Identifying Triggers of Eczema Flares

Common Triggers of Eczema Flares

Soaps and detergents can remove natural lipids from the skin surface, worsening already dry skin in patients with atopic eczema, as noted by the British Medical Journal 1
Food allergies may trigger eczema, particularly in children under 5 years with moderate to severe disease, according to the American Academy of Dermatology 2
Common food allergens include cow's milk, eggs, wheat, soy, and peanut in young children; tree nuts, shellfish, and fish in older children, as reported by the American Academy of Dermatology 2
Aeroallergens such as house dust mites, pollens, animal dander, and fungi can trigger flares, especially in those with moderate to severe atopic dermatitis, as stated by the American Academy of Dermatology 4

The American Academy of Dermatology recommends asking about temporal relationship between exposures and symptom flares to identify triggers 2
The American Academy of Dermatology suggests looking for pattern of distribution: aeroallergen-triggered eczema may be more severe on exposed surfaces of face, neck, arms, legs, and "V" area of chest 4
Bacterial infection is suggested by crusting or weeping, while grouped, punched-out erosions indicate herpes simplex infection, as noted by the British Medical Journal 1

The American Academy of Dermatology recommends considering limited food allergy testing in children under 5 with moderate to severe atopic dermatitis who have: 1) persistent disease despite optimal management, 2) reliable history of immediate allergic reaction after food ingestion, or 3) both 2
Skin prick testing (SPT) and serum-specific IgE level determination can assess for immediate/type I hypersensitivity reactions, as reported by the American Academy of Dermatology 2
Patch testing should be considered for suspected allergic contact dermatitis, particularly in patients with hand and eyelid eczema, according to the British Association of Dermatologists 5

The American Academy of Dermatology suggests looking for time patterns: some triggers cause immediate reactions while others have delayed effects of 2-4 days 2
Targeted testing, such as performing appropriate allergy testing based on history and suspected triggers, is recommended by the American Academy of Dermatology and the British Association of Dermatologists [2] [5]

The American Academy of Dermatology warns against performing broad panel allergy testing without a history of reaction, as positive tests may reflect sensitization without clinical relevance 2
Neglecting to consider secondary bacterial or viral infections as causes of sudden deterioration in previously stable eczema is a common pitfall, as noted by the British Medical Journal 1