Is contact dermatitis (eczema) worse during winter months?

Contact Dermatitis and Eczema Worsen During Winter Months

Yes, contact dermatitis and eczema definitively worsen during winter months due to low humidity and cold temperatures that impair skin barrier function and increase inflammatory responses. 1

Environmental Mechanisms Behind Winter Deterioration

Winter weather creates multiple conditions that damage the skin barrier:

• Low humidity is the primary culprit, causing decreased water-binding capacity in the stratum corneum and increased transepidermal water loss 1
• Cold temperatures compound the problem by reducing overall skin barrier function and making skin more susceptible to mechanical stress 1
• Indoor heating further reduces relative humidity, creating a double exposure to dry conditions both outdoors and indoors 2

Research demonstrates that exposure to 30% humidity for just 3 hours significantly increases skin roughness parameters in patients with atopic eczema, while healthy controls show no such changes 2. This quantitative evidence confirms that even brief periods of low humidity trigger measurable deterioration 2.

Inflammatory and Immunologic Changes

Winter conditions don't just dry the skin—they fundamentally alter immune responses:

• Pro-inflammatory cytokines and cortisol are released by keratinocytes in response to low humidity and temperature 1
• Dermal mast cell numbers increase, making skin more reactive to irritants and allergens 1
• The skin barrier becomes compromised, allowing greater penetration of contact allergens and irritants 1

This creates a vicious cycle where impaired barrier function leads to increased inflammation, which further damages the barrier 1.

Specific Winter-Related Aggravating Factors

Beyond basic environmental conditions, several winter-specific factors worsen contact dermatitis:

• Washing clothes in cold tap water during winter leaves more detergent residue in fabrics, which acts as a chronic irritant against the skin 3
• In one study of 148 atopic dermatitis patients, 78% had widespread dry skin on the trunk during winter, with 76% showing marked improvement after switching to nonionic, additive-reduced detergents for just two weeks 3
• Hot water used for handwashing (more common in winter) is itself an irritant that damages the stratum corneum 4
• Increased frequency of handwashing during winter illness season compounds irritant exposure 5

Clinical Presentation in Winter

The distribution and severity of winter-related contact dermatitis follows predictable patterns:

• Dryness is most prominent around the shoulders and trunk, corresponding to areas of greatest contact with clothing 3
• Affected persons complain of burning sensations, roughness, erythema, scaling, and fissuring 4
• Chronic phase changes dominate, with lichenification and fissuring rather than acute vesiculation 5

Practical Management Approach

To address winter worsening of contact dermatitis, implement these specific interventions:

Immediate environmental modifications:

• Use humidifiers to maintain indoor relative humidity above 30% 2, 1
• Avoid hot water for handwashing; use lukewarm water instead 4
• Switch to nonionic, additive-reduced laundry detergents, particularly if washing in cold water 3

Barrier restoration protocol:

• Apply moisturizers immediately after water exposure to damp skin 5
• Use the "soak and smear" technique: soak hands in plain water for 20 minutes, then immediately apply moisturizer nightly for up to 2 weeks 5
• Apply two fingertip units of moisturizer to hands after each washing 5

For persistent cases:

• Apply topical steroids to mitigate acute flares 5
• Consider patch testing if allergic contact dermatitis is suspected, as this carries a worse prognosis than irritant dermatitis unless the allergen is identified and avoided 5
• For recalcitrant cases, phototherapy or systemic therapy may be necessary 5

Critical Pitfalls to Avoid

• Don't assume all winter dermatitis is purely irritant-based—allergic contact dermatitis can coexist and requires patch testing for definitive diagnosis 5
• Don't rely on clinical appearance alone to distinguish between irritant and allergic contact dermatitis, as morphology is unreliable 4
• Don't overlook occupational factors that may be amplified by winter conditions, such as increased wet work or glove use 5
• Don't use oil-based moisturizers under latex or rubber gloves, as they can break down the material; water-based moisturizers are safe under all glove types 5