3. What’s Triggering my Eczema?
Topics Covered in this module
The Causes of Eczema
What Triggers My Eczema
Causes of Specific Eczema
Part 1: The Causes of Eczema
In the last module we covered the seven different types of eczema in detail. Now, in this module we look at some of the triggers and causes of eczema. Sometimes the trigger of a flareup is obvious. But, as eczema is an bio-individual condition, this means we all will have different reactions and triggers. It’s very important to understand your individual condition. Staying persistent with your focus to skin wellness is important to getting and keeping your eczema under control.
Although the true cause of eczema is still unknown, what we do know is it develops from a combination of genetic and environmental circumstances.
Some eczema sufferers have a mutation of the gene responsible for creating the protein called filaggrin (filament aggregating protein) in the skin. Filaggrin plays an important role in the skin's barrier function. It brings together structural proteins in the outermost skin cells to form tight bundles, flattening and strengthening the cells to create a strong barrier. This is why many people with eczema have very dry and infection prone skin.
There is a great deal of research that shows people with eczema generally have an over reactive immune system that gets triggered by a foreign substance outside or inside the body, resulting in inflammation of the skin.
Genetic
Science believes eczema is genetic. Children are more at risk of developing eczema if they have a relative who has had eczema, asthma or hay fever.
If children’s parent’s have had coeliac disease, the child is also more likely to develop eczema compared to kids born to a parent without the disease.
Additionally, children born to older women are more likely to develop eczema than children born to younger women.
Environmental Factors
Genetics plays a major role in the cause of eczema, however the environment can also play a large role too. Children living in polluted cities are at risk of developing eczema.
So, we now know eczema is aggravated by a combination of both genetic and environmental factors. Eczema flareups are the result of the immune response cells taking defensive action to foreign factors. These foreign factors are called triggers. Some triggers can be controlled while many are more complex.
Triggers such as specific food ingredients, clothes, perfumes, etc can be controlled or avoided easily. However, some triggers such as pollen count, humidity, temperature, pollution etc. are beyond our control. Some weather and environmental triggers can have a dramatic impact on the severity of an eczema flare-up. Winter is never a good time for eczema sufferers as the skin dries out and becomes painfully red and itchy.
Our skin is the largest organ of our body and our first line of defense. Our skin adapts to various weather conditions, for example if the weather is hot the skin will perspire to make it cool. The skin has a layer of fat to keep the body warm when the weather is cold. But for someone living with eczema these adaptation methods are less effective. Eczematous skin loses more water than it should and provides an opening for microbes, allergens, and irritants to enter.
Weather affects each person differently. Even if two individuals are suffering from Atopic Dermatitis, both could react differently. Skin experts believe, damage to the skin’s outer barrier can lower the skin’s ability to adapt to weather changes.
Let’s take a look at some environmental factors and how they affect eczema.
The hygiene hypothesis
Many parents believe that their children should be kept in an environment that is as clean as possible, but research suggests that being exposed to what many would call unclean conditions, is actually good for a child's immune system. Children who are kept in very clean environments have a higher rate of hay fever, asthma, eczema and a wide range of other conditions. This is what is called the hygiene hypothesis. Exposure to certain germs teaches the immune system not to overreact. The body differentiates harmless substances from the harmful substances that trigger eczema and asthma.
But preventing eczema and asthma isn't as simple as avoiding antibacterial soap, having a big family or a pet in the home. Exposure to certain germs may actually occur before a baby is born, inside the womb. A pregnant mother's exposure to infectious germs, toxins or other substances, such as vaccines, may play an important role in the development of a baby's immune system and gut microbiome.
Food and other allergies
To better understand the relationship between eczema and diet, it is helpful to know the difference between food allergies vs. food sensitivities or intolerances.
A food sensitivity, or food intolerance, occurs when a person has trouble digesting certain foods. This can lead to gas, bloating, abdominal pain or diarrhea, for instance. A food allergy, on the other hand, induces an immune response that impacts numerous systems in the body and can cause a range of symptoms.
However, the line between food allergies and food sensitives tends to blur a bit for people with eczema. Eating certain foods may trigger an immune response. Interestingly, for many people, once their inflammation goes down and their skin stops flaring, they can eat some or even all of the foods that were triggering before. I am sure you feel this experience sometimes too. My thinking here is that when the skin is really inflamed, the skin’s threshold to flare is really low and many things can set off a trigger. Think over sensitive. Once your skin has calmed and feeling better, you will have a clearer picture of what the more substantial triggers are, and then you would be wise to continue to avoid them.
People with eczema, especially atopic dermatitis, can also have allergies to dust, mould, pet hair and pollen, all of which can enter through the skin. Your skin is your first line of defense against the outside world — fending off germs, chemicals, allergens and more. If you have eczema however, your skin barrier may be weakened, leading to a cycle of dryness, irritation and inflammation, symptoms which, on their own, contribute to even further skin barrier erosion and worsening symptoms.
