What Is Causing Your Eczema, and What Experts Say You Should Do to Calm Flare-Ups

Eczema is a chronic inflammatory skin disease. According to the National Eczema Association (NEA), there are seven types of the condition, with AD being the most common.

Typically, the skin barrier (the outermost layer of skin) protects the body from irritants, allergens, and bacteria. Eczema occurs for complex reasons that are still being studied, but essentially, the immune system is triggered by an internal or environmental substance and becomes overactive causing the skin barrier to become inflamed, and damaged, and resulting in patches of extremely dry and itchy skin. 

These patches can appear in a number of places on the body but most frequently show up on the face and neck in infants, and as they grow, on hands and feet and in areas where the skin folds, such as behind the knees and inside the elbows.

While AD is most common in youngsters (it often appears between 2 months and 5 years of age and affects about 1 in 10 children in the U.S.), it can occur at any age. 

“Can you get it as a child? Yes. Can you get it as an adult? Yes. Can it linger all your life? Yes, that can happen,” says Cheryl Burgess, MD, FAAD, of the Center for Dermatology and Dermatologic Surgery in Washington, D.C.

Some may see their eczema go away during adolescence. For others, remissions and flare-ups are the norm. It’s been reported that almost two-thirds of AD sufferers continue to experience flare-ups as adults. And it’s not uncommon to suffer from eczema patches on one part of the body as a baby, then experience flare-ups elsewhere on the body decades later.

Studies have shown that in the U.S., Black people experience greater AD prevalence, severity, and persistence than white people do. Also, eczema has been found to affect more Black children (about 14 percent) than white (about 10 percent) and Hispanic children (about 9.5 percent), while Black and Hispanic children tend to have more severe eczema than white children. At the same time, a study published in June found that Hispanic adults have a lower prevalence of AD than all other adult groups. That same study found that AD prevalence is higher in females than males across all ethnicities. Many experts agree that increased study is needed to determine why these differences exist.

“The way we discuss science and the way we teach medicine, we’re often conflating race, genetics and biology, as well,” says Jenna Lester, MD, director of the Skin of Color Program at the University of California San Francisco.

“There’s been study after study showing that there are more genetic differences within racial groups than between them,” she says. “So to use race as a proxy for biology or genetics is flawed. You’ve associated these groups of people based on a social reason and now you’re trying to extrapolate from that and claim there’s common biology, too. It just has not been proven in research to be true.”

Lester feels more nuance is needed when researching eczema—for example, an examination of the link between AD inflammation and stress caused by the impact of racism. A paper published by the Journal of Allergy and Clinical Immunology states that there’s evidence that socioeconomic and healthcare factors influence AD prevalence and severity, and that those factors are more common among racial and ethnic minority populations as a result of racism. Lester also cites environmental injustice—“the fact that Black neighborhoods that are historically redlined areas tend to have higher rates of pollution”—as an underappreciated contributing factor to eczema that requires more research. Redlining is a form of racial discrimination in which financial services—such as business and mortgage loans—are withheld from certain neighborhoods. The practice mostly affects Black people.

“It’s hard to have a couple of studies and then make huge generalizations about whole groups of people that impact their care,” Lester concludes.

Burgess says that AD affects every ethnicity but that the condition can present differently depending on skin color.

The NEA acknowledges that most information about eczema has been learned by studying white skin. 

“Our system narrowly conceptualizes what skin disease looks like,” Lester says. “If there isn’t broad representation, doctors don’t ever tell the medical students or residents, ‘This is what eczema looks like,’ then they can’t counsel families about it. That’s an issue that seeps out from the lack of representation of diverse images in medicine.”

According to the American Academy of Dermatology (AAD), atopic dermatitis appears as a red rash, especially on lighter skin tones, and can range from small, rough bumps to dark brown, purple, or grayish areas more commonly in darker skin tones. And AD typically appears as lesions with more defined borders, similar to psoriasis plaques, in Asian individuals. 

For Nicole Schallig, a theater teacher with white and Southeast Asian heritage from Sacramento, Calif., pink patches appeared along with tiny bumps that could be mistaken for heat rash. Scratching those patches results in cracked, rough skin that’s prone to oozing. She was first diagnosed with AD around age 7, when the rashes began appearing on the crooks of her arms and backs of her knees.

“The outbreaks were embarrassing,” says the 46-year-old, recalling her formative years. “When there was something about my skin that was so dramatic that people were concerned, that always bothered me.”

It is often hereditary and is more likely to occur in people who have asthma, hay fever, and food allergies. 

“It’s not contagious,” Burgess says, debunking a common myth. She adds, “Just because someone else in the family has it doesn’t mean that you’re going to get it. And if you touched one area that has eczema and you develop it in another area, you didn’t spread it from one area to the next. These are some of the common things that people always ask.”

An individual can go for months or even years without experiencing these unpleasant patches. Flare-up triggers vary widely from person to person—including sweat, weather, and other factors. 

