Causes of Eczema and Expert Tips to Manage Flare-Ups

Windy Watson-Crick, a Black mother of two from Altadena, California, has experienced mild, sporadic patches of skin irritation throughout her life, but it wasn’t until her older daughter was diagnosed with atopic dermatitis (AD) as an infant that she realized these were symptoms of eczema.....Read Full Article>>

“I’m lighter-skinned, and my daughter has several shades darker skin than I do,” she explains. “My patches appear pinkish and slightly raised, while hers start off a bit browner than her healthy skin. If she doesn’t treat her patch aggressively, it will darken, become extremely itchy, and grow larger.”

Watson-Crick and her daughter’s experiences mirror those of over 31 million Americans who grapple with eczema—a relentless itch that never truly goes away. Eczema is a chronic inflammatory skin condition, with atopic dermatitis being the most prevalent form, according to the National Eczema Association (NEA).

Typically, the skin barrier acts as a protective shield against irritants, allergens, and bacteria. Eczema arises from complex interactions still being studied; essentially, the immune system becomes overactive in response to an internal or environmental trigger, leading to inflammation, damage to the skin barrier, and resulting in patches of extremely dry and itchy skin.

These patches can manifest on various parts of the body but are most common on the face and neck in infants, later appearing on hands and feet, as well as in areas where the skin folds, such as behind the knees and inside the elbows.

While AD is most frequently seen in young children—often presenting between 2 months and 5 years, affecting about 1 in 10 children in the U.S.—it can develop at any age.

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

Some individuals may find their eczema resolves during adolescence, while others may experience ongoing cycles of remissions and flare-ups. Reports indicate that nearly two-thirds of those with AD continue to face flare-ups into adulthood, and it’s not unusual for eczema to first appear in one area during infancy and later manifest elsewhere in life.

Research indicates that in the U.S., Black individuals experience higher rates of AD prevalence, severity, and persistence compared to white individuals. Black children are affected more significantly—about 14%—than white (approximately 10%) and Hispanic children (about 9.5%), with Black and Hispanic children typically experiencing more severe cases. Interestingly, a recent study showed that Hispanic adults have a lower prevalence of AD than other adult groups. Furthermore, the study found that AD is more common in females across all ethnicities, prompting experts to call for further investigation into the reasons behind these disparities.

“The way we discuss science and the way we teach medicine often conflates race, genetics, and biology,” says Dr. Jenna Lester, director of the Skin of Color Program at the University of California, San Francisco. “Numerous studies have shown more genetic variation within racial groups than between them. Thus, using race as a proxy for biology or genetics is fundamentally flawed. We’ve associated these groups socially, and then attempted to claim a common biology, which hasn’t been substantiated by research.”

Lester argues that a more nuanced approach is needed in eczema research, including an exploration of the relationship between AD inflammation and the stress related to the experience of racism. A study published in the Journal of Allergy and Clinical Immunology suggests that socioeconomic and healthcare disparities, often linked to racism, may contribute to the prevalence and severity of AD, disproportionately affecting racial and ethnic minorities. Lester also highlights environmental injustices, such as the higher pollution rates in historically redlined neighborhoods, as under-researched factors contributing to eczema.

“It’s challenging to generalize from a few studies about entire populations that impact their care,” Lester concludes.

Burgess notes that while AD affects individuals of all ethnic backgrounds, the presentation can differ based on skin color. The NEA recognizes that most eczema research has primarily focused on white skin.

“Our understanding of skin diseases has often been narrowly defined,” Lester explains. “Without broad representation in medical education, doctors are unable to effectively teach medical students and residents what eczema looks like across diverse skin types. This lack of representation in medical imagery is a significant issue.”

According to the American Academy of Dermatology (AAD), atopic dermatitis typically appears as a red rash, especially on lighter skin tones, but can manifest as dark brown, purple, or grayish patches in individuals with darker skin. In Asian individuals, AD often presents with lesions that have more defined borders, resembling psoriasis plaques.

Nicole Schallig, a theater teacher with mixed white and Southeast Asian heritage from Sacramento, California, recalls developing pink patches alongside tiny bumps that resembled heat rash. Scratching these areas led to cracked, rough skin prone to oozing. She was diagnosed with AD at age 7 when rashes began to appear in the crooks of her arms and behind her knees.

