13 Things That May Trigger Atopic Dermatitis Flare Ups
Hot water, certain skincare products, fragrances, and more may cause atopic dermatitis symptoms to flare up.
Medically reviewed by Casey Gallagher, MD
If you have atopic dermatitis—the most common type of eczema—you can have inflamed patches of skin that are so super itchy, they keep you up at night—or cause you to scratch in your sleep. Even though there are treatments, this type of eczema can subside and flare up over and over again—and certain things can act as triggers and cause flare ups. Here are a few of the common culprits that can aggravate symptoms and tips for avoiding skin irritants.
The cause of atopic dermatitis itching is an abnormal immune reaction that changes the skin's structure and function. This change makes the skin itchy and vulnerable to irritants. While people with this type of eczema often also have asthma and allergies, it isn't an allergic reaction.
As people with atopic dermatitis can attest, managing the symptoms can be a daily struggle.
Courtesy of DermNet
Scratching
There's no denying it: Atopic dermatitis is extremely itchy. When you have it, it's hard not to scratch your nagging itch. Sometimes you scratch until you bleed, which can lead to infection and aggravate skin symptoms. Before you know it, you're stuck in a cycle of itching and scratching. Dealing with this skin condition can be emotionally stressful. And guess what? The stress of dealing with uncontrolled symptoms can induce itching, too, as evidence from an observational study suggests.
Tip: Try behavioral therapy that focuses on relaxation techniques and habit reversal, which aim to halt the itch-scratch cycle.
Hot Water
A long, steamy shower or bath might sound enticing. (In blog posts and online patient forums, some people with eczema confess to turning the faucet to near-scalding temperatures for euphoric relief from their itching—at least temporarily.) But dermatologists warn that hot water makes eczema symptoms worse because it dries out the skin. Take short, cooler baths instead of long, hotter ones. Not to mention, at extremely hot temps, you could sustain a serious burn.
Tip: Short daily soak in cool or warm water to help your skin absorb H2O without drying it out. When you're done, gently pat the skin dry with a towel, and follow up with a greasy ointment or hydrating cream or gel to seal in moisture.
Cold, Dry Temperatures
If you have atopic dermatitis, your skin is already dry. Cold weather and low-humidity climates envelop your body in additional dryness, and that can make your skin itchier. Sometimes the change of seasons can also bring on symptoms.
Come the first cold snap in October, patients in the upper Midwest start itching, said Jon Hanifin, MD, professor emeritus of dermatology at Oregon Health & Science University in Portland, Ore. Even in rainy Portland, when people turn on their furnaces, symptoms ensue. "A humid climate is the best place for eczema patients to be," said Dr. Hanifin.
Tip: Keep thermostats low and dress lightly for sleep to avoid night sweating.
Stress
Scientists are trying to get a better handle on the role that stress plays in inflammatory skin diseases. While emotional stress doesn't cause atopic dermatitis, it can exacerbate symptoms. And dealing with flares of itching, in turn, can stress you out. It seems like a vicious cycle. So, the trick to reducing symptom severity is finding ways to alleviate stress. Here are some things that may help cope with stress:
Deep breathing while listening to soothing sounds or music
Yoga or tai chi
Reading
Cuddling a pet
Walking in nature
Doing creative activities (ie. writing, painting, knitting)
Exercising
You may also want to find a support group where you can talk about what you're going through and listen to others who have similar experiences.
Tip: Also try massage, meditation, relaxation techniques, or biofeedback (a technique that helps to train you to control bodily functions to provide relaxation).
Sweating
Is your workout making you itch? People with atopic dermatitis often experience symptoms when they break a sweat, whether they're doing cardio or flopping around in sweaty sheets at night because they're too hot.
Sweating is the body's natural way of cooling off. But when the sweat evaporates, it can dry out the skin and leave behind a salty residue that can aggravate eczema. If you're having a flare-up of atopic dermatitis, you may want to avoid the sweaty workout and tone down the intensity or go for a low-impact exercise instead.
You don't want to skip exercising altogether. The upside of exercise is that it actually helps with eczema. In addition to improving your eczema, exercising also:
Gives you extra energy
Boosts your immune system
Improves your brain health
Lowers stress, depression, and anxiety
Helps you sleep better
Tip: Wear loose clothing, towel off and take breaks during exercise, and shower immediately afterward with cold or lukewarm water.
Soap, Shampoo, and Cleansers
Many personal hygiene products can irritate sensitive eczema skin and strip away natural oils that keep skin moist. To avoid drying out your skin and worsening symptoms, only use cleansers when needed and do not use bubble bath products (they often contain fragrances). If you do use a cleanser, look for one that contains non-irritating ingredients to help repair the skin's barrier.
