Eczema triggers: what can make eczema worse?

Everyone we talked to could name at least one trigger which could make their eczema worse, and many different triggers were mentioned. This included people who also had asthma, allergies and/or hay fever (linked with ‘atopic eczema’). What might be a problem for one person could be completely fine for another. Molly explained that, over time and through talking to others with the condition, “you just kind of learn to realise that every single person with eczema is so different and what triggers it is so different”. 

The most commonly reported triggers by those we interviewed were:
  • stress
  • weather/temperatures
  • allergens (including pet fur/dander)
  • food and drink
  • getting the skin wet and chemicals in water
  • cleaning products
  • cosmetics and bathing products (including fragrances)
  • clothes and fabrics
  • hormones
Working out triggers and allergies could be a trial-and-error process. Some people found it hard to narrow down the possible factors. Some kept ‘food diaries’. These weren’t useful for everyone though, as it could take a lot of time and be tricky to keep track if foods contained a lot of mixed ingredients.

Almost everyone said stress was a trigger for their eczema, relating to different sources:
  • about their studies and exams
  • in jobs, being unemployed and money worries
  • moving home
  • arguments and break-ups
  • bereavements
Many people said that stress and eczema can be a “vicious cycle”: stress leads to itching which makes the eczema worse and causes more stress. Not being able to sleep enough could add to this cycle.

Overall people said their eczema tended to be worse in winter and that heaters, which dry out the air, added to the problem. In contrast, being in the sun seemed to help. However, some people found that hot weather could make them sweat which would lead to itchiness, aggravating their eczema, and make their skin sting. This was especially the case in humid (damp) climates. Lots of people said they tried to keep cool, as this seemed to keep their skin less irritated, but that air conditioning could dry out the skin too. Although different seasons were expected triggers, some people found it hard to predict and prepare for the timing of changing weather. Cat said the weather didn’t seem to make much of a difference to her eczema but she thought that “you’re just happier when it’s light” in summer which might help her eczema.

There are a number of triggers also associated with allergies and asthma which could set off eczema (see also ‘atopic eczema’). This includes:
  • pollen (from grass, flowers, trees)
  • dust
  • damp and mould
  • dander (animal skin/fur)
A few people had patch test for allergies done, but others had been told by their doctors that they couldn’t have one done. This is because lots of different things can irritate the skin, but not all are related to allergies and allergens. An allergy test won’t show all these other things which make the skin flare-up, so the results would be of little help for managing their eczema.
Some people had to give up hobbies that involved coming into contact with things that they were allergic to. This could have a big impact on outdoor activities and hobbies. Himesh switched from playing cricket to tennis to avoid contact with grass and Laura had to stop horse riding. Dust and dirt allergies mean it’s important for some people to have a clean home but coming into contact with harsh chemicals from cleaning products could be bad for their skin. For those living in shared accommodation, such as whilst at university, it could also be difficult to get housemates to understand the importance of keeping a clean living space. (See also ‘Family life and eczema’).
Food and drink

A wide range of foods were thought to trigger eczema. Sometimes these were ‘allergies’, but other times some foods caused reactions but are not strictly allergies. Some of the most frequently mentioned food and drink triggers were: 
  • red meat
  • sweets
  • chocolate
  • fizzy drinks
  • milk/dairy
  • some kinds of fruit (e.g. peaches, melon, red berries)
  • spicy foods
  • processed foods (e.g. pizza)
  • caffeine (e.g. coffee)
  • alcohol
  • nuts
Other food triggers were considered more unusual. It could be difficult to explain this to friends when out eating with them and some wouldn’t believe it. Garlic and sushi both cause Gary’s skin to flare up, but people often challenge him on how this could be. Some people found that they were okay to eat certain foods but couldn’t touch or prepare them raw. Aisha has no food allergies but finds that cutting raw tomatoes hurts the skin on her hands. Some tried food alternatives – Himesh finds goat milk is better for his skin than cow milk.
Getting the skin wet and chemicals in water

