What Causes Eczema to Flare-up? Treatment and Tips for this Common Skin Disorder

By Patricia Ceballos, M.D.

Atopic dermatitis

 

What is eczema?

Eczema is known as “the itch that rashes!” Its initial presentation is frequently in childhood as early as infancy. By the time the patient seeks medical attention, there is usually a rash which may be widespread or limited to the flexures. In infants and toddlers, facial eczema is very common and manifests as redness and subtle blistering of the cheeks and perioral areas. Eczema and impetigo frequently coexist. The good news is that the majority of children will outgrow their eczema by young adulthood. By then, if persistent, it is usually limited in scope and distribution and easier to manage.

 

What does eczema look like?

Eczema (Atopic Dermatitis) is characterized by inflammation within the superficial skin layers. It manifests as itching, reddened scaly skin, excessively dry, cracked, or rough skin, small blisters, and “weeping” skin. The latter develops when excessive fluid accumulates in the epidermis, a phenomenon called spongiosis or “spongy skin.” Inadequate treatment can result in skin thickening, hyperpigmentation, and permanent scarring from vigorous scratching and frequent bacterial infections. It is important to seek specialized care early to prevent these sequelae.

 

Who commonly gets eczema?

Eczema is multifactorial. There’s a genetic component to eczema. It is usually found in families where certain members have one or more forms of atopy—a predisposition for asthma, eczema, or rhinoconjunctivitis associated with a hyperactive immune response to inhaled environmental allergens or foods. Furthermore, eczema patients are at increased risk of developing Contact Dermatitis to chemical exposures via the skin. These chemicals can be components of common topical products or present in our daily habitats.

In addition to genetics, environmental and dietary factors may play a role in any given patient. Polluted environments and climates which are too cold or too hot predispose to its occurrence. Exposure to smoke, particularly cigarette smoke, is deleterious, inciting its development. Excessive bathing, especially in hot water, aggravates eczema. Sweating due to hot temperatures or exercise can trigger a relapse. Certain textile fibers such as wool and synthetic fibers as well as fabric dyes unmask eczema in predisposed persons. Inadequate skin lubrication or the wrong moisturizer can provoke atopic dermatitis!

 

What foods cause eczema?

The association of food and eczema is an interesting phenomenon. I’ve had numerous young patients whose parents believe that citrus foods trigger their child’s eczema. Unless an allergist confirms particular food sensitivities, there is no evidence of a causal relationship. Notwithstanding, patients with atopic dermatitis are more likely to be allergic to milk, eggs, nuts, and shellfish. If you have eczema, testing for food allergies should be part of the evaluation and management.

 

What are common eczema triggers?

The most common eczema triggers are in everyday household products. Soaps, detergents, and moisturizers containing fragrance and formaldehyde abound and are implicated in relapsing or persistent eczema. Even fabric softeners and dryer sheets are a source of chemical allergens and ought to be avoided. An extra rinse cycle in the washer is recommended even when chemical-free detergent is used.

The goal is to minimize exposure to potential irritants. Therefore every eczema patient I treat is placed on a “Free and Clear” (Vanicream) regimen. Such products are free of fragrance and formaldehyde and therefore hypoallergenic. Theraplex moisturizers are similarly endorsed for their relative “purity.” The same with “edible” moisturizers, which are easily procured at the local supermarket and very affordable. Crisco shortening, for example, can soothe dry itchy skin. Proper and adequate moisturizing is a pillar in both prevention and treatment of eczema.

 

Can bacteria cause eczema flare-ups?

Additionally, the role of bacteria in eczema flares must be considered. The skin of most eczema patients is colonized by Staphylococcus aureus, the source of most skin infections in this condition. Once the skin’s integrity has been breached by the inflammation and spongiosis intrinsic to eczema, Staphylococcus aureus multiplies and spreads leading to further inflammation and eczema.

Initial treatment of a severely affected patient with evidence of bacterial infection (impetigo) includes oral and/or topical antibiotics. Dicloxacillin, cephalosporins, and erythromycin treat most Staphylococcus infections. Topical mupirocin 2% ointment is used alone or together with oral antibiotics. Oral antihistamines including Benadryl or Zyrtec attenuate itching.

 

The Best Treatments for Eczema

Topical corticosteroids are the mainstay of treatment. However, there exist other nonsteroidal suppressors of skin inflammation such as the immunomodulator Elidel. In general, ointment formulas are more effective (and efficient) during initial treatment. Eucrisa ointment is a nonsteroidal topical immunomodulator. As a phosphodiesterase-4 inhibitor, it reduces the key inflammation which causes eczema. It is a relatively new player, approved for patients aged 2 years and older. These nonsteroidal formulas are usually combined with a topical cortisone ointment for their “steroid-sparing” effects. The risk of long term side effects of prolonged corticosteroid therapy is very real in a recurring condition like eczema.

Enter Dupixent! Another new and systemic therapeutic option in the treatment of eczema. This “biologic” drug earned FDA approval in 2017. It is approved for adults with severe eczema and is a subcutaneous injection administered at regular intervals. Although it blocks the formation of certain inflammatory mediators in the skin (those implicated in eczema), it is not immunosuppressive and therefore not associated with the risks of most biologic therapies. Another bonus is its minimal side effect profile. This new therapy has been a real game changer in eczema treatment and I’ve been privileged to witness its miraculous transformation of my patients’ lives.

Schedule an appointment with one of the providers at Schweiger Dermatology to get help and choose the best treatment option for your eczema.

 

Additional Suggested Reading:

Eczema, Diaper Rash, and Other Skin Conditions That Might Be Giving Your Little One Grief

Eczema, Diaper Rash, and Other Skin Conditions That Might Be Giving Your Little One Grief

Your Survival Guide for Eczema in the Wintertime

Your Survival Guide for Eczema in the Wintertime

The Truth About Eczema

The Truth About Eczema

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