By Purvi Parikh, MD
If you’ve ever had it, you know it: the dry, red, unbearably itchy skin condition called eczema. And you’re not alone – one out of every 10 people in the United States has it. It’s most common among children, but often found in adults as well.
“Eczema” actually refers to a number of skin conditions, many of which are related to allergy. The most common is atopic dermatitis, or AD, which is often triggered by food or environmental allergens. Contact dermatitis is a reaction to allergens and irritants such as soap, detergent, scratchy clothes or nickel jewelry.
An important part of an eczema treatment plan is preventing exposure to allergens and irritants that set off skin problems.
The 6 most common triggers for eczema:
1. Dry skin – When your skin is dry, it can cause eczema symptoms such as brittle, rough or scaly skin. Some people have a genetic condition associated with a skin protein called filaggrin that causes their skin to lose moisture and allow allergens and bacteria to enter the skin more easily. The best way to prevent an eczema flare is to keep your skin well moisturized. Recent research suggests that moisturizing a baby’s skin from birth may help prevent eczema from developing.
2. Food allergies – Food allergens can play a role in the onset of eczema symptoms, particularly for infants and young children. It’s believed the breakdown of the skin barrier contributes to an allergic response when a food allergen is consumed. Among children under the age of 2, eczema is most often related to milk or egg allergy – but it can occur with any food.
3. Environmental allergies – People with eczema may experience symptoms after exposure to certain grass, tree or ragweed pollen and/or indoor or outdoor mold. Pet dander and dust mites may also trigger symptoms. Since these allergens are often difficult to avoid, the most important treatment is aggressive moisturizing, along with antihistamines and topical skin corticosteroids, if necessary. Skin testing will help identify specific allergies so you can avoid the allergens. Some patients do well with allergen immunotherapy (allergy shots or tablets).
4. Contact allergies – Eczema is sometimes set off by something a person is in contact with on a regular basis. It could be a piece of jewelry that contains nickel; rubber; or chemicals used in cosmetics, disinfectants and skin products. If necessary, an allergist can do a patch test to identify the specific allergens causing the problem. Other potential skin allergens include antibacterial ointments such as neomycin and bacitracin and formaldehyde, which is found in household disinfectants, glues and adhesives.
5. Skin irritants – While they are not allergens, some soaps, detergents, fragrances and wool or synthetic clothing can significantly irritate sensitive skin. Heavy or tight clothing that rubs against the skin can also cause symptoms. Cigarette smoke can also irritate skin, the same way it irritates lungs and eyes. Use gentle, nonirritating products and stick with them. Natural fiber clothing such as cotton or silk is usually most comfortable.
6. Heat – Eczema can flare in hot weather as it can dry out skin or cause sweating. Sweat, in particular, can collect in your armpits or inner part of your elbow, leading to skin irritation. Wear appropriate clothing: light, breathable clothes in the summer. Avoid going outside during peak heat times during the day. If you do go outside, keep a small towel with you to wipe away excess sweat. And stay hydrated to moisturize from the inside out.
No matter what the trigger, the most effective way to fight eczema is to moisturize, moisturize, moisturize. Bathe in lukewarm water, dry skin gently by patting with a towel, then apply an ointment or cream to seal in the moisture. Reapply if necessary.
Prescription ointments, pills and injectable medications may be necessary for severe cases.
Though it’s extremely difficult to avoid scratching, do the best you can, as broken skin is easily infected, and scratching starts the cycle all over again.
If you think you or your child has eczema, schedule an appointment with your doctor; for a specialist, contact an allergist or dermatologist to discuss treatment options.
Purvi Parikh, MD, FACAAI, is a board-certified allergist and immunologist in New York City.
Reviewed by Neil MacIntyre MD