Dr Tariq Jagnarine
Fam Med, Endocrinology/ Diabetes
Atopic dermatitis (AD), also known as eczema, is an inflammatory skin condition that may cause dry, itchy skin. Flare-ups are periods when symptoms of AD worsen. They typically occur after exposure to a trigger. These are things that cause your skin to react, making it dry and flaky.
Causes
Atopic dermatitis flare-ups are typically a result of triggers. Internal triggers like stress or food allergies come from inside your body. External triggers come from something your body has been in contact with, such as environmental allergens, irritants, or dry air.
If you’re unsure about what’s causing your flare-ups, ask yourself:
Did I spend time in a new environment where I may have been exposed to new allergens or irritants?
Did the flare-up happen during a specific activity, like cleaning or exercising?
Did the flare-up happen when changing into a specific item of clothing, like a sweater or a new pair of socks?
Did I eat something different today?
Was I stressed or anxious about a specific event or relationship?
Having the answers to these questions may help you narrow down your list of possible AD triggers.
Understand triggers
Being aware of AD triggers, and taking measures to avoid them is key to preventing AD flare-ups.
• Physical irritants
When the skin touches physical irritants, it may immediately start to itch, burn, or swell. People with lighter skin tones may experience redness, while people with darker skin tones may experience purple or greyness. Many common household and environmental irritants may trigger AD flares. These may include:
• Some clothes’ materials, such as synthetic fibres and wool
• Soaps, detergents, cleaning supplies
• Dust
• Cigarette smoke
• Some fruit juices
People may experience an AD flare-up when they are in a new environment with different irritants. For example, if staying at a hotel that uses harsh detergent to clean the linens.
• Allergens
Some common allergens could trigger an AD flare-up. These may include:
• Pollen
• Animal dander
• Mould
• Dust mites
Try to keep the home and work environments as free from allergens as possible. This may involve daily vacuuming and washing fabrics, like blankets and sheets, often. Some places like bookstores, libraries, and vintage shops trigger flare-ups. If you can’t spend time in a library without scratching your skin, you might need to find a new place to work or study.
• Food
Food allergies and food intolerances don’t cause AD. However, they could trigger a flare-up, especially in children. Nine foods are responsible for 90% of food allergies, according to the Food and Drug Administration. These include:
• Cow’s milk
• Eggs
• Sesame
• Shellfish
• Fish
• Wheat
• Peanuts
• Tree nuts
• Soybeans
Some common food intolerances include lactose, gluten, histamine, and fructose. It may be difficult to identify a food allergy or intolerance as the cause of an AD flare-up. However, a healthcare professional could help determine the cause by testing for allergies. To help them, make a list of any suspected foods and bring this to your appointment. It’s also important to speak with a doctor before eliminating foods from your diet, as this may lead to nutritional deficiencies.
• Keep your skin moisturised
Dry, cold weather may trigger AD flare-ups and cause the skin to become itchy and cracked. This could be painful. Taking a hot bath or shower may also cause moisture loss by making the skin’s oil break down faster. It’s important to have a daily skin care routine and take measures to keep the skin moisturised. The American Academy of Dermatologists Association recommends applying a cream or ointment after bathing or swimming whenever your skin is dry. They also suggest specifically using “fragrance-free” moisturisers. If you’re experiencing an AD flare-up, apply a wet wrap like a cloth or gauze after putting on moisturizer. This is to help retain the moisture. Other tips to help keep your skin moisturized include:
• Taking baths with added oatmeal, baking soda, salt, or a 1/2 cup of bleach per 40 gallons of water
• Staying hydrated
• Protecting your skin when swimming
• Protect your skin from UV light
Some tips may also help you prevent AD flare-ups during exercise, such as:
• Taking short breaks out of the sun and drinking water to lower your body temperature
• Wearing loose clothing to prevent irritation
• Moisturising your skin before and after exercise
• Reduce stress levels
Stress causes the release of hormones like cortisol that affect your immune system. This may lead to inflammation, which could be manifested as eczema flare-ups. Some methods may help reduce your stress levels, including:
• Trying mind-body therapies, such as mindfulness, meditation, and hypnotherapy
• Practising yoga and deep breathing techniques
• Minimising your screen time
• Engaging in moderate-intensity exercise for at least 150 minutes weekly or high-intensity exercise for at least 75 minutes weekly
If these methods don’t help relieve stress, speak with a healthcare professional. They could offer other stress-relieving options for you.
Duration
The duration of an atopic dermatitis flare-up depends on several factors and will vary for each person. Flare-ups may last from a few days to several weeks. You may also experience flare-ups two to three times per month.
Treatment for atopic dermatitis may include medications, topical ointments, light therapy, lifestyle and dietary changes, and natural remedies. Speak with a healthcare professional if you’re experiencing frequent flare-ups. They could help develop a treatment plan that’s right for you.
