“With atopic dermatitis, an overall worsening state could mean someone is experiencing an increase in baseline severity of their flares, they’re seeing an uptick in the total number of flares per year, or both. It really depends on the individual,” says Jonathan Silverberg, MD, PhD, MPH, an associate professor of dermatology at the George Washington School of Medicine in Washington, DC, and a leading researcher on the condition. While there are treatments to help ease symptoms (and you should talk to your doctor if you find your discomfort growing), there are also behaviors you can change that might make a difference. That involves identifying how you might be aggravating your atopic dermatitis. Here, experts offer insights on eight ways you’re making your eczema worse — and what to do instead. While the heat can cause an inflammatory response in the skin that may intensify an itching sensation — leading you to scratch and potentially worsen the rash — the more likely culprit is sweat, according to the National Eczema Association. Perspiration lowers body temperature on hot days, but for people with AD, research has shown that sweating can exacerbate the condition in two ways: by removing moisture from the outer skin layers through evaporation, making skin drier and more susceptible to a flare; and by leaving behind an acidic residue of natural chemicals, including urea, lactate, and minerals, which can irritate rashes even further. Expert tip: If you’re headed outside on a hot day, wear loose-fitting clothes made from a breathable material like cotton-fiber, says Dr. Silverberg. If you find your clothes are getting damp because you’re sweaty, change into a new outfit as quickly as possible, so the wet fabric doesn’t cling to your skin, potentially aggravating your eczema. As soon as you can, “Take a cool shower to help bring down your body temperature and rinse the irritating sweat off,” Silverberg says.
2. Not Taking Enough Care During the Winter Months
Unless you’re living in a tropical climate, it’s nearly impossible to avoid the changes in temperature and air quality that arrive with winter. For people with atopic dermatitis, who have a genetic defect in a skin protein that makes their epidermis unable to lock in moisture, the drying effect of those cold, low-humidity months can be especially harmful. “For some patients, their skin remains extra dry for the entire three or four months of winter and they’ll find they can’t even handle showering or their regular personal care products like they used to,” says Silverberg. Expert tip: First, run a humidifier all winter, says Angela Lamb, MD, an associate professor of dermatology at the Icahn School of Medicine at Mount Sinai in New York City. “Then, make sure you’re using moisturizers at least twice a day, especially within a few minutes of getting out of the shower, so you can lock in that moisture,” she adds.
3. Getting Stressed Out
The body’s physiological reaction to stress is the same whether the worry is acute or chronic: The response, referred to as fight or flight, starts with the release of a cascade of stress hormones — namely cortisol and adrenaline — that suppress the immune system and increase inflammation. For people with atopic dermatitis, research has shown that this inflammation can impair the skin barrier function, potentially leading to more frequent flares. When stress is chronic and the immune system is suppressed for a length of time, you can also become vulnerable to more severe rashes because the skin can’t fight off pathogens as it normally would. “It’s almost inevitable that if someone with atopic dermatitis is going to be in a stressful situation, they’re going to flare,” says Silverberg. Expert tip: Stress can be hard to manage, but tried-and-true stress busters like mindful breathing and yoga can make a difference. For some patients, preventive drug therapy can also help. “We recommend the use of something called proactive therapy," (PDF) Silverberg says. “If you know you’re about to enter a stressful situation or period of work, why wait for a flare to happen? You can get ahead of it by using medications, like steroid creams and other treatments, on areas prone to flaring.” Silverberg notes that this not something he would recommend for every patient with AD, so proceed only under the guidance of your healthcare provider.
4. Indulging in Occasional Long, Hot Showers
While a leisurely, heated soak may feel relaxing, for those with atopic dermatitis, extended exposure to hot water can strip the skin of moisture and essential oils, leaving the outer skin disrupted and more prone to flare, says Dr. Lamb. “It’s a balance, because washing and getting the skin wet is actually good for people with eczema,” she adds. That’s because water washes off any bacteria or irritants on skin that might cause or exacerbate a flare-up. Expert tip: Shower or bathe in water as cool as you can stand, wash with a gentle cleanser, and then, within three minutes of coming out, after lightly patting yourself dry, “trap in that moisture with a really good, thick moisturizer,” says Lamb.
