Managing Symptoms of Atopic Dermatitis through Lifestyle Changes

Perhaps you've stumbled across #SkinTok discussions about atopic dermatitis (AD), or maybe you know someone personally who has the condition. For those who remain unfamiliar, AD, most often referred to as eczema, is a prevalent inflammatory skin condition, explains Mariano Busso, M.D., F.A.A.D., a board-certified dermatologist based in Beverly Hill, California and Miami, Florida.

Eczema causes dry and itchy skin, affecting a sizable proportion of the global population, with studies indicating that up to 10 percent of individuals will experience some form of this condition at some point in their lives. This bothersome condition interferes with sleep, causes emotional stress, and can also disrupt day-to-day life.

Thankfully, although eczema cannot be cured, it can be managed and treated through a mix of home remedies, lifestyle adjustments, and medical treatments. Gaining an understanding of atopic dermatitis, including what causes it and treatment options, can help mitigate the impact it has on someone's life and well-being.

Dr. Busso explains that atopic dermatitis is a chronic, inflammatory skin condition that hinders the skin's ability to retain moisture, causing eczema flare-ups influenced by environmental and lifestyle factors. These flare-ups result in non-contagious splotches on the skin which can itch, swell, blister, or even ooze, but the severity varies from person to person. It is important to note that although these skin reactions may in some instances resemble reactions to poison ivy or oak, eczema is not contagious.

The exact cause of atopic dermatitis is still unknown, but experts believe it could be a mix of genetic, environmental, and biological factors. Molecular geneticist Martin Smith M.D., founder of Untoxicated skincare, suggests that a gene mutation could be responsible, in part, for causing the condition.

These gene mutations, particularly the FLG (Filaggrin) gene, compromises the skin's ability to naturally moisturize, resulting in dryness. A family history of eczema or related conditions like hay fever or asthma also increases one's risk of developing eczema. However, genetic predisposition alone does not cause eczema flare-ups. The onset of the disease depends on interplay between genetic predisposition and environmental or lifestyle factors.

Lifestyle can significantly impact the intensity and frequency of eczema flare-ups. Routine practices such as diet, physical activity, hygiene, stress management, and product selection all play a role in managing the condition. A prescription for atopic dermatitis could include lifestyle modifications, possibly paired with medical interventions like non-steroidal creams or oral JAK inhibitors.

Eczema sufferers often attribute their flare-ups to physical exercise. However, it's not the exercise itself that triggers eczema, but the sweat produced by the body during such activities. When you exercise, your internal body temperature rises leading to sweating, which can strip away the skin's natural oils, making it dry and itchy - an explanation provided by internal medicine physician, Dr. Zion Ko Lamm.

Despite this, it's not advisable to skip exercising entirely as it too can cause flare-ups. Exercise, being an effective stress reliever, can actually prevent eczema flare-ups. Dr. Smith suggests managing how much you sweat while exercising and changing out of sweaty clothes as soon as possible to prevent triggering eczema. Practices like choosing cooler times for outdoor workouts, preferring room-temperature yoga, and washing off sweat immediately after workouts can be beneficial. He also warns against chlorine water if you are swimming, as it can exacerbate eczema.

No matter what form of exercise you prefer, from gym sessions, dog walking, or hiking, breathable clothing is recommended by Dr. Smith. Synthetic materials like nylon and polyester can intensify sweating and hence should be avoided. Instead, materials like Merino wool or bamboo, which allow for adequate airflow, are suitable. Clothing that fits snugly can also trap moisture and aggravate eczema by increasing friction between the fabric and skin.

While it's hard not to scratch itchy areas, scratching can, in fact, worsen eczema symptoms. According to Dr. Smith, the act of scratching releases a chemical that binds to skin nerve endings, expanding the itchiness to other parts of the body. It can break down the skin barrier, thus increasing inflammation.

However, there are ways to alleviate itching without scratching, such as applying a cold wet cloth or an ice pack on the itchy area. Anti-itch creams containing hydrocortisone like Cortizone 10, Aveeno Anti-Itch, and CeraVe Anti-Itch can also help. Further, if you find yourself resorting to these creams regularly, it is suggested to consult your healthcare provider for an alternative treatment. Non-sedating antihistamines like Allegra or Zyrtec may also work by blocking the effects of itch-causing histamines in the blood.

