Living with Eczema

Eczema can be managed day to day by protecting your skin, calming the itch, and knowing what to do when symptoms flare.

At a Glance: Living with Eczema

  • Scratching makes eczema worse, not better. This is called the itch-scratch cycle: scratching relieves the itch for a moment, but it damages the skin barrier and lets in allergens, irritants, and bacteria. This increases inflammation and keeps the itch going.
  • Everyday habits can help. Frequent moisturizing, keeping fingernails short, wearing loose-fitting clothing, and using cooling methods like cool compresses or oatmeal baths can help reduce itching and dry skin.
  • Medications can control inflammation and itch. Topical corticosteroids and non-steroid creams treat inflammation, and for moderate-to-severe eczema, advanced therapies like biologics and JAK inhibitor pills can also help.
  • Sleep and eczema affect each other. Itching is often worst at night, and poor sleep can affect overall well-being. A consistent bedtime routine — moisturizing, controlling itch, and identifying triggers — can help.
  • Weather can change how you manage your eczema. Heat and sweat in summer, and dry indoor air in winter, both require adjustments like more frequent moisturizing or a stronger medication routine.
  • Eczema can take an emotional toll. Support groups, stress-reduction techniques, and talking with a healthcare provider about anxiety or depression are all part of coping with eczema.

Living with eczema can be hard. It is a very uncomfortable condition to live with, and takes an emotional toll on both patients and families. There is no cure, but there are new and better treatments available that can help you control eczema.

In addition to treatments, breaking the itch-scratch cycle is one of the best things you can do to reduce symptoms. Be sure to practice good self care and seek out the support you need and deserve with this difficult condition.

Here are some tips on navigating day-to-day life to help you cope with this challenging disease.

What Is the Itch-Scratch Cycle?

The eczema on your skin is itchy. You scratch. It itches again. You scratch again. The cycle seems unending. What doctors now realize is that when you scratch skin impacted by eczema, you keep the itch going and worsen the condition.

This is called the itch-scratch cycle. Here’s how it happens:

  1. When you scratch, you break down the outer layer of skin, allowing allergens, irritants and bacteria to enter.
  2. Your immune system responds by sending signals to the surface of the skin.
  3. This causes more skin inflammation … and more itching.

Near-constant scratching can affect your quality of life and impact sleep, especially in children. It also increases your risk of infection.

What Can Trigger Eczema Itching?

Common triggers for itching with eczema include:

  • heat and hot water
  • cold, dry air
  • sweating
  • dry skin
  • stress
  • allergens, such as dust mites, pollen, mold, pet dander, and certain foods
  • irritants, such as soaps, detergents, household cleaners, fragrances, and chlorine
  • fabrics, such as wool and polyester

How can you break the itch-scratch cycle of eczema?

‘Just stop scratching’ is easier said than done. Here are strategies and treatments to help relieve or minimize itch in patients with atopic dermatitis.

Frequent moisturizing

Frequent moisturizing can not only soothe the skin but also reduce the itch associated with eczema.

Medications

Medications to relieve the itch of eczema include:

  • steroid creams (topical corticosteroids)
  • non-steroid creams, such as calcineurin inhibitors, PDE4 inhibitors, JAK inhibitor cream, and tapinarof (VTAMA
  • advanced medicines for moderate to severe eczema, such as biologics (shots) and JAK inhibitor pills

Some people may find antihistamines can help relieve itching for a little while. But antihistamines are not an eczema treatment and should not be used long-term.

Talk with your doctor about using these medications for your eczema.

Cool the skin

Placing cool packs (stored in the refrigerator) on affected skin can help relieve itching. You can also apply a cool compress to the skin.

Bathing and moisturizing

A short bath or shower with lukewarm water can help hydrate the skin and wash away irritants. Immediately after the bath or shower, apply a fragrance-free moisturizer while your skin is still damp. This helps seal in the moisture, support the skin barrier, and reduce itch.

Some tips:

  • Use lukewarm water. Do not use hot water.
  • Keep baths or showers to about 5–10 minutes.
  • Use a gentle, fragrance-free cleanser. Avoid scrubbing the skin with a washcloth or loofah.
  • Gently pat your skin dry rather than rubbing it.
  • For baths, stir in colloidal oatmeal, apple cider vinegar or a half-cup of baking powder and bathe for 10 minutes.
  • For temporary relief from itching, rub the skin with vinegar water (one tablespoon of vinegar to one quart of water).

Wear loose-fitting clothes

Loose-fitting clothes can keep the pressure off the skin. Wearing clothes inside out keeps seams from rubbing against your skin, and cutting off tags can help too.

