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Eczema Triggers should be Identified and Avoided!

Eczema triggers! They are sometimes difficult to suss out, but once you eliminate a trigger, you are less likely to get an eczema rash and you realize how much better your skin is!

In terms of interventions, the patient should employ a well-rounded approach that includes:

1. Identifying and avoiding triggers
2. Addressing itch, reducing inflammation, maintaining moisture levels and managing barrier dysfunction
3. Managing sleep and reducing psycho/emotional/social stress

This article covers the topic of identifying and all triggers including foods that trigger eczema.

Identify & Avoid Triggers to Manage Eczema & Atopic Dermatitis

What to Avoid in Real Life

Drinking

Despite the lack of evidence that drinking worsens eczema, drinking causes inflammation and flushing. In addition, drinking deprives the skin of moisture.
It is very likely that drinking will cause an eczema rash if your suffer chronically from eczema.

Avoid activities on a hot and humid day

Singapore is located near the equator. Hence it adopts a tropical climate and has a constant high temperature and high humidity. Climate changes are a very subtle type of environmental trigger, so it can be very important in Singapore to find way to control your most immediate envirnoment.

During hot and humid days it is likely that eczema will flare up. It is very likely that one will sweat more in Singapore, which can worsen an existing eczema flare up. This is why controlling the aircon and humidifier situation in your home is one effective strategy.

Stress

Stress may lead to flare ups, causing pain and soreness to the skin. If you are an eczema patient, it is important not to allow stress to overwhelm you. It is advisable if possible to take more frequent mental breaks when completing a task.

What You Use to “Keep Clean

The first class of triggers to avoid are contact triggers. And the first category of contact triggers to minimize contact with are those that you use to clean your skin!

Avoid soap because they tend to have high pH. The stratum corneum, the outermost layer of your skin, has a lower pH of between 4.5 and 6. This is why moisturzers like Sebamed and Eucerin have low pH as their selling point. On that note, you can consider using acidic water from a Kangen filter if you or someone you know owns one. Filtered acidic water contains low pH minerals, similar to those present in hot springs, sulphur being the most well-known of them.

Note that after taking a shower, there is a strong urge to do something to skin that is clean. The first intervention here is to quickly moisturize and then to put on the body-hugging wrap or clothing. The second is to remain in an environment that does not aggravate the skin, usually one with air-conditioning and, even better if you can afford one, a humidifier thrown in!

Right after the shower, many people may present with redder skin, or may sweat a little. The challenge then is to transition from the shower to a cooler environment. Some people may be able to handle cold showers, but it is not for every constitution.

Your Clothes

Garments are the next class of contact irritants you want to be in control of. As much as you can, wear light cotton clothing that allows the skin to breathe. Avoid using synthetic clothing that may leave the skin humid and prone to perspiration. Avoid wool or other prickly textiles that may irritate sensory nerves fibres in the skin, aggravating itch.

That said, there are many clothing products for use in the treatment and management of various forms of dermatitis, eczema, EB, acne and other forms of allergic skin conditions that affect different areas of the body across all age groups. One such material possesses negative ions into the body upon contact with human skin through vibration because the material it is made from Teviron, which carries a negative charge.

Teviron has also been shown to “regulate the calcium level in your blood serum (healthy level is 4 mg Calcium per 100cc of blood serum). This helps regulate the blood pH level, rejuvenates the cells, enhances the immune system and balance the autonomic nerves.” It claims to be beneficial towards allergies, high blood pressure, diabetes and even insomnia.

Another would be Skinnies. It offers a clinically proven eczema treatment is seam free and irritant free. Used as part of the normal treatment program, Skinnies helps reduce the terrible ‘itch-scratch cycle’ in Eczema and Atopic Dermatitis. In EB patients, Skinnies helps to minimize infection, speed wound healing time, and reduce the frequency of an eczema rash!

The Air Around

What you put on your skin and what you wear over your skin are the most obvious trigger. Next up are environmental triggers. Sometimes, it is just too difficult to control the moods of tropical weather, as the right mix of humidity and heat could just be perfect breeding ground for an eczema flare up!

Keep cool. Avoid drastic changes in humidity or temperature. On that note, consider using an air purifier or humidifier if you can afford to. The humidifier is a device that emits water into the air to increase moisture in the surroundings. The use of humidifiers are recommended to relieve congestion from the common cold, flu and sinus infections. Humidifiers may also help alleviate the symptoms of dry eyes, eczema, itchy skin, dry nasal passages, cracked lips and nosebleeds due to dry air, allergies or asthma. The skin needs humidity levels of at least 30 to 40 percent in order to stay healthy. This humidifier doesn’t warm up the air or cause drastic changes in ambient temperature. If you want the best for an eczema situation, a cool mist is best.

Another option is to select an air purifier to aid in your eczema treatment, choose a purifier with a HEPA filter for the best filtration. Purifiers designed to filter not only dust and pollen but also mould and other bacteria tend to be the most effective. Finally, an air purifier with a humidifier is helpful at keeping your skin moist as it filters allergens out of the air.

Aircon

My patients have managed their aircon situation a number of ways. I will divide management into three separate ways below.

1. Aircon with Humidifier

After the evening shower, you want to immediately enter an aircon room, dry up, moisturize (optional) and then put on long sleeve clothes. The long sleeves are meant to prevent your skin from exposure to the air, which can be drying in an air-conditioned room. Then turn on the humidifier so your skin is comfortable with the cool of the aircon and reduced dryness from the humidifier.