Dr. Smith strongly recommends moisturizing for people with eczema. A hydrating cream can lock moisture into your skin and compensate for the decreased presence of a natural moisturizing factor in individuals with eczema. Dr. Zion recommends moisturizers rich in ceramides, fatty acids, glycerin, panthenol, and hyaluronic acids as they help hold moisture while also working to repair the skin barrier.

Suitable options include Eczema Honey, CeraVe Eczema Relief Cream, and Vaseline Eczema Calming Therapy Cream. Dr. Smith advises applying moisturizer every time after washing hands and right after a shower or bath. Even when you're caught up in routine activities like waiting for a Zoom call to start or a traffic signal to change, there's never a wrong time to reapply moisturizer if you have eczema.

Eczema is an inflammatory condition, so implementing an anti-inflammatory eating protocol can be helpful for some people, according to Dr. Busso. The best eating plan will vary from person to person as specific inflammatory triggers can vary, he says, so it’s best to consult with your healthcare provider and a nutritionist prior to upheaving your current diet. Generally, adopting an atopic dermatitis-friendly diet will require an individual to keep track of their food so they can identify triggers and avoid them in the future.

In addition to eliminating inflammatory foods, experts recommend adding anti-inflammatory foods and ingredients, which can “limit your inflammation burden,” says Dr. Smith. Foods that may help lower inflammation include fresh fruits and vegetables, olive oil, and whole grains. “Omega-3 fatty acids, which are often found in fish such as salmon, mackerel, and sardines, are also anti-inflammatory,” he says. 

Widely known as public enemy number one, it should come as no surprise that stress can also negatively impact individuals with eczema. “Stress can lead to flare-ups in a few ways,” Dr. Zion says. First, when stress levels are high, cortisol levels are too. Cortisol is the stress hormone, and when there’s a lot of it in the body, it can disrupt the immune system, she says. “This can make the body more susceptible to inflammatory triggers, as well as weaken the skin barrier.” 

Further, when individuals are chronically stressed, they are more likely to neglect their bodies and hygiene habits, which can exacerbate the eczema. Often, stressed individuals will neglect their bodies by getting inadequate sleep, making poor dietary choices, and possibly neglecting their skincare routine,” she says.  For these reasons and more, it’s essential that people with eczema implement stress-relieving protocols into their daily routines.

Wet wrap therapy, a treatment for severe eczema, is currently being studied by the National Institute of Allergy and Infectious Diseases — if you love a bath, this innovative eczema treatment may appeal to you. Wet wrap therapy involves taking a lukewarm bath and then applying a combination of topical medicine and moisturizer to your skin. It is then sealed in place with a wrap of wet gauze. “The aim here is to lock moisture into the skin to repair the skin barrier and prevent evaporation,” Dr. Smith explains. 

Typically, it is recommended that individuals take a bath and apply the wrap three times a day. “It is a time-consuming process,” he says. “But it can also be done for a short period of time (15-30 minutes) twice a day, or even overnight.”

You can make a few easy edits to your bath and wash routine that may help reduce your risk for flare-ups.  First, check the ingredient list of your soaps, washes, shampoos, conditioners, and lotions to ensure they don't contain any potentially irritating ingredients.

Opt instead for scent-free washes and products, like Dirty Labs Laundry Detergent, Dove Sensitive Skin, and Free & Clear Shampoo for Sensitive Skin. “If you must wear perfume or collagen, spray it on your clothing to keep from inducing a flare-up,” Dr. Smith says. 

You'll also want to avoid really hot showers and baths and limit your time in the water to 10 minutes. “Hot water can strip the skin barrier of its natural oils, leading to significant damage that increases the risk for flare-up,” says Dr. Zion. When you get out of the shower, pat yourself dry with a towel and then liberally apply a thick, non-fragrant moisturizing cream, she says. Again, you want a moisturizer that contains ingredients (like petroleum) that will lock in hydration.