What causes eczema flare-ups? Common triggers

Eczema is a long-term skin condition that comes and goes, and a doctor confirms the diagnosis. The times when it gets worse are called flare-ups. The things that set off a flare-up are called triggers. This guide lists the common triggers named by the NHS, the American Academy of Dermatology (AAD), MedlinePlus and NIAMS, explains how to find your own, and says when a flare needs a doctor. A trigger is different from a cause. The guide to what causes eczema explains why people have eczema in the first place, and the complete guide to eczema covers the whole condition.

What a flare-up looks like

NICE, the UK body that writes guidance for doctors, describes the signs of a flare as increased dryness, itching, redness, swelling and general irritability. The AAD says a flare can start in one area while another heals, and that flares often return to the same place again and again. The guide to what eczema looks like shows how flares appear on different skin tones.

The common triggers

The AAD says anything that causes eczema to flare is known as a trigger, and that different people have different triggers. The main groups are below.

Things that touch your skin

• Soap and detergent. The NHS lists soap and washing detergent among the things that make atopic eczema worse. The NHS page on moisturizers says everyday soaps, shampoos and shower gels usually dry out the skin and can make eczema worse. The AAD lists harsh detergents.
• Fragrance. The AAD says fragrance can cause atopic dermatitis to flare, and advises using only products labelled "fragrance free." It warns that "unscented" means the fragrance has been covered up, and that it can still trigger a flare. MedlinePlus lists perfumes and dyes added to lotions or soaps.
• Rough fabrics. MedlinePlus names rough materials such as wool. The AAD advises never wearing wool next to the skin and choosing loose, 100 percent cotton clothing.
• Skin care products. The AAD lists skin care products among common triggers, and says other ingredients besides fragrance can cause a flare. It suggests testing new products first, as described below.
• Metals. For pompholyx, a type of eczema on the hands and feet, the NHS lists an allergy or sensitivity to metals such as nickel or cobalt.

Heat, cold and the air

• Heat and sweat. The NHS lists heat and changes in temperature, and says being hot can make eczema itchier. The AAD says sweat from overheating can trigger a flare-up.
• Cold, dry air. MedlinePlus lists cold and dry winter air. The AAD says cold temperatures dry the skin, which can make atopic dermatitis flare.
• Sudden changes in temperature. MedlinePlus lists getting too hot or too cold, and sudden changes in temperature.
• Too much water. MedlinePlus lists drying out of the skin from frequent baths or showers and from swimming often. The NHS says getting the hands wet often can trigger pompholyx.

Inside the body

• Stress. The NHS lists stress, and MedlinePlus lists emotional stress. The AAD says stress often becomes a trigger in the tween and teen years, and that research shows managing stress well can reduce flares.
• Illness and infection. MedlinePlus lists colds and the flu. The NHS lists skin infections such as staph.
• Hormonal changes. The NHS lists hormonal changes, such as during pregnancy.

Allergens

• Airborne allergens. The NHS lists pollen, house dust mites and pets. MedlinePlus lists allergies to pollen, mold, dust mites or animals.
• Foods. The NHS lists certain foods. MedlinePlus names eggs as a food that may cause a reaction in a young child, and says to talk to a doctor first.

Triggers for children at school and play

Children meet triggers in places adults do not. The AAD says heat and sweat are common triggers during sport, and that pool water can irritate eczema and cause a flare. It says that by following some precautions, most children with eczema can take part in gym class and sport. A child's doctor can suggest the right steps for that child.

Triggers for other types of eczema

Each type of eczema has its own triggers. The NHS says contact dermatitis is set off by a specific irritant or allergen, most often soaps, detergents, solvents or frequent contact with water, and that avoiding it usually lets the skin clear. For pompholyx, the NHS lists strong chemicals, metals such as nickel, wet hands, stress, and heat and sweat. For discoid eczema, it says a minor skin injury such as an insect bite or a burn can start an outbreak, and that dry, cold climates can make it worse. The guide to types of eczema describes each type.

Food and eczema: go carefully

Food is the trigger people most often try to remove on their own, and the health bodies advise against doing that without help. The NHS says not to change your diet unless a doctor tells you to, and says this includes mothers who breastfeed a baby with eczema. NICE says food allergy is sometimes linked to eczema, especially in the youngest children, and advises families not to use shop or internet allergy tests, because there is no evidence of their value. The AAD says that in most cases, atopic dermatitis is not caused or triggered by a specific allergy. If you think a food makes your eczema worse, a doctor can arrange proper testing.

Stress and eczema

Stress and eczema can affect each other. The AAD says itch, pain and poor sleep from eczema can make people anxious or depressed, and flares can trigger those feelings. NICE says the exact role of stress, humidity and extreme temperatures in causing flares is unclear, and that people should avoid these factors when possible. NIAMS suggests stress management and relaxation techniques, and support from family, friends, health professionals and support groups. It also suggests counseling for anyone who feels overwhelmed, embarrassed or anxious about their skin.

Why flares often come at night

Many people find eczema itchier at night. The NHS says discoid eczema tends to be itchiest at night, and NIAMS lists sleep loss among the conditions that often come with atopic dermatitis. MedlinePlus suggests keeping fingernails short and wearing light gloves during sleep if scratching at night is a problem. NIAMS says that if itching keeps you from restful sleep, you should talk to your doctor about better control.

How to find your own triggers

The AAD says that if you can find your triggers and avoid them, this can help reduce flare-ups, and that your dermatologist can help. Some practical steps drawn from the sources:

1. Write down each flare. Record the date, where it appeared, the weather, any new products, clothes, foods, illness and how stressed you felt. NIAMS says a doctor plans treatment around the triggers that are unique to you, and a record helps with that.
2. Change one thing at a time. Switching one product at a time makes it easier to see what helped.
3. Test new products. The AAD suggests putting a small amount of a new product on the inside of your arm every day for 7 to 10 days, and using it only if the skin stays clear. The guide on how to patch test a new skincare product explains the steps.
4. Ask about allergy testing. For contact dermatitis, a doctor may arrange patch testing to find an allergy.

The AAD says some people may not be able to find specific triggers. It also says that by sticking to a treatment plan, most people can ease symptoms and reduce flare-ups.

Everyday ways to avoid triggers

The NHS and the AAD suggest:

• wash with a moisturizer or a mild, fragrance-free cleanser instead of soap
• use fragrance-free and dye-free laundry detergent, and wash new clothes before wearing them
• wear loose cotton clothing and remove scratchy tags
• keep cool, and keep your home at a steady temperature and humidity
• take short, warm baths or showers, then moisturize while the skin is still damp
• keep nails short, and gently rub itchy skin with a finger instead of scratching

The guide to moisturizing and bathing for eczema covers the bathroom steps in detail.

When a flare needs a doctor

Follow the plan your doctor gave you when a flare starts. NICE asks doctors to give clear instructions on how to manage flares. The NHS says to see a doctor if treatments are not helping, and to ask for an urgent appointment if the skin is blistered, crusty, leaking fluid or has spots with pus, if it is painful, swollen or warm, if it suddenly gets worse or bigger, or if you have a high temperature. These can be signs of infection. The guide on how eczema is treated describes what a doctor may offer for frequent flares, and the guide can eczema be cured? explains what long-term control looks like.