Eczema, also called atopic dermatitis, is a disease of inflammation. In fact, the “-itis” in its name refers to inflammation. When you have eczema, your skin becomes inflamed, red, and itchy. Inflammation isn’t always a bad thing. When it’s your immune system’s response to an injury or infection, it includes the release of antibodies and proteins, as well as increased blood flow to the damaged area. This response helps the body fight germs and heal from cuts and other injuries. But with eczema, your immune system overreacts to typically harmless substances in your environment. What results is a state of constant, or chronic inflammation. Over time, the inflammation damages your skin, leaving it red and itchy.

Common causes of inflammation

Certain things set off inflammation flare-ups in people with eczema. Here are some common triggers.

Diet

Certain foods increase inflammation in the body, including:
  • fried foods like french fries and fried chicken
  • sodas and other sugary drinks
  • red meat (burgers, steaks) and processed meat (hot dogs, sausages)
  • refined carbs like cookies, white bread, and cake
  • margarine, shortening, and lard
Eliminating these foods may help clear your skin. But before you make any drastic dietary changes, speak with a healthcare professional. Your doctor or a dietitian can put you on an elimination diet to try to clear your skin without taking away the nutrients your body needs. After your skin clears, you may be able to add foods back into your diet, one at a time.

Cigarette smoke

Tobacco is linked to a number of serious health problems, including cancer and health disease. Eczema is another health issue resulting from tobacco use. In addition to irritating the skin, cigarette smoke has a harmful effect on the immune system. It produces chronic inflammation in the body. Smokers have higher levels of inflammatory markers like C-reactive protein (CRP) in their blood. A study in the Journal of the American Academy of Dermatology found that people who either smoke or are exposed to secondhand smoke are more likely to get eczema than those who aren’t exposed. Quitting smoking can take time, though. More than half of smokers say they’ve tried to quit, and not everyone has been successful. Tools like nicotine replacement products and medications can help you manage the urge to smoke. If you need help creating a cessation plan, talk with your doctor.

Allergies

Eczema is an allergic disease. This means your immune system reacts to normally harmless substances in your environment by producing inflammation. Some of the allergens most likely to trigger eczema are:
  • chemicals and fragrances in detergents, cosmetics, and household cleaners
  • dust mites
  • pollen
  • pet dander
  • nickel or other metals
  • certain foods, as noted above
One way to avoid a skin reaction is to do your best to avoid your triggers. Consider keeping a diary to help you identify which substances make you itch. Allergy shots might help, too. This form of treatment gives you very small doses of your trigger substance, giving your body a chance to build up a tolerance to the trigger and keep you from reacting.

Lack of sleep

A solid seven to nine hours of sleep each night is essential for healthy immune function. Sleep helps your immune system learn how to react properly to germs and other threats. That may be why people who don’t sleep well tend to get more infections and allergies. Inflammation rises when the sleep pattern is broken. Disrupted sleep can throw off this cycle and lead to more persistent inflammation. The constant itching from eczema makes it even harder to sleep, which can throw you into a cycle of not enough sleep, in particular REM sleep, and too much itchiness. Getting your eczema under control with medication, moisturizers, and other treatments can help you sleep more soundly.

Stress

Your emotional health and the health of your skin are closely connected. When you’re under stress, your body releases hormones like adrenaline and cortisol. In larger-than-normal amounts, cortisol can trigger inflammation in the skin. Dealing with stress-induced flares can make you even more anxious and upset. Managing stress can help prevent flare-ups. Here are some ways to keep stress at bay:
  • Relax with a good book or meditate for a few minutes a day.
  • Steer your thoughts away from stress with a good distraction, such as a funny movie or a call with a good friend.
  • Exercise. Be careful about getting overheated, though, if heat is a known eczema trigger.
  • Find people to talk with about your eczema symptoms.

Infections

Eczema puts you at higher risk for infections. In part, this is because a problem with your skin barrier lets in more bacteria and other germs. Another reason is that inflammation interferes with your skin’s natural immune response against these germs. To prevent infections:
  • Take a warm shower or bath each day.
  • Apply a thick layer of moisturizer or prescribed topical medicine after bathing.
  • Use a steroid cream or calcineurin inhibitor to bring down inflammation and improve your skin’s barrier against germs.

Treatments

Treating eczema starts with learning and then avoiding your triggers. Bathing or showering in warm water every day and then using an oil-rich moisturizer afterward will prevent your skin from drying out and getting itchy. These topical treatments, some available over the counter and others by prescription, bring down inflammation and stop the itch:
  • steroids
  • antihistamines, such as Benadryl, Zyrtec, and Claritin
  • calcineurin inhibitors, such as tacrolimus ointment (Protopic) and cream (Elidel)
For moderate-to-severe eczema, doctors sometimes prescribe immunosuppressants like azathioprine, cyclosporine, or methotrexate. These medications lower the overactive immune response and help to relieve eczema symptoms. People with mild-to-moderate eczema may be prescribed crisaborole. The steroid-free topical ointment was approved to treat eczema in 2016 by the Food and Drug Administration (FDA). Biologics are a newer type of injectable medication. These biological products target the immune system response that causes inflammation in eczema. Dupilumab (Dupixent) is the only biologic FDA-approved to treat eczema. It blocks two key chemicals that contribute to the process of inflammation: interleukin-4 (IL-4) and interleukin-13 (IL-13).

Talk with your doctor

If eczema symptoms are interfering with your daily life, ask your doctor what type of inflammation is causing them, and how to manage them. Keep track of your symptoms and their causes to identify your triggers. Eczema is often part of a group of conditions that doctors call the “atopic march.” People with eczema often have asthma and allergies, too. If you have these conditions, you may also need treatment for them.

Takeaway

Inflammation is a part of eczema that contributes to symptoms like redness and itch. There are many ways to reduce inflammation, including diet adjustments, trigger avoidance, and over-the-counter and prescription medications. It could take a bit of trial and error to find the eczema treatment that finally relieves the inflammation and itch for you. Be persistent — if the first treatment you try doesn’t help, go back to your doctor and discuss other options.