Hot water, certain skincare products, fragrances, and more may cause atopic dermatitis symptoms to flare up.
June 19, 2017
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Atopic dermatitis triggers
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). The cause? An abnormal immune reaction that changes the skin's structure and function making it itchy and vulnerable to irritants. While this type of eczema runs in families with asthma and allergies, it isn't an allergic reaction.
Even though there are treatments, this type of eczema can subside and flare-up over and over again—and certain things can make it worse. Natalie Zill, a Ventura, Calif., salesperson, struggles daily to manage her symptoms. The 24-year-old used a popular facial moisturizer every day for a while until her eczema returned three years ago.
“There was one day I put it on and my whole face was on fire,” she said. “I really have to make sure, especially for my face, what ingredients are in the lotions.”
Here are a few of the common culprits that can exacerbate symptoms and tips for avoiding skin irritants.
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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 vicious 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, according to a scientific review.
Tip: Try behavioral therapy that focuses on relaxation techniques and habit reversal, which aim to halt the itch-scratch cycle.
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A long, steamy shower or bath might sound enticing. (In blog posts and online patient forums, some eczema sufferers 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. And, at extreme temps, you could sustain a serious burn.
Tip: Short daily soaks in cool or warm water help your skin absorb H2O without drying it out. Follow up with a greasy ointment or hydrating cream or gel to seal in moisture.
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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, says Jon Hanifin, M.D., professor 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,” he says.
Tip: Keep thermostats low and dress lightly for sleep to avoid night sweating, according to the National Eczema Association.
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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. So, the trick to reducing symptom severity is finding ways to alleviate stress.
One night, Zill tossed and turned. Unable to get comfortable, she found a YouTube video on hypnosis for relaxation. Blotting out her itchy thoughts with more soothing images really helped, she said. "It would actually put me to sleep," she says.
Tip: Also try massage, yoga, meditation, relaxation techniques, or biofeedback.
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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.
At one point, Zill gained weight from taking prednisone, a powerful immune-suppressing drug, which she takes now and again to manage her flares. Working out is tough enough—“your heart’s pumping; your muscles are working”—but when you’re sweating and itching, there’s a whole other level of pain on top of that, she says.
Tip: Wear loose clothing, towel off during exercise, and shower immediately afterward.
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Soap, shampoo, and bubble bath
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), according to the American Academy of Dermatology. If you do use a cleanser, look for one that contains non-irritating ingredients (such as colloidal oatmeal) to help repair the skin’s barrier, like Aveeno Daily Moisturizing Body Wash ($7; ) and Vanicream Liquid Basic Cleansing Facial Cleaner ($9; ). And in addition to avoiding fragrance, it’s also a good idea to select skincare products that don’t contain parabens or formaldehydes, which can also irritate skin.
Tip: Toss the soap. Choose a gentle hydrating cleanser instead.
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Fragrances and preservatives
Dyes and fragrances can be extremely irritating for sensitive skin, and can cause eczema symptoms to flare up. And fragrance isn’t just found in soaps and bottle 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: Shop carefully. Even fragrance-free products can contain chemicals that irritate the skin.
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Chemical sunscreens contain active ingredients that absorb ultraviolet (UV) light. The worry is that these ingredients can generate free radicals that damage skin and seep into the skin, according to the National Eczema Association. They may also irritate sensitive skin, especially for people with eczema or rosacea, explains 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.
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Wool and synthetic fabrics
Some fibers are more irritating to the skin than others. Wool is notoriously prickly, and many synthetic fabric are too abrasive against the skin. Cotton clothing and bedding are usually recommended for people with atopic dermatitis because it’s cool and breathable.
Tip: Launder new garments before wearing them to wash away any irritating chemicals and dyes.
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Pollen, mold, and dust
Any number of environmental allergens can worsen skin symptoms. Zill, whose eczema returned with a vengeance three years ago, had blood and skin testing to pinpoint her allergic triggers. The results: She’s severely allergic to pollen, dust, and dust mites. To reduce her dust exposure, she recently moved to a new apartment with hardwood flooring instead of carpeting, but confesses that it really didn’t help. What may help: using a HEPA-filtration vacuum. These models filter out 99.7% of small particles for cleaner carpets and air.
Tip: Invest in hypoallergenic pillowcases and mattress covers to keep out potential allergens.
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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 (found in 90% of skin atopic dermatitis skin lesions) and herpes simplex virus. Last year, Zill acquired an infection that caused her to break out in little bumps, called pustules, all over her body. “It looked like I had measles,” and she felt exhausted.
Tip: While antibiotics are useless for viral infections, they may be an appropriate way to treat—but not prevent—bacterial infections. Experts also recommend taking a bath in a mild bleach solution (a half-cup of household beach for a full tub, according to the ) two to three times a week to reduce bacterial growth on the skin.
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Women with eczema may find their symptoms worsen during pregnancy or when they’re having their period. Zill is no exception.
“When you go on your period, the first couple days are the worst,” she says. “You whole system is sensitive to everything. I feel like my skin gets more sensitive, too, around that time.” So, along with bad camps, she has to deals with a more painful type of itch than usual.
Tip: This won’t help your flare, but when you’re bloated and in pain, could there possibly be anything more comforting than a pint of chocolate-chip cookie dough ice cream? Go for a gluten-free, dairy-free version.
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Food allergies may play a role in atopic dermatitis, although the evidence isn't as strong as it is for other triggers. There are a couple ways that certain foods might affect skin symptoms. In one reaction, symptoms can occur within a couple minutes after eating a certain food, causing red and itchy skin. Less common are reactions that take longer, which can occur hours after eating a food. 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 doctor and get tested to pinpoint problematic ingredients. Exclusion diets (cutting out the suspected allergen) and should only be done with a doctor's supervision.