What Causes Eczema to Flare Up?

Eczema can flare up when someone is exposed to triggers, which vary from person to person. However, if you know what your triggers are, you can help get control over them. Here's what to know about eczema flare-ups and how to track down your triggers to help prevent and manage them.

What Is an Eczema Flare-Up?

Eczema is the medical term for certain skin conditions in people with dry, sensitive skin that tends to get very itchy and develop rashes. Eczema usually comes and goes. When it becomes active, it's called a flare-up.

A flare often occurs in response to a trigger, which may be an allergy, irritant, emotional state, or environmental condition. The itching can be very intense, making it hard not to scratch, but scratching makes it worse. The itch-scratch cycle can lead to skin damage or infection and make you miserable.

What Triggers Eczema Flare-Ups?

A long list of factors can trigger an eczema flare-up, and they differ from person to person. Sometimes you can get ahead of flares or shorten them by avoiding triggers or stopping your exposure to them as quickly as possible. Here are some of the more common triggers for eczema flares:

Stress

Physical stressors such as illness or surgery and psychological stressors can trigger eczema flare-ups. When a person has physical or psychological stress, the body releases hormones, including cortisol.

Cortisol usually has an anti-inflammatory effect, but if it stays at a high level, the body becomes resistant to it. That allows the release of substances that cause inflammation. That can lead to an eczema flare-up.

Allergies

An allergic reaction is when your body's immune system overreacts to certain substances that are not normally dangerous (allergens). For some people, an allergy can make eczema worse.

Skin affected by eczema can be dry and sensitive. In people with an allergy, exposure to an allergen can lead to more skin symptoms.

The allergens may be in the environment like pet dander, dust mites, or pollen. Some people are allergic to metals like nickel. For some people with eczema, a food allergy can lead to an eczema flare when they eat that food.

Irritants

An irritant is different from an allergen because the inflammation is a response to something touching your skin rather than a systemic immune reaction. Many substances can cause this form of eczema, also called contact dermatitis. Some of the more common irritants include:

• Cleaning agents like detergents and soaps, especially with fragrances
• Lanolin, made from sheep fur and found in cosmetics and creams
• Sulfates found in cleaning products that break down oil
• Urea, which is often found in skincare products
• Latex rubber
• Synthetic fabrics like polyester
• Rough fabrics like wool
• Chemicals in the workplace including epoxy resins and formaldehyde

These potentially irritating substances can be found in many items you may frequently use, like cleansing and cleaning agents, cosmetics, clothing, bedding, jewelry, and furniture.

Environmental Conditions

Some eczema triggers are all around you. They include:

• Changes in seasons
• Extreme weather
• Very dry conditions
• Very humid conditions
• High altitudes, where the air is usually drier
• Long exposure to hot water (like long baths or showers)
• Chlorinated water
• Salt water
• Yeast (Malassezia species) that is normally on the skin but can cause a flare
• Cigarette smoke
• Cockroach debris, including feces, body parts, and saliva

How to Treat Eczema Flares

A good rule of thumb is to start treating eczema as soon as you feel an itch coming on. The longer you wait, the harder it can be to break the cycle. Unfortunately, there is no cure for eczema, but effective treatments and techniques exist. At home, these include:

• Keep skin well hydrated and moisturized with unscented products. Ointments and creams are best.
• Consider skipping a bath or shower. Keep them short and use tepid water.
• Treat your skin gently, and don't rub.
• Add baking soda or oatmeal to your bath.
• Use bath oil (as long as it doesn't contain fragrance).
• Try a bleach bath (1/2 cup to a full tub) unless you're sensitive to chlorine. This decreases bacteria and yeast on the skin, which could lead to infection and impair the healing of eczema plaques.
• Add mineral salts (such as Dead Sea salts) to the bath (1 cup to a full tub) for severe flares.
• Add about 1 cup of apple cider vinegar to the tub.
• Try over-the-counter (OTC) hydrocortisone anti-itch creams or lotions.

If your eczema is still not under control, a healthcare provider can recommend treatment, including:

• Topical immunomodulators you apply to the skin to regulate the immune response, such as Opzelura (ruxolitinib) cream, Protopic (tacrolimus) ointment, Elidel (pimecrolimus) cream, and Eucrisa (crisaborole)
• Topical steroids
• Oral steroids or other systemic immunosuppressants, including Cibinqo (abrocitinib), Rinvoq (upadacitinib), Rheumatrex (methotrexate), and cyclosporine.
• Biologics, which are targeted immunosuppressants, including Dupixent (dupilumab) and Adbry (tralokinumab-ldrm)
• Wet wrap therapy can be done at home after guidance from a healthcare provider
• Phototherapy (UV light treatment for widespread eczema)

The prescription medications for eczema can be very effective, but all drugs have side effects. Discuss the benefits and risks with your healthcare provider to understand the medication and how it may affect you.

How to Prevent Eczema Flares

You can take steps to help ward off eczema flare-ups or shorten them. Managing eczema flares means doing detective work to identify triggers and taking care of your skin. Often there is a lag time between exposure to a trigger and the itch developing.

Here are some tips to help keep the itch at bay:

• Keep an eczema diary. When you feel a flare coming on, think about any potential triggers you've been exposed to within the last several days and note them. Over time, you may see some patterns.
• Stay moisturized. Dry skin and eczema go hand-in-hand.
• Get familiar with common triggers. Develop the habit of reading cosmetics, cleansing agents, and household products ingredient labels.
• Think seasonally. When the air is dry, such as during the winter or at altitude, think ahead and add additional moisturizer to your routine.
• Follow your healthcare provider's advice.

Summary

Eczema is an itchy rash that comes and goes. A flare can make your skin so itchy that it's hard not to scratch, but that will make it worse. People have different triggers for eczema, and figuring out what yours are can help you avoid flare-ups.

If you get a flare, have a plan to start treating the itch as soon as you can, which makes it easier to get it under control. Your healthcare provider can help recommend home treatment or give you prescription medication if necessary to relieve the annoyance of eczema flares.

A Word From Verywell

If you have eczema, your skin isn't able to do its job of protecting you from damage and infection as well as it could. As a result, the skin barrier is compromised, so it is important to learn to take extra special care of it.

Eczema flares take some time and attention, so have a game plan. See a healthcare provider if the flares are driving you crazy and don't know what's causing them. Eczema can disrupt your sleep and wellbeing, so it's worth the attention you may have to pay to get it under control.