A damaged skin barrier can prevent the skin from retaining moisture, which can lead to flare-ups.

“In general, we see reactions seasonally,” Burgess says of her AD patients. “We do see it commonly in the springtime with the blooming of the flowers and trees. In the summertime, you can see people react to grass—people with eczema will say, ‘I can’t sit on the grass because I start itching.’” 

She says ragweed season—the summer or early fall—can trigger flare-ups, as can a mixture of rain and autumnal piles of leaves combining to create mold. “I see people who have eczema all year round.”

The list of eczema triggers can also include harsh soaps, detergents and fabric softeners, pet dander, hormonal shifts, and nickel (and other metals used in jewelry and tech gadgets), as well as sudden weather changes, such as strong, dry winds or a cold snap. Additionally, studies have found that chronic stress is a common eczema trigger.

Foods linked to flare-ups include such widely known allergens as tree nuts, eggs, soy, cow’s milk, wheat, and shellfish. Schallig, who was diagnosed with the autoimmune disorder celiac disease six years ago, learned that gluten was affecting not only her digestive system but also her eczema. She says eliminating it from her diet decreased her AD flare-ups. Burgess also cites citric acid (found in fruit juices and tomatoes) as another common trigger. 

Triggers and symptoms can differ for individuals within the same family.

Watson-Crick and her daughter share some triggers—environmental allergies and dehydration—but only Watson-Crick’s daughter flares up from contact with topical irritants and consuming dairy, sugar, soy, and certain nuts. 

“When she was younger,” she says of her now-19-year-old, “it was hard to keep socks on her hands so she wouldn’t scratch her face. And then it was very hard to adopt eating and cleaning habits that limited allergens that might aggravate her eczema. Helping her accept the sensitivity of her system and work with it, rather than battle it, was and is incredibly difficult.”

If you suffer from eczema, it’s best to work with your dermatologist to find a treatment regimen that works for you.

Get a cream or ask about a prescription medication. Topical (meaning, applied to the skin) corticosteroids and nonsteroidal topicals—both of which have anti-inflammatory effects—are usually used to treat AD. 

Over-the-counter creams containing at least 1 percent hydrocortisone can calm mild flare-ups. Burgess calls out Cortizone-10 as a go-to. (It’s also available as a generic.)

While there is currently no cure for eczema, keeping the skin moisturized on a daily basis—applying moisture one to three times a day—is a big part of maintaining healthy skin and keeping flare-ups away. The AAD says moisturizing right after bathing can help hydrate the skin.

Go for sensitive-skin products and avoid scrubbing the skin. “Some general rules are to think about products that are specifically designed for sensitive skin,” Introcaso says. “Whether it’s a wash or a moisturizer, you want to think about products that say specifically that they’re for sensitive skin, and also things that don’t have a fragrance.” (Fragrances can often be allergens.)

When it comes to soaps, Introcaso recommends Dove Sensitive Skin Beauty Bar, and lathering the soap by hand and not with washcloths or loofahs. “Our skin was not designed to be scrubbed with a physical item,” she says, adding that, particularly for people with atopic dermatitis, such abrasion is too irritating.

Pay attention to the water temperature. Bathing in warm water is best, Introcaso says, as hot water can cause damage to the skin barrier. She advocates for a simple, “less is more” bathing regimen, noting, “You don’t even necessarily have to put soap on your arms and legs every day if they’re not dirty.” Experts also recommend keeping showers and baths short to prevent skin from drying out.

Consider diluted bleach baths. And Introcaso says some data has shown that diluted bleach baths (and we’re talking very diluted) have also been proven helpful in preventing flare-ups because they help to decrease bacteria on the skin, thereby helping to decrease inflammation over time. She advises mixing a quarter-cup of regular-strength bleach—the kind you’d use for laundry—into half of a bathtub of water, then soaking skin for about 10 minutes. This can be done two or three times a week (even for kids).

Remember to moisturize. As mentioned, keeping the skin moisturized is key. Both Burgess and Introcaso recommend using petroleum jelly. For options that are less greasy, Burgess suggests Hyaluronic Cleansing Melts and Sensitive Soothing Moisturizer, both by Olay, as well as LaRoche-Posay’s Lipikar AP+M moisturizer, while Introcaso points to Eucerin and CeraVe. Introcaso also recommends Vanicream Moisturizing Cream. “It’s very inexpensive,” she says, “and they have very few ingredients. They purposefully keep things as simple as possible.” 

Some studies have shown that those with AD should say no to lanolin, and such herbal ingredients as tea tree oil, olive oil, and aloe because they can cause contact dermatitis, a rash caused by direct skin exposure to an allergen. And retinoids found in some acne and anti-aging products can irritate sensitive skin. Burgess rounds out the list of no-no’s with shea butter-based products, particularly for those who have a nut allergy.