9 Sneaky Triggers of an Eczema Flare
Having eczema doesn’t mean non-stop symptoms. Your skin can be totally fine for a while, and then, bam!, suddenly you’re itching and rashing hard. While a flare-up may seem like it appeared out of nowhere, it always comes with a trigger. To keep your skin calm, we asked top dermatologists to identify the red flags of an imminent episode, plus what you should do if those flags are a-flyin’.
You’re Itchy as Heck
“Eczema is referred to as the itch that rashes,” says Josh Zeichner, M.D., director of cosmetic and clinical research in dermatology at the Ichan School of Medicine at Mount Sinai Medical Center in New York City. Typically, the itch precedes the redness. For some, it’s a mild itch. For others, it’s intense and can interferes with work and sleep. That first itch is a signal to reach for your eczema medication: topical steroids or immunomodulators (non-steroid creams) and, in severe cases, immune-suppressing oral drugs and injections. They will quell your symptoms and protect skin’s barrier from scratch-related damage.
You’re Out Sick
Cough, cough, scratch. Your eczema can flare when you’re down for the count with an illness like a cold or the flu. “While not traditionally a major trigger, an upper respiratory infection may promote systemic inflammation and trigger an eczema flare,” Dr. Zeichner says. The theory behind this one is that your immune system is already on high alert when you’re sick, and because eczema is an immune-driven disease, you may get an outbreak at the same time you’re fighting a bug.
Your Skin Feels Dry
With eczema, you may notice your skin feels dry and tight even before it itches or reddens. That’s because the dryness signifies that your skin barrier isn’t doing its job: Moisture is escaping via microscopic cracks in skin’s surface. That leaky barrier also lets irritants and allergens into skin, setting off the inflammatory response that leads to eczema’s redness, scaling, and rashes. “It’s important to moisturize all the time,” not just during a flare, says dermatologist Rebecca Guttman-Yassky, M.D., director of the Center for Excellence in Eczema at the Ichan School of Medicine at Mount Sinai Medical Center.
You’re Stressed Out
A big deadline at work can make you see red. “When you’re stressed, your body is in a pro-inflammatory state and releases chemicals that can trigger an eczema flare,” says Mona Gohara, M.D., an associate clinical professor of dermatology at Yale University. In a 2019 study, researchers found a significant link between high levels of occupational stress and hand eczema (participants had jobs in healthcare, textiles, and construction). The authors say the findings suggest a need for coping strategies for occupational stress, and a previous study found that stress management interventions—including psychotherapy, biofeedback, and hypnotherapy—proved helpful for eczema symptoms.
You Have Seasonal Allergies
“There’s a large bag of diseases that are all related, including seasonal allergies, hay fever, food allergies, asthma, and eczema,” says Dr. Guttman-Yassky. “If you have one, then you may get another.” Why? The same things that make your annoying seasonal allergies act up (such as pollen, mold, dust mites) can make skin react, too. Once you’re exposed to these allergens, your body has an immune response, triggering inflammation that plays out in the form of eczema patches.
The Season Just Changed
There’s no off-season for eczema. Which, in some cases, comes back to our previous slide about allergies. In fall, when ragweed is raging, you might be scratching as you’re sneezing. In winter, the cold air coupled with dry, indoor heat can lead to a breakdown of skin’s protective barrier, causing water loss and making skin more vulnerable to irritants and allergens. In spring, pollen and hay fever can irritate your nasal passages and your skin. And, finally, summer brings lots of sweat, swimming, and dry, air-conditioned air, all of which can make eczema symptoms appear.
You’re Using New Skincare Products
Switching body washes, using a new anti-ager, or even sampling a perfume can lead to eczema. “If you deviate from your usual gentle skincare routine, you may get a flare-up,” says Dr. Gohara. Remember, if you have eczema, irritants and allergens easily slip through skin’s surface. The biggest offenders can include fragrances, dyes, preservatives, harsh soaps, skin-exfoliating acids (such as salicylic or glycolic), and retinol, which can all aggravate and further parch your delicate skin, in turn activating the immune response that leads to eczema patches. Try any new product on the inside of your arm before slathering it all over.
You Have Dark Patches of Skin
An eczema outbreak doesn’t always arrive in red and pink, especially if you have dark skin, on which redness isn’t so apparent. Instead, you may see reddish-brown, purple, gray, or deep brown patches, according to the National Eczema Association. Also, African Americans are more likely to develop papular eczema, which presents with small bumps on the torso, arms, and legs, and also around the hair follicles, known as follicular accentuation. If you’re not aware of these signs, you may not realize you’re experiencing eczema.
It’s That Time of the Month
Bad moods. Raging headaches. Now eczema? The drop in estrogen right before your period (and also during menopause) can cause skin dryness…and, in turn, eczema symptoms. Experts have dubbed this cyclical itch “estrogen dermatitis.” Pregnancy can induce the condition, too: Your immune system is hyper-focused on fighting off allergens and irritants in an effort to keep the fetus safe, which can bring on the inflammatory immune response that triggers eczema. If you have pregnancy-induced eczema, stick to basic, fragrance-free hydrating products, and run anything new by your gyno, says Dr. Gohara.
Whether you’re sniffly or stressed, get on your eczema medications (or see a dermatologist for such meds, if you need them) and be diligent about using a non-irritating moisturizer that also helps shore up a faulty barrier. Fatty acids (such as shea butter and ceramides) and humectants (such as glycerin) are helpful. If the trigger is one you can avoid (say, a specific ingredient or allergen), by all means do! “Once you’re exposed to a trigger, the eczema flare-up might be unavoidable,” says Dr. Guttman-Yassky.
Work Stress and Eczema: Dermatology Research and Practice. (2019). “Relationship Between Hand Eczema Severity And Occupational Stress: A Cross-Sectional Study.” new.hindawi.com/journals/drp/2019/8301896/
Stress Management and Eczema: Journal of the American Academy of Dermatology. (2014). “Guidelines of Care for the Management of Atopic Dermatitis Part 4: Prevention of Disease Flares and Use of Adjunctive Therapies and Approaches.” ncbi.nlm.nih.gov/pmc/articles/PMC4430554/
Eczema and Allergies: The National Eczema Association. (n.d.). “Eczema Causes and Triggers.” nationaleczema.org/eczema/causes-and-triggers-of-eczema/
Eczema and Dark Skin: National Eczema Association. (n.d.). “Everything You Need to Know About Eczema in Skin of Color.” nationaleczema.org/skin-of-color/
Hormone-induced Eczema: European Journal of Obstetrics, Gynecology, and Reproductive. (1997). “Estrogen Dermatitis.” ncbi.nlm.nih.gov/pubmed/9076430