Having an Eczema Flare-Up? Here’s What To Do

Just when you think the redness, dryness and itchiness have finally gone away — think again. You look down at your knees or elbows, and another eczema flare-up has begun.

Atopic dermatitis is the most common type of eczema, but that doesn’t make it any less tricky to manage. The key is knowing your specific triggers and making changes to avoid future flare-ups.

Family medicine specialist Saadia Hussain, MD, explains why eczema flare-ups happen, how to prevent them and how to find relief.

Eczema flare-ups

An eczema flare-up is when one or more areas of your body — commonly your hands, feet, chest or neck — break out in an intense, itchy or dry rash. During an eczema flare, your symptoms suddenly get worse, resulting in:

• Inflamed red, gray or brown patches on your skin
• Flaky, dry or cracked skin
• Extremely itchy skin that gets worse at night
• Blistering or bleeding
• Small bumps that crust over and leak fluid

“Research shows patients with moderate to severe atopic dermatitis experience an average of nine flares per year, with duration ranging from days to weeks depending on severity,” says Dr. Hussain. “For many, flare-ups tend to come back whenever you’re faced with specific irritants, allergies or triggers.”

Common triggers for eczema flare-ups

Eczema can flare up for a variety of reasons, including:

• Allergens, like dust, pollen, pet dander and certain foods
• Environmental factors, like dry air, smoke or sudden changes in temperature
• Internal factors, like stress, hormonal changes and infections
• External factors, like certain medications, injury and products that irritate your skin

Eczema flare-ups often involve some combination of these. And because an overreactive immune system causes eczema, anything that triggers your immune system to kick in can inevitably cause an eczema flare.

“Using harsh cleaners or solvents, for example, can also cause eczema to flare up because it can take all the fat and oil out of the skin and damage the skin barrier,” explains Dr. Hussain. “As a result, you get inflammation in the affected area, and your symptoms get worse.”

Other common irritants that can cause eczema flare-ups include:

• Shampoos
• Detergents
• Disinfectants
• Fabrics like wool or polyester
• Metals, like nickel

If something irritates your skin, it can also weaken your skin barrier to the point that it makes you more vulnerable to an allergy.

“The irritant not only causes a rash, but it also makes it more likely for you to become allergic to that irritant as well,” he adds. “Since your immune system responds to allergens as a threat, you then experience worse symptoms whenever you come into contact with that specific irritant.”

Relief tips for eczema flare-ups

Another key to relieving an eczema flare-up is to take good care of your skin, even after it has gone away or calmed down. It’s important to see a dermatologist to figure out the triggers that are causing your reactions. They can also recommend a variety of over-the-counter and prescription creams or lotions to keep on hand for future flare-ups.

Combined with lifestyle changes, like exercise and healthy eating habits, eczema flare-ups are commonly treated with:

• Topical corticosteroids
• Topical calcineurin inhibitors, like pimecrolimus or tacrolimus ointment
• Phototherapy (light therapy)
• Systemic immunomodulators, like dupilumab and other biologics and JAK inhibitors, for moderate-to-severe cases

“Our goal is to help restore the skin barrier,” emphasizes Dr. Hussain. “When the skin is inflamed, it’s partly a result of the skin barrier being compromised. When your skin is damaged, it allows things to penetrate a little more and for things to be more irritating. So, it ends up being a vicious cycle.”

What about antihistamines?

“While oral antihistamines are commonly used for itch relief, they have limited effectiveness for atopic dermatitis-related itch and are not recommended as a primary treatment for eczema,” clarifies Dr. Hussain.

Unlike allergic reactions, where histamine drives itching, the itch in atopic dermatitis involves different inflammatory pathways that antihistamines don’t effectively target.

“However, sedating antihistamines may occasionally help with sleep if nighttime itching is disrupting rest because it has a drowsiness side effect,” he adds.

As for preventing an eczema flare-up, Dr. Hussain recommends the following:

• Use a fragrance-free cream or moisturizer daily to reinforce your skin and keep it hydrated. Using it right after a shower or bath helps lock in that moisture.
• Use a humidifier to help moisten the air and your skin while you’re sleeping.
• Don’t take extremely hot showers and try using a gentler water pressure setting to avoid irritating your skin.
• Simplify your skin care routine by avoiding chemicals, fragrances and other irritants. And switch out any products that cause redness or cracked skin for gentler versions.
• Consider proactive (maintenance) therapy. Even after your eczema clears, applying topical corticosteroids or calcineurin inhibitors (like tacrolimus or pimecrolimus) a couple times a week to areas that frequently flare can help prevent future flare-ups. Talk to your dermatologist about whether this is right for you.
• Be prepared for extreme temperatures and changing seasons. “If your skin tends to be drier, the wintertime tends to be worse,” Dr. Hussain notes. “But some people are more irritated by things that happen in the summertime, like sweating.”
• Try wearing looser clothing or switching to a gentler fabric, especially if your flare-up tends to be triggered by sweating and hot weather.
• Participate in stress-relieving activities that help you be more mindful and in the moment, while also not triggering another eczema flare-up.
• Work with a dietitian if you suspect you have a food allergy that’s triggering your eczema flare-up. They may recommend an anti-inflammatory diet and can help you make those adjustments.

When to see a doctor

Even mild eczema flare-ups over a long period of time can affect your well-being. You’ll want to see a healthcare provider if you experience:

• Increasingly more painful flare-ups
• Rapidly changing symptoms
• Flare-ups that spread to new areas of your body
• Crusting skin
• Oozing fluid
• Sleep disturbances
• Disruption to daily activities

“You might see a dermatologist or an allergist,” says Dr. Hussain. “We all work together to try and figure out if there are any factors you can modify in your lifestyle. And when there isn’t, we can recommend a number of new medications to help treat eczema.”