Does eczema worsen with cold weather?

Does Eczema Worsen with Cold Weather?

Yes, eczema definitively worsens in cold weather due to low humidity and low temperatures that impair skin barrier function, increase inflammation, and trigger flares—particularly during winter months when indoor heating further reduces air moisture.

Mechanism of Cold Weather Exacerbation

Cold and dry weather conditions directly damage the skin barrier through multiple pathways:

• Low humidity causes the stratum corneum to become rigid and brittle, leading to increased skin roughness, pruritus, and progression to eczema 1
• Exposure to low air humidity (30% or less) significantly increases skin roughness parameters in atopic eczema patients within just 3 hours, while healthy controls show no such changes 2
• Cold temperatures and low humidity collectively decrease overall skin barrier function and increase susceptibility to mechanical stress, making the skin more reactive to irritants and allergens 3
• Keratinocytes release pro-inflammatory cytokines and cortisol in response to cold/dry conditions, while dermal mast cell numbers increase, creating a pro-inflammatory environment 3

Clinical Evidence of Seasonal Patterns

Multiple studies confirm worse eczema symptoms during cold, dry seasons:

• Published data consistently show that cold and dry weather increase both the prevalence and risk of flares in patients with atopic dermatitis 3
• Seasonal variation demonstrates symptoms worsening in winter and improving in summer, with a large English cohort of 519 children showing this pattern 4
• Patients have 1.6 times higher odds of presenting with atopic dermatitis during dry seasons compared to wet seasons, with low humidity, low precipitation, and reduced cloud cover being the most significant meteorological factors 5

The "Dry" Irritant Contact Dermatitis Component

Cold weather creates a specific type of irritant dermatitis:

• Chronic cumulative irritant contact dermatitis occurs from repetitive exposure to "dry" irritants including low-humidity air, heat, powders, paper, and dusts 6
• At relative humidity of 10% or less, the horny layer becomes rigid and brittle, with the combination of low humidity, high temperature, and rapid air movement dehydrating the outer stratum corneum 1

Critical Management During Cold Weather

Essential Preventive Measures

• Use mild, pH-neutral (pH 5) non-soap cleansers or dispersible creams as soap substitutes to preserve the skin's natural lipid barrier, as harsh soaps and detergents remove natural lipids and worsen dryness 7
• Apply fragrance-free moisturizers containing petrolatum or mineral oil immediately after bathing to damp skin to create a surface lipid film that prevents transepidermal water loss 7
• Reapply moisturizer every 3-4 hours and after each face washing 7
• Use tepid (not hot) water for bathing, as hot water worsens symptoms 7
• Pat skin dry with clean, smooth towels rather than rubbing 7

Environmental Modifications

• Raise indoor relative humidity when possible, as low-humidity lesions resolve quickly with routine use of moisturizers and/or raising the relative humidity 1
• Avoid rapid air movement and excessive indoor heating that further dehydrates the stratum corneum 1

Treatment Adjustments for Winter Flares

• Apply low-potency topical corticosteroids (hydrocortisone 1% or prednicarbate 0.02%) for significant erythema and inflammation, but limit use to 2-4 weeks maximum, especially on the face, due to risks of skin atrophy and telangiectasia 7
• Watch for secondary bacterial infection (crusting, weeping) requiring antibiotics, or herpes simplex superinfection (grouped, punched-out erosions) requiring acyclovir 7

Common Pitfalls to Avoid

• Do not use alcohol-containing preparations, as they significantly worsen dryness and can trigger flares 7
• Avoid greasy or occlusive creams that can facilitate folliculitis development 7
• Do not use topical acne medications (especially retinoids) as they may irritate and worsen the condition due to their drying effects 7
• Avoid overuse of non-sedating antihistamines, which provide no benefit in eczema treatment 7

When Disease Severity Doesn't Matter

Importantly, the likelihood of temperature-related flares does not differ by baseline disease severity, and different emollient types do not provide differential protection against temperature changes 4. This means all eczema patients require the same preventive approach during cold weather regardless of their usual disease severity.