“Fortunately, when you understand more about your skin barrier, you can take steps to strengthen it for relief of your eczema.”
With eczema, however, the skin barrier can’t function as effectively and may be “leaky.” There are a number of reasons for this. One is because many people with eczema have a protein gene deficiency called filaggrin. In fact, up to 30% of eczema patients have mutations in the gene for filaggrin. Filaggrin helps structurally, binding keratin filaments together to strengthen and flatten skin cells. If you don’t have enough functioning filaggrin, skin cells can lose moisture, and develop gaps between them (effectively leaving “holes” in the wall of your skin). With loss of moisture, skin also becomes dry and itchy, leading you to scratch or rub, which can further weaken the skin barrier. Inadequate filaggrin production can also impact the skin’s pH, allowing abnormal bacterial growth that can prompt immune responses like inflammation.
Allergens enter through the skin, encouraging the immune cells in the skin to form a variety of other cells, which result in the allergy. The interaction, of this genetic mutation with the environment is how an allergy in skin disorder such as a topic dermatitis coexist.
For instance, a baby with filaggrin defect living with a dog has an increased risk of developing asthma as well as eczema. Here’s another example, living in an environment with a high pollen count may also make them susceptible to hay-fever. Their allergic reactions may be triggers and result in an eczema flare up.
Part 2: What’s Triggering My Eczema
Even though we still don’t know the causes of eczema, we do have a solid understanding of what can trigger a flareup. A trigger is something that causes a flare up or can make a flareup worse.
The most common triggers are substances that irritate the skin. These can include anything from certain types of clothing, such as wool and synthetic fibers, to perfumes, make up, household cleaning agents or skin cleanses. We will discuss these toxins in a future mole in this course.
Other substances that can come in close contact with your skin and can trigger flareups are:
Dust
Sand
Chlorine
Solvents
Pollen
Shampoo + Conditioners
Here’s a list of certain actions + different environments which can cause your skin to dry out, or become sensitive:
Prolonged exposure to water
Being too hot or too cold
Taking baths or showers that are too hot or last too long
Not using a skin cream after a bath
Stress, Anxiety and Depression
We know stress and anxiety can cause a visible reaction in our skin condition. I certainly believe that the time has come to incorporate some of these stress alleviation techniques.
10 techniques to tackle stress at home:
Stop what you’re doing and take some slow, deep breaths.
Get control over fleeting thoughts through mindful meditation.
Perform some light, movements such as yoga, tai chi.
Write down any negative thoughts and feelings in your journal and let it go.
Occupy your hands (and mind) with crafts like knitting, coloring or scrap-booking.
Listen to a compilation of soothing sounds or music. Oddly I love listening to my dog snoring.
Get outside. Even a simple walk around the neighborhood can be highly therapeutic.
Take a nice, relaxing soak in the tub and personalize your bathing experience with Epsom salts, and pure essential oils.
Turn on a diffuser with pure essential oils inside to help turn on the brakes of your brain.
Practice self-care. Take 4 drops of pure Lavender essential oil with 4 drops of coconut oil and rub this on the bottom of your feet.
Eczema sufferers don’t always consider depression or anxiety to be one of their triggers. Even though stress has long been identified as a trigger for depression and a trigger for eczema flareups. People with eczema noticed their skin condition flare-up before an exam or job interview, or during times of personal anxiety such as a family argument.
Which comes first? Does eczema bring on depression, or does stress, anxiety and depression bring on eczema? In a later module, you will learn different effective ways to reduce stress and depression associated with eczema.
The importance of knowing your triggers
It’s super vital you become aware and begin to take note of what triggers your eczema. Often this is obvious, but life is busy and often we float through day unaware of allergies or sensitivities you have to certain substances.
Later in this course I will introduce you to various ways to manage your skin triggers and protocols for treating your condition. It’s always a good idea to work with your chosen health care provider to work out other causes, flareups and triggers. For example, she may be able to test and track how your skin reacts to substances and household products, plus show you how to best manage your stress levels.
Part 3: Causes of Specific Eczema Conditions
In this next section, let’s dive into the various causes of specific types of eczema, this section goes beyond only atopic dermatitis.
Causes of Seborrhoeic eczema
The cause of Seborrhoeic eczema is due to an inflammatory reaction to excess Malassezia yeast, an organism that normally lives on the skin's surface. The Malessezia overgrows and the immune system seems to overreact to it, leading to an inflammatory response that results in skin changes.
Certain medical conditions can increase people’s risk of developing seborrheic dermatitis, including psoriasis, HIV, acne, rosacea, Parkinson’s disease, epilepsy, alcoholism, depression, eating disorders and recovery from a stroke or heart attack.