Some people said that getting their skin wet (washing/showering, swimming, doing the washing-up, being in the rain) could flare up their eczema, even though drinking water and staying hydrated really helped their skin. Many avoided swimming because of the impact of water, and especially chlorine, on their skin. However, Evie found that chlorine wasn’t a problem for her skin and in fact seemed to help her eczema heal faster. Being in the sea/salty water was another trigger mentioned by a lot of people, though Gary found that one of the best places for his skin was a salty sea on holiday. Lizzie’s skin reacts to hard water (which has a high mineral content), so she had a water filter installed at her family home. Lots of people said they used rubber gloves when washing-up so their skin didn’t get wet or come into contact with washing-up liquid. At times, Maham’s worn rubber gloves when washing her hair and brushing her teeth because getting her hands wet was so uncomfortable.
Cleaning products

The strong chemicals in cleaning products could trigger some people’s eczema. These included washing-up liquids, bathroom cleaners/bleach and laundry detergent. Avoiding contact with cleaning products and keeping rubber gloves dry could be difficult, especially in shared houses. Staying over at other people’s houses was a worry for some people, because the laundry detergents used on bedding and towels might trigger their skin. (See also ‘Family life and eczema’).

Cosmetics and bathing products

Eczema can be triggered by things such as:
  • shampoos
  • shower gels, soaps and bubble baths (including for handwashing)
  • deodorants
  • sun-cream
  • perfumes
  • shaving gels
  • make-up (and make-up removers)
  • nail varnish (and nail varnish removers)
  • hair dye
  • hair styling products like gel
  • cosmetic (i.e. non-medical) moisturisers
  • face washes and scrubs
Some people found a product used on one part of the body triggered eczema on another, such as sprays (like hair spray and deodorant) or things used in the shower (such as shampoo). Most people tried to avoid things which were very perfumed and they preferred to have products with more ‘natural’ or ‘organic’ ingredients. Caution should be taken though – even if products were sold as ‘natural’, they may actually contain fragrances and some contain steroids. Bathing products for ‘sensitive skin’ were fine for some people, but still upset eczema for others. Some people knew of particular ingredients they had to avoid; for Laura, this was lanolin (a wool-based wax) and for Molly this was parabens (a range of preservatives). People often used a mix of prescribed treatments (such as emollients) in addition to shop-bought ones. 

Hair removal could also be tricky – some people found it helped their eczema as growing back hairs irritated their skin, others found it was better to let facial and body hair grow out. Instead of using shaving foams, Vicky and Himesh use one of their emollients.
Clothes and fabrics

Some fabrics can irritate the skin and prompt an eczema flare-up, such as woolly jumpers and poly (synthetic) materials. Other fabrics mentioned by people included sequins, leather, fake fur and denim. People said that they tried to stick with wearing cotton-based clothes and some also used cotton bedsheets. Many mentioned that tight clothes flared up their eczema further but very loose clothing could make it too easy to scratch or cause friction on their skin. People had to think carefully about style and fit when choosing clothes. Alice’s childhood experiences of itchy fabric and sticky emollient (creams) on her arms have made her dislike wearing long sleeved clothes. Others, such as Katie-Lauren, prefer to layer up clothes as a kind of barrier between the skin and itchy fabrics. Clothes also made a difference to the person’s temperature. Molly layers up when walking to lectures in the winter but sometimes overheats in the process of getting there, which irritates her skin. Jewellery, especially ‘cheap’ metals, could also cause flare-ups.

Some people said their eczema had changed during puberty, which they linked with hormones. Sometimes eczema became worse but for others, it could improve for a while. For some of the young women we spoke to there were a number of other triggers related to hormones which could flare-up their eczema such as: menstrual periods, using contraceptives such as the pill or the hormonal coil, or after sex. Some people had conditions which affected their hormone levels and seemed to be linked to their eczema, such as hyperhidrosis for George which means he sweats more, and polycystic ovary syndrome for Ele.


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