What causes an atopic dermatitis (eczema) flare-up?

From the Guidelines

To manage an eczema flare-up, start with gentle, fragrance-free moisturizers like CeraVe, Eucerin, or Vanicream applied multiple times daily, especially after bathing while skin is still damp, as recommended by recent guidelines 1. When managing an eczema flare-up, it's essential to consider the potential causes and contributing factors. According to a study published in 2020 1, hand dermatitis that is allergic in nature requires identification and avoidance of allergens, as well as application of a topical steroid to mitigate flares.

Key Considerations

• Identify and avoid triggers such as certain fabrics, detergents, foods, stress, or environmental factors, as suggested by a 2014 study 1.
• Use over-the-counter 1% hydrocortisone cream twice daily for up to 7 days on affected areas for mild to moderate flares.
• For severe or persistent flares lasting more than two weeks despite treatment, consult a healthcare provider, as you may need stronger medications like topical calcineurin inhibitors (tacrolimus, pimecrolimus) or systemic treatments.

Additional Recommendations

• Take short, lukewarm showers using mild, fragrance-free cleansers and avoid scratching, which worsens inflammation.
• Antihistamines like cetirizine (10mg daily) or diphenhydramine (25-50mg at bedtime) can help reduce itching, as mentioned in a 2014 study 1.
• Patch testing may be necessary to evaluate for a clinically relevant causal allergen in cases of suspected allergic contact dermatitis, as recommended by a 2020 study 1.

From the Research

Eczema Flare-Up Treatment

• Topical corticosteroids are a first-line treatment for eczema flare-ups, with potent and very potent topical corticosteroids being more effective than mild topical corticosteroids 2, 3, 4
• The effectiveness of topical corticosteroids is similar between once daily and twice daily (or more) frequent use 2
• Topical corticosteroids weekend (proactive) therapy is probably better than no topical corticosteroids/reactive use to prevent eczema relapse (flare-ups) 2
• Other treatments such as topical calcineurin inhibitors (e.g. pimecrolimus and tacrolimus) and phosphodiesterase-4 (PDE-4) inhibitors can be used in conjunction with topical corticosteroids as first-line treatment 3, 5

Local Adverse Events

• Local adverse events such as abnormal skin thinning, application-site reactions, and pigmentation changes can occur with topical corticosteroids and other treatments 2, 3, 4
• The risk of local adverse events increases with prolonged use, higher potency, and application to areas of thinner skin 6
• Tacrolimus 0.1% and crisaborole 2% are most likely to cause local application-site reactions, while topical steroids are least likely to cause these reactions 3, 4

Treatment Duration and Frequency

• The optimal duration of treatment for eczema flare-ups is not well established, with most trials lasting between 1-5 weeks 2
• Topical corticosteroids can be applied once or twice per day for up to three weeks for super-high-potency corticosteroids or up to 12 weeks for high- or medium-potency corticosteroids 6
• Maintenance therapy with liberal use of emollients and daily bathing with soap-free cleansers can help prevent eczema relapse (flare-ups) 5