5. Using Products With Fragrances, Chemicals, or Preservatives
“Personal care products are definitely a major trigger for patients with eczema,” says Silverberg. That’s because fragrances, preservatives, surfactants, and other ingredients in these and other items, such as laundry detergents, can trigger itching and irritation that can make flares worse. Expert tip: “Remember, ‘clean’ products, which I recommend to patients, doesn’t automatically mean natural or organic, because sometimes those contain essential oils and other ingredients that may be naturally derived but can also be quite harsh to the skin,” says Silverberg. Make sure to avoid common skin care additives that are known to irritate eczema, and look for products that are fragrance-free, dye-free, and use as few ingredients possible, he adds.
6. Wearing Wool or Synthetic Fabrics
Certain synthetic materials, including nylons and polyesters, don’t “breathe” well, leading to overheating, sweating, and irritation, especially when worn in warm weather or during physical exertion. Wool may be breathable and naturally moisture-wicking, but it’s often too scratchy or rough for people with atopic dermatitis, triggering itching that lead to worsening flares. Rough seams, labels, and fastenings can also rub, causing additional issues for sensitive skin. Expert tip: Not all wool is created equal: Fine-woven merino and soft cashmere may not cause the same aggravation to the skin. In fact, a study published in 2019 in the journal Dermatitis found that, compared with standard clothes wearing, AD patients who wore a base layer of fine merino wool saw a drop in the severity of their outbreak, which the authors suggested could be due to it having less friction against the body. Aside from that, “Eczema patients typically do best with loose-fitting, cotton-fiber clothes,” says Silverberg. Clothing made of silk or bamboo should also be fine, though cut out any labels that might scratch. And make sure to wash all new clothes before wearing, says the National Eczema Association, since irritating chemicals are often present in new clothing to create a more appealing finish when hanging on racks.
7. Getting Hot and Sweaty From a Workout
Quick changes in body temperature that occur when running, biking, or even walking can further inflame a flare and itch; so can sweat. Still, the benefits of exercise are inarguable. “I’ve had patients come to me and say that another healthcare providers told them not to exercise to avoid heat and sweat, and I think that that is highly inadvisable. The overall benefits of exercise on our health and longevity are essential,” says Silverberg. Expert tip: Make sure your workout clothes are eczema-friendly. “Loose fitting, breathable fibers are going to much better tolerated on the skin than a tight spandex that really can have a lot of friction and buildup of heat and sweat,” says Silverberg. After your workout, immediately get into a cool shower or bath to lower your body temperature and rinse off the irritating sweat, says Silverberg. Then lightly pat yourself dry, add moisturizer, and if your doctor approves, apply any topical medication you’ve been prescribed. Finally, remember that even a lower-intensity workout can be good for you: “You don’t need to be dripping in sweat to get the benefits of exercise,” says Lamb.
8. Scratching Your Itch
It’s hard not to scratch when a main symptom of eczema is terrible itching. And when you do things that can make a flare feel worse, like getting overheated, resistance can feel futile. “Whenever you raise your body temperature and start sweating, you get a histamine release, which can create more intense itching,” says Lamb. “Then if you do scratch, the itching just gets worse, and it can become a chronic itch-scratch cycle.” Expert tip: “If you feel the need to scratch, try patting yourself instead,” says Lamb. She also encourages using cool compresses, which can calm the inflammation. “Take a damp washcloth, put it in the refrigerator or freezer for a little while, and then just apply it to your skin,” she says. “It’s very soothing and really takes down that itch.” If those methods don’t work and you feel stuck in an itch-scratch cycle, talk to your doctor about whether you’re a good candidate for an oral or injectable medication to help calm the resistant flare.