Another thing that is important to avoid is fragrance. While you may think "unscented" products would be better, you should avoid them as well because they still contain fragrance that has been masked.
Tip: Toss the soap. Choose a gentle hydrating cleanser instead.
Fragrances and Preservatives
Dyes and fragrances can be extremely irritating for sensitive skin and can cause eczema symptoms to flare up. And the fragrance isn't just found in soaps and bottles of perfume—it can also show up in makeup, moisturizer, shampoo and conditioner, and household products such as laundry detergent, fabric softener, and dryer sheets. To suss out safe-for-your-skin products, look for the terms "hypoallergenic" and "free of dyes and fragrances" on the label. With laundry detergents, dye- and perfume-free brands will include "free and clear" on the bottle.
Tip: Look for the National Eczema Association (NEA) Seal of Acceptance. Products with this seal are recognized as suitable for caring for eczema or sensitive skin. (This seal can be found on a wide range of products from hair care and household products to clothing and fabrics.)
Chemical Sunscreen
Chemical sunscreens contain active ingredients that absorb ultraviolet (UV) light. The worry is that these ingredients may irritate sensitive skin, especially for people with eczema or rosacea, explained Debra Jaliman, MD, a New York City-based dermatologist.
To stay sun-safe without exacerbating eczema symptoms, look for physical sunscreens (also called mineral sunscreens), which contain ingredients such as titanium dioxide and zinc oxide that work by deflecting UV rays. These products sit atop the skin and are not absorbed into the skin.
Tip: Select a sunscreen that provides "broad spectrum" protection with an SPF of 30 or more. And choose sunscreens that have the NEA Seal of Acceptance.
Wool and Synthetic Fabrics
Some fibers are more irritating to the skin than others. Wool is notoriously prickly, and many synthetic fabrics are too abrasive against the skin. Fabrics like wool and polyester can be eczema triggers. Cotton clothing and bedding are usually recommended for people with atopic dermatitis because cotton is cool and breathable. Bamboo is another eczema-friendly fiber.
Tip: Check the tags before buying. Launder new garments before wearing them to wash away any irritating chemicals and dyes.
Pollen, Mold, and Dust
Any number of environmental allergens can worsen skin symptoms. It may help to get your blood and skin tested to pinpoint your allergic triggers.
If dust mites are the culprits, you may want to cut back on the carpet, upholstered furniture, and stuffed animals in your home. If you react to pollen, using air conditioning can help—and it can reduce sweating too. To reduce molds, your indoor humidity should be less than 40–50%. You can also treat mold-prone areas with dilute white vinegar or dilute bleach.
Tip: Invest in hypoallergenic pillowcases and mattress covers to keep out potential allergens. And if those things don't help, what may is using a HEPA-filtration vacuum.
Bacterial and Viral Infections
Bacterial and viral infections can worsen atopic dermatitis. It's one reason scratching is discouraged, although people with atopic dermatitis can have more skin-surface bacteria due to their abnormal skin function. When people scratch their skin, they can easily introduce germs like Staphylococcus aureus and herpes simplex virus.
Tip: While antibiotics are useless for viral infections, they may be an appropriate way to treat—but not prevent—bacterial infections.
Hormones
People in childbearing years who have eczema may find their symptoms worsen during pregnancy or when they're having their period. In fact, about half of female patients with atopic dermatitis see their symptoms worsen before their period starts, as was reported in a study. Additionally, 52% of female patients with atopic dermatitis in one group and 61% in another group also noticed symptoms worsening during pregnancy.
Tip: Pay special attention to your triggers before you start menstruating or if you are pregnant. While your hormones are changing your skin's behavior, it's good to reduce the things in your environment that can cause a flare-up.
Food Allergies
Food allergies may play a role in atopic dermatitis, although the evidence isn't as strong as it is for other triggers. We do know, that the two are associated in some way; 20–40% of children with atopic dermatitis have an IgE-mediated food allergy. IgE-mediated means that the body's allergic antibodies increase in the blood. But healthcare providers will try to treat the skin first before looking at food allergies. Speak to a nutritionist if you're concerned that certain foods might be aggravating your eczema symptoms.
Tip: Don't make any drastic dietary changes based on a hunch. Talk to your healthcare provider and get tested to pinpoint problematic ingredients. Exclusion diets (cutting out the suspected allergen) can lead to nutritional deficiencies and should only be done under a medical professional's supervision.
A Quick Review
There are certain irritants that can exacerbate symptoms of atopic dermatitis. Hormones, allergens, chemical sunscreens, fragrance, and sweat are just some of the examples of irritants you may want to steer clear of if you have atopic dermatitis. If you are having trouble pinpointing your triggers, talk to your healthcare provider to figure out the best course of treatment.
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