Managing Eczema Flare-ups (A Dermatologist’s Guide)

Eczema affects individuals worldwide and can significantly impact daily life. It is characterised by skin inflammation, leading to itching, redness, and often discomfort. In this article, we’ll explore the common triggers for eczema flare-ups, and strategies and treatments that may help manage these flare-ups.

Understanding Eczema

Eczema, or atopic dermatitis, is a general term for several types of skin inflammation. It comes in various forms, each with its unique features:

• Atopic dermatitis: Often hereditary, it usually starts in early childhood and is often part of the “atopic triad” with asthma and hay fever.
• Contact dermatitis: This arises when the skin reacts to a substance it comes into contact with, resulting in inflamed, red, and itchy skin.
• Dyshidrotic eczema: Characterised by small, itchy blisters on the hands and feet.
• Nummular eczema: This presents as round, circular patches of irritable skin, which can be very itchy.

Common Triggers for Eczema Flare-ups

Allergens

Allergens are substances that can cause a reaction in people who are sensitive to them. These can trigger an immune response in individuals with eczema, resulting in symptom flare-ups. Common allergens include:

• Dust mites: These are tiny creatures found in household dust. They thrive in warm, humid environments such as bedding, upholstered furniture, and carpets.
• Pet dander: Consists of tiny, even microscopic, flecks of skin shed by animals with fur or feathers. For some, contact with pet dander can lead to an eczema flare-up.
• Pollen: Pollen from trees, grasses, and weeds can be inhaled and cause allergic reactions in sensitive individuals, leading to eczema flare-ups.
• Mould: Mould spores in damp areas can be a trigger. Regular cleaning and good ventilation can help to control mould growth.

Irritants

Irritants are substances that can cause inflammation of the skin upon contact. These substances can worsen existing eczema or potentially even cause a new flare-up. They can be found in everyday products such as:

• Detergents: Cleaning products often contain harsh chemicals that can strip the skin of natural oils, leading to dryness and irritation.
• Soaps and shampoos: These products can also contain chemicals that have a drying effect on the skin.
• Fabrics: Certain fabrics, like wool and some synthetics, can be irritating when they come into contact with the skin.

Weather Conditions

The weather can also affect eczema:

• Extreme temperatures: Very hot or cold weather can dry out the skin, leading to eczema flare-ups. Staying in air-conditioned or heated rooms can also have a similar effect.
• Humidity: Dry air can draw moisture out of the skin, exacerbating eczema symptoms.

Stress

While not a direct cause of eczema, emotional stress can trigger a flare-up in some people. The exact relationship between stress and eczema is not entirely understood, but it’s believed that stress can worsen the body’s inflammatory response, leading to a flare-up.

Infections

Infections, whether bacterial, viral, or fungal, can cause an eczema flare-up:

• Bacterial infections: Bacteria, such as Staphylococcus aureus, can infect the skin, especially if scratched and broken open. This can exacerbate eczema symptoms.
• Viral infections: Viruses, like the herpes simplex virus, also lead to eczema flare-ups in some individuals.
• Fungal infections: Fungal infections may exist conconmitantly with eczema.

Strategies to Prevent Eczema Flare-ups

Moisturise Regularly

The skin barrier can be compromised in eczema, causing it to lose moisture faster than normal. A fragrance-free moisturiser helps seal moisture and maintain barrier function, thereby keeping the skin hydrated and reducing dryness and itching. Moisturisers should be applied multiple times a day, especially after bathing.

Avoid Harsh Soaps

Many commercial soaps and body washes contain chemicals and fragrances that can strip away natural oils from the skin’s surface, causing it to dry out and exacerbate eczema symptoms.

Opting for gentle, fragrance-free soaps or non-soap cleansers can help avoid this irritation. Non-soap cleansers are often pH balanced to the skin, which helps maintain the skin’s natural barrier.

Take Shorter Showers or Baths

While taking a long, hot shower or bath may be tempting, doing so can dehydrate the skin or damage the skin barrier. Instead, opt for shorter showers or baths using lukewarm water. This practice will help preserve the skin’s natural oils and maintain its hydration levels.

Pat Dry After a Shower

Vigorous rubbing with a towel after a shower or bath can irritate, potentially leading to an eczema flare-up. Instead, gently pat the skin dry with a soft towel. This method is less likely to aggravate the skin or cause damage.

Lifestyle Modifications for Managing Eczema

Several lifestyle modifications can also help manage eczema:

Diet

Some people may find that specific foods trigger their eczema. Identifying and avoiding these can be beneficial. Ideally, this should be done under a dermatologist’s guidance to ensure the specific foods to avoid and include while remaining balanced.

Stress Management

Emotional stress can contribute to eczema flare-ups. Employing stress management techniques such as mindfulness, meditation, and yoga can help manage stress levels, potentially reducing the frequency and severity of flare-ups.

Clothing

Soft, breathable materials such as cotton can help prevent skin irritation. In contrast, synthetic fabrics or wool can cause overheating and irritate the skin, leading to a potential flare-up.

Dermatologist-Recommended Treatments for Eczema Flare-ups

Topical Corticosteroids

Topical corticosteroids are anti-inflammatory medications available in various strengths. They are prescribed based on the severity and location of eczema, with stronger preparations typically used for short-term treatment of severe flare-ups and milder ones for maintenance therapy or sensitive areas like the face.

Calcineurin Inhibitors

Calcineurin inhibitors, such as tacrolimus and pimecrolimus, are non-steroid topical medications that reduce inflammation by suppressing the immune system. They are typically used when other treatments have not been effective or are unsuitable, such as for long-term maintenance therapy or areas where skin thinning might be a concern with topical steroids.

Biologics

Biologics are a relatively new treatment option for severe eczema. These medications, like Dupilumab, are injected and work by targeting specific parts of the immune system that contribute to the inflammation seen in eczema.

Conclusion

Eczema, while a chronic condition, can be managed effectively with appropriate treatments, understanding personal triggers, and making necessary lifestyle modifications. If your symptoms are affecting your ability to cope with daily life, consult with our dermatologist for comprehensive management of this condition.