Scratch with care

If you must scratch, try stroking the itchy area using the top side of the hand instead of your fingernails. A cool, smooth object (like a small stone) can also relieve itch without breaking the skin.

Keep fingernails short

Keep your fingernails cut very short – especially for infants and young children. Put eczema mittens on a baby’s hands; your baby still may try to scratch, but not with fingernails.

Find a distraction

Keep your hands occupied so you don’t focus on itching. Some suggestions include using a pop-it toy, fidget spinner or stress ball. Crafting like coloring, knitting and beading could help. For children, try to distract them with games.

How Can You Improve Sleep with Eczema?

Quality sleep is critical to overall health, but it’s often hard for people with eczema. Itching is often at its worst at night, when there are no activities to distract your mind and body. It’s also a sign that eczema symptoms are not well controlled.

Sleep disruption can have a significant impact on well-being, especially with children. Here are tips to develop a bedtime routine and help ease the itch:

Two tween boys sleeping in the morning after being up all night with asthma issues.

Moisturize your skin before bed

Treating your skin with moisturizer before bed can help control eczema symptoms as you try to sleep.

Consider taking a bath before bed. Wet the skin with lukewarm water – just enough for moisture to soak into the skin. When the bath ends, pat the skin dry – don’t wipe it dry. Apply a hypoallergenic moisturizer immediately after the bath. This helps the skin trap the moisture.

Hypoallergenic moisturizers are recommended because fragrance-based products can sometimes further irritate the skin.

Take medication

Using medication before bed can help calm your skin before bed. Anti-inflammatory ointments and creams can help ease itching and scratching during sleep.

Over-the-counter options include low-potency steroid creams (like hydrocortisone), which are anti-inflammatory. If these don’t control your symptoms, talk with your doctor about other options, which include:

  • Higher-strength corticosteroid creams and ointments (by prescription)
  • Non-steroid creams, such as calcineurin inhibitors, PDE4 inhibitors, JAK inhibitors or Tapinarof
  • If your eczema still isn’t controlled, your doctor may consider adding an advanced therapy, such as biologics or JAK inhibitors.

Anti-inflammatories are typically used in conjunction with moisturizers. They control inflammation when the skin is moisturized. An overnight wet wrap using cool or refrigerated clothing may also help relieve itching.

asian Woman scratching her arm while outside sitting on a park bench

How to Find Out Your Eczema Triggers?

Eczema triggers are different for everyone. It’s important to pay attention to what you are exposed to that makes your skin flare. Keep track of when your symptoms flare and what you were exposed to before the flare. This can help you and your healthcare provider identify patterns.

Common eczema triggers include:

  • heat and sweating
  • weather changes
  • dry air
  • wool or synthetic fabrics
  • tight clothing
  • seasonal and/or environmental allergens, such as pollen, mold, pet dander and dust mites
  • certain foods or food allergens
  • soaps, detergents and other cleaning products that are not fragrance-free
  • stress and anxiety

Talk with your healthcare provider about testing (if needed). Skin or blood testing can help identify if environmental allergens are causing eczema flare-ups. Oral food challenges can also be used to diagnose a food allergy that is triggering eczema.

Once you have identified your trigger(s), work together with your healthcare provider on avoidance strategies to better manage the condition.

You may not be able to identify a specific trigger for every eczema flare. But with an effective eczema treatment plan, you’ll know how to keep symptoms in check until you can identify a trigger.

How Do Hot and Cold Weather Affect Eczema?

Extreme temperatures can take a toll on your skin. Both hot, humid weather and cold, dry air can trigger or worsen eczema symptoms. Here’s a look at how to handle hot and cold weather and some practical tips for avoiding flare-ups.

Hot weather

Dry heat and sweat are common eczema triggers. Summer wardrobes such as shorts, sleeveless tops and bathing suits can expose more skin to these triggers. You can control eczema in warm weather by conditioning the skin and soothing the itch. Some tips:

Keep up with moisturizers

Just because summer humidity feels clammy doesn’t mean you should let up on keeping your skin hydrated. The more you moisturize at the beach, pool or club, the better. And don’t forget to moisturize again after a warm (not hot!) bath. This can seal in water in your skin.

Use sunscreen wisely

Sunshine may actually improve eczema symptoms for some people, but protecting your skin from sun damage is still important. Choose a fragrance-free sunscreen without dyes or alcohol, especially for sensitive skin. (If you’re a new parent, keep your baby out of the sun and use protecting clothing and shade instead of sunscreen.)

