Eczema - Triggers and Irritants

If you have eczema, avoiding certain triggers and irritants may help to prevent flare-ups of symptoms.

What are triggers and irritants?

In most people who have eczema there is no apparent reason why the eczema may 'flare-up' from time to time. However, some flare-ups may be caused (triggered) or made worse by irritants to the skin, or other factors. This leaflet briefly discusses some possible triggers and irritants. (There are separate leaflets in this series called 'Atopic Eczema - a General Overview', 'Topical Steroids for Eczema' and 'Emollients (Moisturisers) for Eczema'.

Soaps and detergents

Soaps and detergents remove the natural 'oils' from the skin. This tends to make the skin dry and itchy, and more sensitive to irritants.

Therefore, avoid soaps, bubble baths, etc, when you wash. Instead, use a thick emollient (moisturiser) as a soap substitute and add an emollient to the a bath or shower. (See separate leaflet called 'Emollients (Moisturisers) for Eczema' for details.) Wear rubber gloves with a cotton lining when using detergents or working with other similar chemicals.

After you wash clothes with detergent, rinse them well. Some 'biological' detergents are said by some people to be irritating. However, there is little proof that commonly used detergents which are used in the normal way make eczema worse.

Toiletries and perfumes

Some people with eczema find that the perfumes, preservatives, and alcohols, in toiletries and make-up can be irritating. It may be best to avoid these, or only use bland products.

Clothing

Wear cotton clothes next to the skin rather than irritating fabrics such as wool. However, it is probably the smoothness of the material rather than the type of the material which helps. Some smooth man-made fabrics are probably just as good as cotton.

Temperature

Avoid getting too hot or too cold. Extremes of temperature and humidity may trigger a flare-up of eczema symptoms.

Stress, habitual scratching and the 'itch-scratch cycle'

Stress does not cause eczema. However, some people react to stress by 'habit' scratching. It is thought that scratching can make itch worse, which makes you want to scratch more, etc. This is called the 'itch- scratch' cycle and can make eczema worse. As far as possible, try to keep scratching to a minimum. Keep fingernails cut short so that any scratching is not so sharp and severe. Consider wearing cotton gloves at night if you tend to scratch in your sleep.

Some people find that relaxation exercises or other similar techniques helps to reduce stress. This may help to reduce 'habit' scratching, which may help to reduce the severity of eczema.

Food sensitivity and eczema

Less than 1 in 10 children with atopic eczema have a food sensitivity (allergy) which can make symptoms worse. In general, it is young children with severe eczema who may have a food sensitivity as a trigger factor. The most common foods which trigger eczema symptoms in some people include: cow's milk, eggs, soya, wheat, fish, and nuts.

How do I know if a food is making eczema worse?

• Immediate food sensitivity occurs in some cases. Symptoms develop within two hours of eating the trigger food. Itching and scratching may worsen shortly after eating the 'trigger' food. A common sign is redness, swelling and irritation around the mouth. Another skin symptom that may develop is urticaria (itchy, fluid filled lumps on the skin similar to nettle stings). Other symptoms may occur such as abdominal pain, vomiting, wheezing, itchy eyes and sneezing.
• Delayed food sensitivity occurs in some cases. Symptoms develop 6-24 hours after eating the trigger food. Symptoms include worsening of itching and eczema. Sometimes abdominal pain and diarrhoea also occur.

If you suspect a food is making eczema symptoms worse, then see a doctor. You may be asked to keep a diary over 4-6 weeks. The diary aims to record any symptoms and all foods and drink taken. It may help to identify one or more suspect foods.

To confirm the diagnosis of a food sensitivity, you should see a dietician who may recommend an 'exclusion and challenge' test. This involves:

• Stopping all sources of the suspected food for 2-6 weeks to see if the eczema improves.
• Then eating the suspect food to see if the eczema is made worse.
• Then stopping the suspect food again to see if the eczema improves again.

It is important that the above test is supervised by a dietician to make sure that it is done properly and that the diet used during the test period is well balanced. If a food sensitivity is confirmed, then a diet which excludes the trigger food may help to reduce eczema symptoms.

Some other points about food sensitivity and eczema

• If a child's eczema is mild and easily treated with emollients (moisturisers) and short courses of steroid creams or ointments then there is no need to consider excluding foods.
• Even if a food sensitivity is proved, excluding the food is unlikely to 'cure' eczema. Symptoms may become less severe. However, you are still likely to need the usual treatments of emollients and steroid creams or ointments.

House dust mite

House dust mite is a tiny insect that occurs in every home. You cannot see it without a microscope. It mainly lives in bedrooms and mattresses as part of the dust.

Many people with eczema are allergic to house dust mite. If you are allergic, you have to greatly reduce the number of house dust mite for any chance that symptoms may improve. However, it is impossible to clear house dust mite completely from a home, and it is hard work to greatly reduce their number to a level which may be of benefit.

Therefore, if your eczema is mild to moderate, and can be managed by the usual treatments of emollients and short courses of topical steroids, it is usually not worthwhile doing anything about house dust mite.

However, if you have moderate or severe eczema which is difficult to control with the usual treatments, you may wish to consider reducing the level of house dust mite from your home. (A skin prick test may help to confirm the allergy before embarking on the following measures which are hard work.)

To greatly reduce the number of house dust mite:

• Remove carpets (where possible) from the bedroom. Avoid soft furnishing in the bedroom.
• Use dust tight ('mite proof') covers for mattress, duvet, and pillow (a good bed retailer will be able to advise). This can be left in place for several months. The usual covers can be put on top of the special covers, but should be washed every 1-2 weeks at 60 degrees centigrade.
• Use feather rather than synthetic pillows (this is the opposite to what used to be thought).
• Wet-dust the bedroom furniture every 1-2 weeks. Some people advise dusting even more frequently - even daily dusting.
• Vacuum or clean the bedroom floor regularly. Use a vacuum cleaner with a good filter (this removes the mite and prevents small particles coming out through the vacuum exhaust).
• Vacuum the mattress once a week.
• Regularly ventilate the bedroom (open the door and a window for a while on most days).
• Keep soft toys to a minimum. Put them in the freezer in a plastic bag for 24 hours now and again. This kills any mites on them. If the toys are washable, wash them at 60 degrees centigrade after putting them in the freezer.
• Try to keep humidity low (for example, do not dry washing on the radiator). An electric blanket decreases humidity in the bed which helps to keep mite numbers down in a mattress.

Pets

Some parents report that symptoms in children become worse when they are in close contact with pets. It is an allergy to animal dander which may be responsible. If you suspect a pet, it may be worth removing the pet to another home for a while to see if symptoms improve.

Other possible triggers

Other possible factors which may trigger symptoms, or make symptoms worse, include: pollens, moulds, pregnancy, and hormone changes before a period in women. However, these may not be avoidable. There may also be other factors which have not yet been identified which can trigger symptoms in people who have eczema.

Further help and information

National Eczema Society
Hill House, Highgate Hill, London, N19 5NA
Tel (Helpline): 0870 241 3604   Web: www.eczema.org

© EMIS and PIP 2004   Updated: September 2004   Review Date: October 2005   CHIQ Accredited   PRODIGY Validated