Most children with atopic eczema experience a flare up with no apparent reason from time to time. A trigger is not something that causes eczema. But it can cause a flare or worsen a flare. Avoiding irritants to the skin and other triggers wherever possible is an important step for treatment of atopic eczema.

Examples of other things that can irritate the skin include:

• Soaps and Cleansers
  Usage of soaps and bubble baths should be avoided.  They remove the natural oils from the skin, making the skin dry, itchy and more prone to irritation. Instead use a soap substitute plus a bath/shower emollient, such as Aqueous cream.
• Biological washing powder and fabric conditioners
  These can also worsen eczema.  Patients are advised to wear rubber gloves with cotton lining when using detergents or working with other similar chemicals.  After washing clothes with detergent, rinse them well.
• Toiletries and perfumes
  Many eczema patients find these products irritating to the skin. It may be best to avoid these or only use bland products.
• Clothing
  Wear cotton clothes rather than wool that may irritate the skin.  However, it is probably the smoothness of the material rather than the type of material which helps. Some smooth man-made fabrics are just as good as cotton.
• Temperature
  Extremes of temperature and humidity may trigger a flare-up of eczema.
• Stress, habitual scratching and the itch-scratch cycle
  Stress has been identified as a possible trigger.  However some believe stress does not cause eczema.  They believe some people react to stress by habit scratching.  It is thought that scratching can release more chemicals, which worsen the itch.  This is called itch-scratch cycle.
  To help this, keep fingernails short so that scratching is not so sharp and severe. Consider mittens for babies and cotton gloves at night if child tends to scratch at night. Relaxation exercises or similar techniques help to reduce stress.  This may help to reduce habit scratching, which may help to reduce severity of eczema.
• Infection
  Localized skin infection is usually introduced by scratching and it can aggravate eczema.Cold and flu and some other bacterial infection can also trigger eczema.
• Food allergy and eczema
  • Generally, the younger children with severe eczema who may have food allergy as a triggering factor. The most common foods which trigger eczema symptoms in some people include cows’ milk, eggs, soya, wheat, fish and nuts.
  • Immediate food allergies occur in some cases, within 2 hours of trigger consumption.
  • Common symptoms are itchiness, swelling and irritation of the lips.
  • Urticarial (fluid-filled red lumps on the skin) is another skin symptom.
  • Other symptoms include vomiting, abdominal pain, wheezing, itchy eyes and sneezing.
  • Delayed food allergy occurs 6-24 hours after eating the trigger food.
  • Symptoms include worsening of itching and eczema and sometimes abdominal pain and diarrhea.

  If food allergy is suspected, do consult a doctor.  Leaving out certain foods without an allergy being confirmed is not usually recommended.

• House dust mites
  • House dust mite is a very tiny insect that occurs in every home. It can only be seen using a microscope. It is mainly found in bedrooms and mattresses as part of the dust.
  • Eczema patients are commonly allergic to house dust mites
  • The research studies that have looked into whether reducing house dust mite is helpful have not been conclusive. It is impossible to clear house dust mite completely from home and it is difficult to greatly reduce their number to a level which may be of benefit. Thus generally, it is not usually advised to do anything about house dust mite.
  • Guideline from National Institute for Health and Clinical Excellence (NICE) states that “There are conflicting data on the effectiveness of using house dust mite avoidance strategies in the management of childhood atopic eczema. Many of the currently suggested techniques are time-consuming and expensive for parents/ carers and it is important to establish their value.”
  • There are some people with severe eczema which is difficult to control with the usual treatment. The following gives an idea of how to clear house dust mites. However it has to be emphasized that it is hard work, not usually recommended and the value of this is not clear.
  • To greatly reduce the numbers of house dust mites:
    • Remove carpets (where possible) from the bedroom. Avoid soft furnishing in the bedroom
    • Use dust-tight (‘mite-proof’) covers for any 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 60⁰
    • 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 60⁰C after they have been 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 contact with pets.  It is usually an allergy to the animal dander. If this is suspected, it may be worthwhile 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
    • Molds
    • Pregnancy and hormonal changes before a period in women
    • Dust and sand
    • Chlorine
    • Solvents
    • Irritant in the environment
    • Cigarette smoke

  Actions and environments that cause the skin to dry out or become otherwise sensitive can trigger flares. Some examples include:

  • prolonged exposure to water
  • being too hot or too cold
  • sweating and then becoming chilled
  • taking baths or showers that are too hot or last too long
  • not using a skin lubricant after a bath
  • low humidity in the winter
  • living in a climate that is dry year-round

References:

1. http://www.webmd.com/skin-problems-and-treatments/eczema/eczema-causes
2. http://kidshealth.org/parent/infections/skin/eczema_atopic_dermatitis.html
3. http://www.patient.co.uk/health/Eczema-Triggers-and-Irritants.htm