Eczema Explained: What Causes It and How Can I Improve it?

Living with eczema can be stressful and unpredictable. Flare-ups of dry, itchy patches of skin can strike seemingly out of nowhere. Though it typically comes and goes, eczema is a long-lasting skin condition that occurs when a trigger causes your skin to become inflamed. Even though it may seem out of your control, you can take steps to discover your triggers, reduce your exposure, and calm your inflamed skin when you do have a flare-up.

What causes eczema?

Doctors don’t yet know exactly what causes eczema. Atopic eczema, the most common type, appears to be immune-related. Although eczema itself is not an allergy, children and adults who have eczema often develop asthma or other allergic conditions, known clinically as the “atopic march”. It is believed that allergens to which a child is exposed early on may start with mild eczema that could be followed by hay fever (allergic rhinitis) and/or food allergy and later on asthma (or in its milder form referred to as hyperactive airway disease).

What triggers an eczema flare-up?

Substances that irritate the skin are the most common triggers for eczema flares. Everything from soaps and detergents to perfume and dust can trigger an eczema flare in susceptible individuals. Some people experience a flare-up when temperatures are too hot or too cold. Stress, dry skin, and sweating can also trigger an eczema flare. A japanese study shoed that people with atopic dermatitis (a more advanced form of eczema) have an allergy to their own sweat.

At Levit Dermatology, Eyal Levit, MD and his board certified dermatologists, provides treatment for eczema and advice and guidance on adjustments you can make to your lifestyle to control eczema flares and reduce symptoms. Here are some helpful tips to help you get your eczema under control.

Moisturize

People with eczema have skin that is sensitive to irritants and becomes dry quite easily. In a vicious cycle, having dry skin can trigger an eczema flare. Keeping your skin moisturized can help control eczema flares, especially in the summertime. Your provider can recommend a moisturizer that is appropriate for your skin. Your provider may prescribe a clinical-grade moisturizer designed to improve moisture retention. As a general rule a moisturizer should be applied over damp or wet skin not dry one. The moisturizer should be with the least amount of ingredients to reduce likelihood of an allergy to it (Dr. Levit has seen allergic reactions even to aquaphor and steroid creams). 

Showering

While some doctors suggest you shower less frequently, Dr Levit is of the opinion you should shower as often as you need, Ideally once a day unless you worked out and need more often, with the caveat you follow the following instructions:

Avoid long showers, hot water, sponges or scrubs, and bubble baths. 

Use soap that is fragrance free (not unscented (unscented has extra scents to mask the smell)). Use the soap only in the skin folds. The skin folds is where the specialized sweat ducts produce oil-rich sweat which mixes with skin bacteria to produce thio-alcohols (smells like sulfur, onion, and raw meat.)) In the skin folds (under the breasts, groin, buttock folds) a detergent soap is needed to wash off these oils and avoid the smell. The rest of the skin can be washed with water. Once you are done showering Dr. Levit advises removing the water off the skin with your hands so it's not soaking wet and then applying the moisturizing cream. Occasionally people apply massage oil first then apply a moisturizing cream over it. The idea is to trap the water under a layer of occlusive moisturizer forcing the water to penetrate into the skin and maintaining the skin barrier function. On rare occasions people may have irritation from occlusive moisturizers and they may prefer ones such as CeraVe.

Shampoo should be ideally without sulfates as it too can be a cause of skin irritation and allergies.

Keep skin cool and sweat free

Just as important as moisturizing, it’s equally necessary to keep your skin cool and sweat free.. Areas that accumulate sweat, such as the back of the knees and insides of the elbows are prone to eczema flares. Whether you’re sweating after a hard workout at the gym or perspiring in the summer sun, it’s important to avoid allowing sweat to accumulate on your skin. It’s a good idea to carry a towel to wipe that sweat off. This will help improve your symptoms and reduce flares. Having said that, it's important to keep the skin moisturized and having a humidifier in the home to reduce air dryness and thus reduce the transepidermal water loss helps keep the skin integrity and reduce bacterial infections. Make sure you clean the humidifier regularly as instructed by the manufacturer.

Avoid snug-fitting synthetic clothing

Tight clothing, wool, polyester and nylon can easily irritate the skin of people with eczema leading to sweat and overheating. Because your skin is so sensitive, it’s wise to avoid clothing that compresses the skin. It’s best to wear breathable fabrics that fit loosely and allow your skin to breathe. Remove any tags and watch for any protruding objects like buttons or seems that may rub or irritate the skin. Some suggest covering the seams with silk strips. Here are some natural breathable soft fabrics that are recommended for eczema patients:

1. Cotton- soft,breathable, cool and absorbs sweat and is the most commonly recommended textile for eczema patients.
2. Silk- like cotton is soft and breathable but staines easily from creams and is difficult to wash (unlike cotton)
3. Linen- besides being breathable has antimicrobial properties and is hypoallergenic and thus also very good for eczema
4. Bamboo clothing- a great option as it is soft, breathable, hypoallergenic, antimicrobial, & is the softest fabric next to silk. It is 4x more absorbent than cotton and can maintain body temperature by rapidly wicking the sweat and moisture. Still some may be sensitive to it- so try one before you change your wardrobe.

Nutrition:

A research study of 24 patients revealed that supplementing with the amino acid L-Histidine 4gm per day for 8 weeks had a better outcome than mid-potency topical steroid application in patients with atopic dermatitis (severe form of eczema). There were no side effects and the results continued after the participants stopped the supplementation.

We all know about the importance of a healthy gut. Dr. Levit recommends probiotics to his patients preferably lactose free and ones that are refrigerated, some take plane Kefir for gut health and if you're not lactose intolerant Dr. Levit said that kefir is a great way to help improve gut health and reduce inflammation.

Other foods are ones high in Omega-3 (as fish), and ones high in flavonoids such as tomatoes and red peppers. The more bright the colors of the vegetables the higher the content of the flavonoids. One supplement that mimics the anti inflammatory effect of flavonoids is Resveratrol (a non-flavonoid polyphenol). Another supplement Dr. Levit has been recommending and has been using for the past 8 years is NMN (Nicotinamide mononucleotide) now a bit harder to find as it is unavailable in the USA. Both supplements should be taken at a dose of 1000mg per day, a bit more has not been shown in Dr. Levit’s personal experience with his patients to be of any concern.

Medications

From topical steroids to non-steroidal topical medications such as Opzelura (approved for 12 years and older) and to oral pills such as RInvoq and Cibinqo (both approved for 12 year old and above) and to subcutaneous injections such as Dupixent (approved for 6 months and above). Dr. Levit has used all of the above therapies except a recently approved injectable called Adbry (an IL-13 blocking injection done every 2 weeks that was approved 12/2021 but is only being offered in a few weeks to the general population in more recent days). Dr. Levit reports that although all these medications are helpful and have revolutionized the treatment of eczema, he believes ideally one should always try to find the triggers while following proper skin care, and a healthy lifestyle and diet.

Avoid triggers

Steering clear of triggers plays a major role in controlling eczema flares. Your provider can help you learn what your triggers are so that you can avoid them. Keep a daily journal about your symptoms and what you’ve been exposed to so that you can find patterns and determine what substances in your environment are triggering your flares.

Dr. Levit and his board certified dermatologists help patients manage eczema and control flare-ups. Seeing a specialist is one of the best steps you can take toward getting your eczema under control. 

For high-quality eczema care, call our Brooklyn, New York office, or book your appointment online.