Having an eczema flare-up is like taking a master class in self-control. You really, really want to scratch that itch, but you also know that short-term flood of relief is just going to make things worse in the long run.
Fighting this temptation (and living with this health condition in general) is enough to make anyone wonder what causes eczema in the first place. The answer isn’t totally clear, but here, experts share what they know so far.
Eczema ultimately comes down to an issue with your skin barrier, which is supposed to protect you from things like bacteria, irritants, and allergens.
If you have eczema, a gene variation keeps that barrier from giving you all of the protection it should, the Mayo Clinic explains. This leaves your skin vulnerable to things that can irritate it and trigger an immune response that causes eczema symptoms. Common triggers include sweat, stress, soaps and detergents, and dust and pollen, among others.
There are various types of eczema, but the most prevalent is atopic dermatitis, hence why experts sometimes refer to it as “classic eczema.” This condition can make your skin itchy, inflamed, and desert-dry. People with atopic dermatitis often also experience symptoms like thick, cracked, scaly skin and red or brownish-gray patches that can show up anywhere but are most likely to form on the hands, feet, ankles, wrists, neck, upper chest, eyelids, and inside the bends of the elbows and knees, the Mayo Clinic says.
It doesn’t stop there: Eczema can also surface as weepy little bumps that get crusty when you scratch them. If you (understandably) do that, you may be left to deal with raw, tender, and swollen skin as a result.
Really the only good news here is that having atopic dermatitis doesn’t usually translate into a 24/7 battle with dry, itchy, irritated skin. Many people have flare-ups of symptoms followed by periods where things are A-OK in the skin department. But, while it’s possible to at the very least manage atopic dermatitis by moisturizing, avoiding triggers, and taking other steps, there’s no cure for this condition.
Experts don’t totally understand why some people develop eczema and others don’t, but genetics, where you live, and even your mom’s age could play a role, among other factors.
There are a lot of questions around why atopic dermatitis arises in some people, but the American Academy of Dermatology (AAD) says the following factors raise your risk of having eczema:
Your genetics: Having a family history of eczema, allergies, or asthma is the strongest risk factor for developing eczema, the AAD says. This is part of what’s known as the atopic march, Jonathan I. Silverberg, M.D., Ph.D., M.P.H., a dermatologist at Northwestern Memorial Hospital, tells SELF.
The atopic march is a phenomenon in which a person experiences a progression of certain atopic (allergic) conditions throughout their life, the American Academy of Allergy Asthma & Immunology (AAAAI) says. This usually starts with having atopic dermatitis as a child, then evolves into dealing with things like allergies, hay fever, and asthma as you get older.
Where you live: Having grown up in a developed area can increase your risk of having eczema, the AAD says. This may come down to what experts call the hygiene hypothesis, which is the theory that when living conditions are too clean, kids aren’t exposed to germs that train their immune systems to tell the difference between harmless and harmful irritants, the AAAAI explains.
Things only get compounded if that developed region in which you grew up was wracked with pollution, or if you’re exposed to a lot of pollution now, the AAD says. All that exposure to potential irritants could cause your skin to freak out more than it would otherwise, Gary Goldenberg, M.D., assistant clinical professor of dermatology at the Icahn School of Medicine at Mount Sinai Hospital, tells SELF. In some people, that freakout manifests as eczema.
You may also be more likely to deal with eczema if you live in a cold climate, since it can dry out your skin and make it more susceptible to irritation, Dr. Goldenberg explains.
Your gender: It appears that women are slightly more likely than men to develop eczema, the AAD says. It would be easy to chalk this up to, say, hormonal fluctuations that come along with having a menstrual cycle, but doctors really don’t know why this disparity exists, Temitayo Ogunleye, M.D., assistant professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania, tells SELF. “We don’t find clinically that flare-ups correspond with menstrual cycles,” she points out.
Your socioeconomic status: Eczema is more common in people of higher socioeconomic status, the AAD says. This goes back to the hygiene hypothesis, Dr. Ogunleye says, explaining that people who grow up with higher socioeconomic status have typically been exposed to germs less often, so their immune systems might overreact when encountering a substance they interpret as a threat.
Your mom’s age when you were born: People who give birth toward the end of their childbearing years seem to have children with higher rates of eczema, the AAD says. “I’ve seen this association clinically as well,” Dr. Silverberg says. It’s been tough for experts to suss out the individual factors behind this. “Ultimately, we really don’t know why this happens,” Dr. Silverberg says.
If you have eczema, you might not know the root cause, but you should know that there is treatment available to help.
Reducing your exposure to your triggers as best as you can might go a long way toward preventing eczema flares, Dr. Goldenberg says.
Moisturizing your skin at least twice a day with creams, ointments, and lotions can also help, the Mayo Clinic says, as can avoiding hot showers, which might just dry out and irritate your skin even more. (That doesn’t mean you’re destined to take cold showers for the rest of your life—just aim for temps that are, at most, warm, not hot enough to brew tea.)
Your doctor may prescribe a corticosteroid cream, ointment, or oral medication to help keep inflammation and itching at bay during flare-ups, the Mayo Clinic says. If your doctor suspects that you’re at risk of a bacterial infection due to eczema-induced cracks or sores in your skin (or if they know you already have a full-fledged bacterial infection), they may give you an antibiotic cream or oral antibiotics to help quash it.
Whatever the cause of your eczema, talk to your doctor about your treatment options and keep the conversation open. Don’t be afraid to speak up if your skin isn’t as itch-free as you’d like—you and your doctor may simply need to try something else to get your condition to a more manageable level.