Rinse off

Rinse off periodically to wash away allergens, irritants (salt! sand! chlorine!) and sweat on your skin, then reapply moisturizer.

Stay hydrated

Drink plenty of fluids to avoid becoming too hot.

Cold weather

During the winter, our skin loses moisture much more quickly than in the summer, spring or fall. This is a problem for people with eczema. Here are some preventive tips to keep your skin from over-drying in wintertime.

Increase your moisturizing routine.

If you normally moisturize once a day, such as after a bath or shower, do it two or even three times a day during winter so skin does not become dry and cracked.

Consider a humidifier

Running heaters during the winter makes indoor air even drier; humidifiers are designed to put moisture back in the air.

Avoid wool clothing

As you dress warmly for the outdoors, make sure you put on hats, scarves, sweaters and gloves that are not made from wool, as these can irritate and increase itching.

Talk with your doctor

If your usual treatment isn’t controlling flares during this time, talk with your doctor about whether a stronger medication is needed for the winter months.

Managing Anxiety and Depression When You Have Eczema

For some people, living with eczema can cause feelings of anxiety, sadness, frustration and loneliness. Visible rashes, constant itching and discomfort can affect your emotional well-being. You may avoid social activities or worry about when the next flare will happen. And symptoms can make it hard to sleep, leaving you feeling tired and overwhelmed.

Healthy habits can help you cope with anxiety and depression. Here are some recommendations to help you:

Follow your eczema treatment plan

Getting your eczema under control may help your emotional well-being. Follow your treatment plan and talk with your healthcare provider if your symptoms are not improving.

Create routines

Following a routine can make eczema care easier to manage and reduce anxiety and stress. It turns skin care into a regular habit rather than something you have to remember during a flare. For example, apply moisturizer at the same time every day. Try going to bed and waking up at the same time each day.

Talk to a mental health professional

You don’t have to handle anxiety or depression by yourself. A therapist, counselor or mental health professional can help you learn ways to manage anxiety and depression, as well as stress and negative thoughts.

Find a support group

Find people who support you in real life or virtually through a support group or online community. Stay connected with friends and family, even if it is through a phone call or text. Talk to other eczema patients about how they manage the condition.

Stay active

If you need a distraction from your symptoms, try physical activity such as walking, swimming or another activity you enjoy. Regular meditation and yoga can help you control anxiety by redirecting your thoughts. This can help reduce stress and improve your mood. Choose activities that feel comfortable for your skin.

Make time for things you enjoy

Be patient with yourself

Eczema flares happen, but they don’t have to define who you are. Having a difficult day does not mean you are failing to manage your condition.

Many people may not understand how emotionally painful and draining eczema can be. If you are struggling with eczema, remember that the more you support yourself emotionally, the more you can cope with the challenges that eczema brings.

Talk to your doctor about any depression or mental health concerns.

Conditions that can look like eczema 

Several skin and immune conditions cause rashes, itching, or swelling that get mistaken for eczema. They differ in what triggers them, how they are diagnosed, and how they are treated. If a rash is not responding to eczema treatment, ask a board-certified allergist or dermatologist whether one of these could be the cause: 

  • Aquagenic urticaria causes hives after contact with water.
  • Celiac disease can cause dermatitis herpetiformis, an intensely itchy blistering rash.
  • Chronic spontaneous urticaria (CSU) is hives lasting six weeks or longer with no identifiable trigger.
  • Chronic urticaria (hives) causes welts that move around, with individual welts usually fading within 24 hours.
  • Cold urticaria brings on hives, swelling, and welts after exposure to cold.
  • Contact dermatitis is actually a form of eczema, but it is triggered by an allergen or irritant touching the skin rather than by atopic disease.
  • Hereditary angioedema (HAE) causes deep swelling without hives or itching, and does not respond to antihistamines or corticosteroids.
  • Mast cell diseases, including mastocytosis and mast cell activation syndrome, can cause unexplained skin rashes along with other body-wide symptoms.
  • Primary immunodeficiency diseases include several disorders that produce severe, treatment-resistant eczema-like rashes starting in infancy.
  • Psoriasis produces thick, sharply defined, scaly plaques, often on elbows, knees, and scalp.
  • Rosacea causes flushing, lasting changes in skin color, and sometimes acne-like bumps on the face, often with burning or stinging.
  • Scabies is caused by tiny mites that burrow into the skin, producing a rash with intense itching that often worsens at night.
  • Seborrheic dermatitis is a form of eczema that causes flaky, sometimes greasy patches on the scalp, face, and other oily areas of the skin.