comprehensive approach that works from the inside out.

Eat a diet rich in nutrients that are required for healthy skin, including: 

• Collagen
• Omega-3 fatty acids
• Vitamin A
• Vitamin C
• Vitamin E
• Zinc

Because the skin's outer layer contains about 30% water, dehydration can exacerbate dry, cracked skin. A general rule of thumb to avoid being dehydrated is to drink half your body weight in ounces of water daily.

Moisturizing regularly helps maintain the skin barrier and trap moisture in. Using moisturizers will reduce the severity of eczema symptoms, flare frequency, and the need for topical corticosteroid medications.

The higher the oil content a moisturizer has, the better it will treat eczema. Ointments, creams, and skin barrier creams effectively lock moisture into the skin. Aveeno parabens lotion, Cerave moisturizing cream, and Cetaphil lotion are designed specifically to treat eczema-prone skin. (32) 

Moisturizers infused with the following ingredients can also add additional anti-itch and anti-inflammatory benefits:

• Oat
• Shea butter
• Aloe
• Hyaluronic acid
• Vitamin E
• Niacinamide
• Ceramides (32) 

When to See a Dermatologist

Schedule an appointment with a dermatologist to discuss managing your eczema if you experience any of the following:

• Persistent or worsening eczema despite treatment
• Frequent eczema flares
• Signs of infection, such as increased redness, pain, swelling, pus, and fever
• Severe symptoms that interfere with daily living or emotional health (18) 

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Key Takeaways

• Eczema is a prevalent chronic skin condition, but that doesn't mean it has to control your life.
• By understanding what specifically exacerbates your symptoms, you can proactively avoid these triggers and minimize flare-ups.
• Being vigilant about your environment, skincare products, and dietary choices, while also addressing stress and seeking professional medical advice, forms a comprehensive strategy for eczema management. 
• A combination of lifestyle adjustments and personalized medical guidance can significantly enhance your ability to control eczema.