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Scratching the Surface: The Maddening Irritation of Eczema

Brooke Frederick, the creator behind Minimalist Mama, has experienced eczema her entire adult life. The worst of it is on her hands and fingers, which is particularly bad because it interferes with her job.

“I’m a blogger and though I know I really need to create some short video content (like packing a hospital bag or showing nursery drawers) I have avoided it because I don’t want to show my hands on camera,” Brooke says.

While many people with eczema feel self-conscious about the condition, it’s actually quite common, affecting as many as 31.6 million Americans, according to the National Eczema Association. (For context, that’s equal to nearly four times the population of New York City.)

While eczema is an umbrella term for a variety of skin irritation conditions, what we are talking about here, and what is generally meant when people use the term “eczema,” is the type known as atopic dermatitis.

What Causes Eczema to Flare Up?

Simply put, eczema is inflammation of the skin. While symptoms can vary, eczema usually looks like dry, scaly patches of red, purplish, or even whitish flaky skin. In some cases it can take on the appearance of small reddish bumps. The affected area is often itchy and can resemble a rash.

“[Excema] is caused by underlying genetic factors and how they interact with the environment and skin’s integrity,” says Dr. Geeta Yadav, dermatologist and founder of FACET Dermatology. “When an irritant (such as extreme temperatures) or allergen (including ingredients in certain soaps or fragrances) comes in contact with your skin, your immune system goes into overdrive, leading to inflammation." 

While there is a strong genetic component to who gets eczema (Brooke’s baby also has it), what triggers the initial onset of the condition varies by person.

“The skin condition can manifest during early childhood, but about half will outgrow the condition or show improvement as they age,” Dr. Yadav says. “Adult-onset eczema can occur and can be related to skin becoming drier with age.”

The Triggers Are Many — But There Are a Few Commonalities

Brooke’s eczema really got bad around ten years ago; her cuts were oozing, and she was scratching herself to the point of bleeding every night. This was also around the time she started bodybuilding.

“I had to drink three whey protein shakes a day, and I think that the over exposure to dairy caused an intolerance— at least that’s my theory,” she says. She believes all the dairy caused leaky gut syndrome, an immune reaction to issues with digestion. A dairy elimination diet helped get her eczema under control, but it still flares up from time to time. Brooke also has noticed a correlation between her back being out of alignment and her eczema acting up. While these two problems may not seem connected, both can be caused by immune responses manifesting in the body.

As Brooke’s experience shows, there’s no one reason that eczema begins and no universal trigger for a new outbreak. But there is one common factor in all eczema cases – inflammation.

“Inflammation is triggered by your body's immune system,” Dr. Yadav says, and people with eczema often have an overactive immune system and many people who experience eczema will have either a personal or family history of food or environmental allergies.

While the spark for a new flare-up is highly personal, there are a few common triggers:

  • Seasonal changes: The summer can increase eczema due to a rise in heat, humidity, and sweating; the winter can cause issues due to the lack of humidity, aka dryness.

  • Environmental factors: Indoor and outdoor pollutants, exposure to tobacco smoke, or living in a city can all increase the chances of an outbreak of eczema. Dr. Fishman says that people with atopic dermatitis also have a higher incidence of asthma and environmental allergies.

  • Beauty and skincare products: According to Dr. Yadav, common triggers can also include hair dye or other products like henna or even certain black textiles, all of which contain an ingredient called paraphenylenediamine. Exposure to products with added fragrance like detergents, scented skincare, and perfumes as well as some jewelry (especially for people with a sensitivity to nickel), can also result in a flare.

  • Hot water: Showering or taking a bath in hot water, getting in a hot tub, or even washing dishes can cause eczema.

  • Lifestyle factors: Some food triggers including gluten, soy, and dairy can set an eczema outbreak in motion.

What Do Hormones Have to Do with It?

There is a strong link between eczema and your hormones. One 2021 study showed 50% of women with eczema experienced their condition worsening a week or so before their period. It’s not uncommon for eczema to flare during pregnancy – or in some cases clear up – or in the postpartum period. In the 1950s, before the skin condition was understood as it is today, my grandmother’s eczema got so bad after giving birth to my mother that she wound up in the hospital. Dr. Yadav notes that it’s also common to see eczema get worse during perimenopause and menopause.

“The three major hormones: estrogen, testosterone, [and progesterone] all affect eczema by increasing or decreasing certain inflammatory chemicals called cytokines. They also all affect the skin barrier in different ways, which is an important consideration in eczema severity,” Dr. Fishman explains.

The frustrating thing is that there doesn’t seem to be any rhyme or reason as to who experiences eczema flares during pregnancy or the postpartum period, and who finally gets some relief; it appears to be pure luck (mixed with a side of biology) that determines whether your eczema flares during any particular period. And to make it even more confounding, you may experience a flare in one pregnancy and have disappearing symptoms during another.

Eczema Is Finicky, But There Are a Few Things You Can Do

The most frustrating thing about eczema is there is no cure, but there are things you can do to try to control and calm it. For Brooke, eliminating dairy and regularly seeing a chiropractor were the most helpful steps she took to manage her eczem. She also uses a topical steroid cream when her flares get bad, though she says the downside of the eczema cream is that they thin the skin overtime, leading to painful cuts and tears.

But what works as an eczema treatment for one person may not work for another. “There is a lot of conflicting data on what can help atopic dermatitis,” Dr. Fishman says.  “Some studies show fish oil helps, and others show it does nothing. Same with probiotics. Food triggers can play a role in some people – such as gluten, soy, nuts, and milk – but play little to no role in others. I do think for any inflammatory disorder, such as atopic dermatitis, reducing stress is key.”

Certain medications and prescription creams may help, as does using gentle, fragrance-free cleansers, taking lukewarm baths or showers (and don’t forget to wear gloves for dishwashing), and keeping skin moisturized. Dr. Fishman specifically calls out sunflower oil and shea butter as two ingredients that can provide some relief.

“Above all, learning what triggers your eczema flare-ups is essential to managing them,” Dr. Yadav says. While you probably want to ignore your eczema or slather on some lotion and call it a day, the best thing you can do is pay attention to what is going on in your life, hormones, and skincare routine when an eczema rash appears. After that, it’s a game of trial and error to figure out what works best for you and your skin. 

Is there a skin condition you would like to know more about? Email us at [email protected].

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