If you have atopic eczema, avoiding certain causes (triggers) and irritants may help to prevent flare-ups of symptoms.
What is eczema/dermatitis?
The terms eczema and dermatitis mean much the same. That is, an inflammation of the skin. It causes red, itchy skin which may also blister. There are two main types of dermatitis/eczema:
- Atopic eczema. This is caused by a problem from within the body. If you have atopic eczema you are born with a tendency for your skin to become inflamed. Various parts of the skin tend to flare up with inflammation from time to time.
- Contact dermatitis. This is caused by a substance from outside the body. This typically causes patches of inflammation on areas of skin which have come into contact with the substance. If you avoid the offending substance, the skin inflammation should go away.
The rest of this leaflet is only about factors that may trigger or irritate atopic eczema. See separate leaflet called Atopic Eczema and one called Contact Dermatitis which provide a general overview of the conditions.
What are triggers and irritants?
In most people who have atopic eczema there is no apparent reason why the eczema may flare up from time to time. However, some flare-ups may be caused (triggered) or made worse by irritants to the skin, or by other factors.
This leaflet briefly discusses some possible triggers and irritants.
Soaps and detergents
Soaps and detergents remove the natural oils from the skin. This tends to make the skin dry and itchy and more sensitive to irritants.
Therefore, avoid soaps, bubble baths, etc, when you wash. Instead, use a thick moisturiser (emollient) as a soap substitute and add an emollient to the a bath or shower. See separate leaflet called Emollients (Moisturisers) for Eczema for details. Wear rubber gloves with a cotton lining when using detergents or working with other similar chemicals.
After you wash clothes with detergent, rinse them well. Biological detergents are known trigger factors and fabric conditioners can make some people's eczema worse.
Toiletries and perfumes
Some people with eczema find that the perfumes, preservatives and alcohols in toiletries and make-up can be irritating. It may be best to avoid these, or only use bland products.
Wear cotton clothes next to the skin rather than irritating fabrics such as wool. However, it is probably the smoothness of the material rather than the type of material which helps. Some smooth man-made fabrics are probably just as good as cotton.
Avoid getting too hot or too cold. Extremes of temperature and humidity may trigger a flare-up of eczema symptoms.
Stress, habitual scratching and the itch-scratch cycle
Stress does not cause eczema. However, some people react to stress by habit scratching. It is thought that scratching can make itch worse, which makes you want to scratch more, etc. This is called the itch-scratch cycle and can make eczema worse. Try as much as possible not to scratch the eczema. To help with this, keep fingernails cut short so that any scratching is not so sharp and severe. Consider wearing cotton gloves at night if you tend to scratch in your sleep, and use anti-scratch mittens for babies. If you need to relieve an itch, rub with fingers rather than scratch with nails.
Some people find that relaxation exercises or similar techniques help to reduce stress. This may help to reduce habit scratching, which may help to reduce the severity of eczema.
Infection, often introduced by scratching, can aggravate eczema.
Food allergy and eczema
Less than 1 in 10 children with atopic eczema have a food allergy which can make symptoms worse. In general, it is young children with severe eczema who may have a food allergy as a trigger factor. The most common foods which cause (trigger) eczema symptoms in some people include: cows' milk, eggs, soya, wheat, fish and nuts.
How do I know if a food is making eczema worse?
- Immediate food allergy occurs in some cases. Symptoms develop within two hours of eating the trigger food. Itching and scratching may worsen shortly after eating the trigger food. A common sign is redness, swelling and irritation around the mouth. Another skin symptom that may develop is urticaria. In this condition, itchy, fluid-filled lumps appear on the skin - similar to nettle stings. Other symptoms may occur such as tummy (abdominal) pain, being sick (vomiting), wheezing, itchy eyes and sneezing.
- Delayed food allergy occurs in some cases. Symptoms develop 6-24 hours after eating the trigger food. Symptoms include worsening of itching and eczema. Sometimes abdominal pain and diarrhoea also occur.
If you suspect a food is making eczema symptoms worse then see a doctor. You may be asked to keep a diary over 4-6 weeks. The diary aims to record any symptoms and all foods and drink taken. It may help to identify one or more suspect foods.
To confirm the diagnosis of a food allergy, you will need to see an allergy specialist. Leaving out certain foods without an allergy being confirmed is not usually recommended.
House dust mite
House dust mite is a tiny insect that occurs in every home. You cannot see it without a microscope. It mainly lives in bedrooms and mattresses as part of the dust.
Many people with eczema are allergic to house dust mite. However, in general, it is not usually advised to do anything about house dust mite. This is because:
- The research studies that have looked into whether reducing house dust mite is helpful have not been conclusive. There is some evidence that reducing house dust mite may help but further research is really needed to confirm this.
- It is impossible to clear house dust mite completely from a home and it is hard work to reduce their number to a level which may be of benefit.
- Treatment with other methods such as moisturisers (emollients) and short courses of topical steroids usually works well. Therefore, the effort of trying to eliminate house dust mite is not usually warranted.
A guideline published in 2007 from the National Institute for Health and Care Excellence (NICE) - referenced at the end of this leaflet - states: "There are conflicting data on the effectiveness of using house dust mite avoidance strategies in the management of childhood atopic eczema. Many of the currently suggested techniques are time-consuming and expensive for parents/carers and it is important to establish their value."
However, later research suggests that house dust mite is linked to atopic eczema particularly when it occurs in young children. It has to be stressed, it is hard work and not usually recommended. However, if you want to try to reduce the numbers of house dust mite, a separate leaflet called House Dust Mite and Pet Allergy is available.
Some parents report that symptoms in children become worse when they are in contact with pets. It is an allergy to animal dander which may be responsible. If you suspect a pet may be the cause, it may be worth removing the pet to another home for a while to see if symptoms improve. For further information see House Dust Mite and Pet Allergy.
Other possible triggers
Other possible factors which may cause (trigger) symptoms, or make symptoms worse, include pollens, moulds, pregnancy and hormonal changes before a period in women. However, these may not be avoidable. There may also be other factors which have not yet been identified which can trigger symptoms in people who have eczema.
Further help & information
Dr Tim Kenny
Dr Laurence Knott
Dr Hannah Gronow