“The outbreaks were embarrassing,” says the 46-year-old. “When people were concerned about something so noticeable on my skin, it always bothered me.”

Eczema often has a hereditary component and is more likely to occur in individuals with asthma, hay fever, and food allergies.

“It’s not contagious,” Burgess clarifies, dispelling a common misconception. “Having a family member with eczema doesn’t mean you’ll get it, and if you touch one area with eczema and develop it in another, it’s not because you spread it.”

Individuals may experience months or even years without flare-ups, but triggers can vary widely, including sweat, weather changes, and other factors. A compromised skin barrier can hinder moisture retention, leading to flare-ups.

“In general, we see seasonal reactions,” Burgess explains. “Springtime often brings reactions due to blooming flowers and trees. In summer, people may react to grass—many with eczema report they can’t sit on grass without itching.”

She notes that ragweed season in late summer or early fall can provoke flare-ups, along with the combination of rain and autumn leaves that create mold. “Some patients experience eczema all year round.”

Triggers can also encompass harsh soaps, detergents, fabric softeners, pet dander, hormonal changes, and metals like nickel found in jewelry and tech devices, along with sudden weather shifts such as strong winds or cold snaps. Chronic stress is another recognized eczema trigger.

Common food allergens linked to flare-ups include tree nuts, eggs, soy, cow’s milk, wheat, and shellfish. Schallig, who was diagnosed with celiac disease six years ago, found that eliminating gluten not only improved her digestive health but also reduced her eczema flare-ups. Burgess also identifies citric acid, found in fruit juices and tomatoes, as another frequent trigger.

Even within the same family, triggers and symptoms can differ.

Watson-Crick and her daughter share some common triggers, including environmental allergies and dehydration, but her daughter uniquely reacts to topical irritants and specific foods like dairy, sugar, soy, and certain nuts.

“When she was younger,” Watson-Crick recalls of her now-19-year-old daughter, “it was challenging to keep socks on her hands to prevent her from scratching her face. Adopting eating and cleaning habits to minimize allergens that could aggravate her eczema was also difficult. Helping her accept her sensitivity and work with it, rather than fight against it, has been incredibly challenging.”

For those suffering from eczema, collaborating with a dermatologist to establish an effective treatment plan is crucial.

Options may include over-the-counter creams or prescription medications. Topical corticosteroids and non-steroidal topicals, both known for their anti-inflammatory properties, are commonly used to treat AD.

For mild flare-ups, over-the-counter creams containing at least 1% hydrocortisone can be effective. Burgess recommends Cortizone-10, which is also available as a generic option.

Depending on the severity, location, and age of the patient, dermatologists may prescribe stronger medications, such as topical steroids, oral treatments like JAK inhibitors, or injectable medications, including Dupixent and Adbry, as noted by Camille Introcaso, MD, head of dermatology at Cooper University Health Care in New Jersey.

Consistency is key when using medications. It’s essential to follow prescribed dosages and treatment durations, as prolonged use can lead to adverse effects, such as skin thinning.

“Generally, I tell my patients if something hasn’t improved within two weeks of consistent daily use, it’s time to consult a dermatologist,” Burgess advises.

Follow prescribed instructions closely. Adults should exercise caution when applying medication to children since dosages are tailored to body weight and surface area.

“Medications for children must be calculated differently—much like how baby aspirin differs from adult aspirin,” she adds.

Additional Treatment Options for Flare-Ups

According to the AAD, wet wrap therapy can be an effective way to reduce inflammation. This involves applying a topical steroid to the skin and layering wet and then dry gauze or bandages over the affected area.

Antihistamines can provide temporary relief from itchy skin caused by other allergic symptoms, such as a runny nose or itchy throat. However, some studies indicate that propylene glycol—commonly found in oral antihistamines and corticosteroids—can trigger allergic reactions in those with AD.

For some eczema sufferers, swimming in a chlorinated pool can provide relief in hot weather, although reactions can vary. “Some find chlorination soothing; others find it irritating,” says Burgess.

Phototherapy is another option. “Phototherapy helps by altering the immune response in the skin,” Introcaso explains. “UVB rays can decrease localized inflammation.” However, the risks of sunburn and skin cancer, particularly for those with lighter skin, must be balanced with the therapeutic benefits. Dermatologists can offer in-office or at-home UVB phototherapy treatments.