What Are Common Triggers for Atopic Dermatitis?

Atopic dermatitis (AD), or eczema, is a chronic skin condition that has periods of remission and flare-ups of worsened symptoms. Eczema can be triggered by a number of factors, and it is important for anyone with atopic dermatitis to work with their healthcare provider to identify their personal triggers and avoid or prevent them whenever possible.

Figure 1. Atopic dermatitis triggers

Scratching dry skin

When skin becomes dry, it can also cause itchiness, and the itch-scratch cycle of atopic dermatitis is one of the processes that seems to continue or amplify the symptoms of the disease. Scratching the areas of skin affected by eczema can cause breaks in the skin, which increase the risk of infection. Repeated scratching also leads to areas of lichenification, or thickened skin that may have knots or be lighter or darker than surrounding skin.^1,2

Skin irritants

Atopic dermatitis damages the skin’s natural barrier protection, which can make the skin more sensitive when exposed to substances in the environment. These substances are collectively called irritants because of their ability to irritate the skin. Various irritants may cause additional redness, itchiness, or a burning sensation. Environmental irritants can be different for each individual with eczema but may include certain fabrics used in clothing, such as wool, some soaps or laundry detergents, cleaning solutions, dust, sand, cigarette smoke, or chemicals.^3,4

Stress related eczema flares

One environmental factor that plays a role in the development of atopic dermatitis is emotional stress. One of the key characteristics of AD is a dysfunction in the immune system, which leads to chronic inflammation in the skin. Stress seems to worsen this dysfunction of the immune response, creating more of the inflammatory reaction. People with eczema have an increased response to stress, including a higher amount of cortisol released in the body. Stress also negatively affects the skin barrier function, which can lead to more moisture loss and increased susceptibility to infection.⁵

Winter eczema or seasonal dermatitis

The weather can aggravate or trigger atopic dermatitis, leading some to call it winter eczema or seasonal dermatitis. Low ambient humidity is thought to worsen dryness of the skin. Both the severity of the disease and the activity (the number of lesions) can be influenced by the climate and weather, sometimes with dramatic changes within a few days or weeks.⁶

Eczema and infections

Infections by bacteria, virus, or fungi can trigger AD. Over 90% of AD skin lesions are found to have the bacteria staphylococcus aureus (staph), which can produce toxins that aggravate AD. Another common viral infection that can trigger flares of atopic dermatitis is herpes simplex virus (HSV). The dysfunction in the immune system that is part of the cause of AD also puts people at a higher risk for viral and fungal infections.⁷

Allergens

Allergens are common triggers for atopic dermatitis (AD), although the allergens that cause a reaction may differ between individuals, and not everyone with eczema finds that allergens are a trigger. Common allergens that trigger AD include certain foods, pet dander, dust mites, molds, and pollens.⁷

Sweat and saliva triggers

Bodily fluids like sweat or excess saliva can act as triggers for atopic dermatitis. In infants, excess saliva can aggravate AD, especially during periods of intense drooling such as teething. In children and adults, excessive sweat on the skin can trigger AD. For this reason, having a skin care regimen can be an important way to reduce the risk of a flare-up of AD skin symptoms.^8,9

Hormonal triggers

In some women, hormone fluctuations may act as a trigger for atopic dermatitis, causing a flare-up of symptoms or a worsening of their condition. Hormone fluctuations are commonly experienced just before and during menstruation, during pregnancy, following pregnancy (postpartum), and at the transition to menopause (perimenopause).¹⁰