Common triggers for seborrheic dermatitis include:
Stress
Hormonal changes or illness
Harsh detergents, solvents, chemicals and soaps
Cold, dry weather
Some medications, including psoralen, interferon and lithium
Causes of Contact Dermatitis
There are many different triggers for contact dermatitis. It may develop from everyday substances such as water, mechanical factors such as pressure or friction, and environmental changes such as extremes in weather and humidity.
There are a large number of potential allergy-producing chemicals. Here are the common ones that are problems for patients with atopic dermatitis:
Irritant contact dermatitis is the most common form of these two conditions. This skin reaction occurs when a substance damages your skins outer protective layer. Common toxic substances like strong chemicals toxic hair dyes, fertilizers, pesticides, or even airborne substances such as sawdust and pollution.
Allergic contact dermatitis occurs when a substance, often entering your body through food or medicine, triggers an allergic reaction in your skin. Babies and children often develop this type from baby wipes, disposable nappies, sunscreen, and even clothing made from synthetic fibers.
Between the two forms there are thousands of different known allergens and skin irritants. Everything from soap, cosmetics, detergents, chemicals, latex, mold, jewelry, animal fur, soil and plants can be a trigger.
If you suffer from contact dermatitis it is necessary to look at what substances you’re coming into contact with on a regular basis. Examine your workspace and the hobbies you have. Some jobs put you more at risk of being exposed to substances.
For example:
Healthcare and dental employees
Mechanics
Construction of metal workers
Hairdressers and beauticians
Cleaners
Gardeners and agricultural workers
Cooking, baking and working with food
Swimming and scuba-diving because the rubber goggles and face masks can cause an allergic reaction
Metals: nickel, cobalt, and chromium
Nickel allergy is extremely common among adults and children. Nickel is found in a range of metallic items, such as jewelry, zippers, buttons, belt buckles, and coins.
Cobalt is a common contaminant in various metals, including nickel, and people allergic to nickel are often allergic to cobalt because of its widespread use.
Chromium salts, often found in paints, cement, and leather products may induce an excess trigger.
Synthetic Fragrances
Fragrances are very common culprits of allergic contact dermatitis especially in persons with eczema. These substances can be found in various cosmetics, perfumes, food flavorings, and toothpastes.
Antibacterial Ointments
Antibacterial ointments such as neomycin and bacitracin are often used in homes to treat scratches and wounds, many people develop allergic reactions to these.
Isothiazolinones
Isothiazolinones, including methylchloroisothiazolinone and methylisothiazolinone (MCI/MI), are another type of preservative used in many personal care products to inhibit fungi and bacterial growth, as well as to protect the product from oxygen and light, to prevent the product from damage or degradation.
It is often found in many “wash-off” bathroom products such as shampoos, body washes, and cosmetics. Importantly, read the label of your wet wipes as this ingredient is often included.
Cocamidopropyl betaine (CAPB)
Cocamidopropyl betaine (CAPB) is a detergent chemical used to thicken shampoos, soaps and lotions, and reduce static cling in clothing. Clothing and skin care products containing this chemical are often irritating to people with eczema and should definitely be avoided.
Paraphenylene-diamine (PPD)
Paraphenylene-diamine (PPD) is a strong sensitizing chemical that is used in hair-dye. It is prohibited in skin-contacting products due to the allergy potential. Nevertheless, PPD continues to be used in various unregulated products such as black henna temporary tattoos, which are frequently found in child-friendly environments. PPD is often used to dye shoes black, and can cross-react with some medications, such as antihistamines.
Hypoallergenic and preservative-free does not mean risk free!
These terms are often used by manufacturers to imply a lower risk of developing an allergic reaction to their product, however, the use of these slogans is not regulated. The ingredients may still contain known allergens!
Causes Dyshidrotic Eczema
It's not clear exactly what causes Dyshidrotic eczema, but it may be triggered or made worse by:
a fungal skin infection
a reaction to something that has touched your skin – such as certain metals (particularly nickel), detergents, household chemicals, soap, shampoo, cosmetic products or perfume
stress
Many experts believe this form of eczema is linked to seasonal allergies, especially when changes and humidity occur, overall it is more common in people who have:
Atopic dermatitis or a family history of a topic dermatitis
Hay-fever
Fungal or bacterial skin infections
Emotional stress
Changes in the weather
Working with certain chemicals
Having your hands immersed in water for long periods on a daily basis
Causes Discoid Eczema
The cause of Discoid Eczema is unknown, however experts believe it may occur as a result of having particularly dry skin. Dry skin means your skin can’t effectively protect you from substances that you come in contact with, as we discussed earlier.
These can be average everyday substances, such as, soap may begin to irritate your skin when you use it.
Discoid eczema also appears to be more common during the winter months when indoor humidity levels are much lower and the skin dries out. Be mindful of the clothing and body care products you are currently using and switch to natural clothing and natural skin care and house cleaning products. We will be discussing solutions in further modules.