2. No Aircon (fan optional)

Some patient decide they want normal air, and they still do well with it. These are also patients who do not do so well with the cold (yes there are such patients). They may have mild perspiration but still do well without an air-conditioned environment.

Some do well with a light fan to move the air a little in their room

3. Option of Portable Aircon

This would be a not-so-strong portable aircon like this one recommended by a patient, which is desirable because it is midway between a fan situation and an aircon situation.

Environmental Triggers

In almost all cases, an air purifier will not single-handedly eliminate the effects of eczema. If you suffer from atopic dermatitis, take additional measures to ensure that your house is allergen-free. Cover your bedding in hypoallergenic bed and pillow covers and wash all bedding and clothes in a mild detergent without fabric softener.

Check that living environment does not have mites. House dust mites live on human dead skin cells found in household dust and their waste products are one of the most common causes of year-round allergy and asthma. Vacuuming and dusting the house on a frequent basis is not enough to remove dust mites and their waste. Up to 95% of mites may remain after vacuuming because they live deep inside the stuffing of upholstered furniture, mattresses, pillows, carpets, stuffed animals, and toys.

Bedding and Dust Mites

Use a zippered, dust- proof cover for mattresses and pillows. These covers are made of a material with pores too small to let dust mites and their waste products get through. They are referred to as allergen- impermeable. Plastic or vinyl covers are the least expensive, but some people find them uncomfortable. Allergen impermeable covers made of fabric can be purchased from allergy supply companies as well as from many stores selling bedding products. Wash sheets, blankets, bedspreads, duvet covers, and comforters every week. Water temperatures of at least 130° F are needed to kill dust mites.

Wherever possible, try to rid the bedroom of all types of materials that mites love. Choose washable bedding and toys. Try to limit the number of stuffed toys and upholstered furniture if you don’t want to suffer from eczema rash everyday! Avoid use of wall-to-wall carpeting if possible. Keep pets out of this room as well. Roll up shades are easier to clean than fabric curtains, but if you do have curtains, be sure to wash them often.

Special vacuum cleaner bags (microfiltration bags) are available which help reduce the amount of dust, which gets stirred up during vacuuming. Special filters for vacuum cleaners can also help keep mites and mite waste from circulating back into the air. You can buy these bags and filters in large department stores and from an allergy supply company or in some specialty vacuum stores.

Swimming can Cause a Flare!

Avoid swimming for the time being. Chlorine is an irritant. But is also may help with its antibacterial effect. Dryness of the skin after swimming is likely to occur if the pH of the pool water is raised (pH above neutral can cause dry skin, as can calcium build-up).

How a Bath May Help or Harm

Soaking in a bath can be beneficial because you moisturize the skin while removing dirt and bacteria. However, note that soaking for more than 20mins can dry up skin instead and use lukewarm water. Apply emollient immediately after drying.

There are many nourishing formula to help relief the itch from dryness. Oats is frequently used to fight dryness by leaving a protective layer on the skin, cleanses and moisturizes, and helps maintain the skin’s natural barrier function. The naturally occurring antioxidants in oats have also been found to exhibit inflammatory properties.

Food Triggers

Atopic eczema can sometimes be caused by food allergens, especially before the age of one. Some studies of children and young people with atopic eczema found that one-third to nearly two-thirds also had a food allergy.

For some individuals with eczema, certain foods will trigger an exacerbation of symptoms. The most common culprits are an excess of sugar, dairy or wheat (especially those in processed food). Some individuals are particularly sensitive to eggs and nuts, and there are a rare few who show immediate reactions to nuts, soy (tamari) and even citrus fruits like mandarin oranges!

Other triggers are much harder to detect and IgE or IgG may be helpful here. Examples include an intolerance to kiwi fruit or peaches!

Common Foods that Trigger Eczema:

  1. Sugar: Consuming excessive amounts of sugar can potentially exacerbate eczema symptoms due to various interconnected mechanisms within the body. High sugar intake has been linked to inflammation, which plays a significant role in the development and worsening of eczema. By consuming sugar, insulin levels shoot up and trigger the release of pro-inflammatory molecules, which can disrupt the normal functioning of the skin’s barrier and exacerbate the immune response. Additionally, a diet high in sugar may contribute to gut microbiota imbalance, which may trigger eczema. Lastly, sugar can contribute to glycation, a process where sugars bind to proteins and form harmful molecules called advanced glycation end-products (AGEs),which trigger oxidative stress and inflammation, both of which are implicated in eczema pathogenesis.
  2. Dairy Products: Dairy, including milk, cheese, and yogurt, is a common trigger for eczema in some individuals. It is believed that proteins such as casein and whey in dairy may contribute to allergic reactions or sensitivities in certain people. Interestingly, there are people who respond badly to cow’s milk, but is not affected by eating cheese or yoghurt. Choosing dairy alternatives or lactose-free options may be worth exploring for those prone to eczema triggers.
  3. Wheat and Gluten: Wheat and gluten-containing grains have been linked to eczema symptoms in some individuals. Gluten sensitivity or wheat allergy can contribute to skin inflammation and itching. Exploring gluten-free alternatives and monitoring the impact on eczema can be a valuable strategy for those suspecting a connection.
  4. Eggs: Eggs, particularly the egg whites, are another potential trigger for eczema. Some individuals may be sensitive or allergic to proteins found in eggs, leading to skin reactions.
  5. Nuts: Various nuts, such as peanuts and tree nuts, have been reported as eczema triggers. Allergies to nuts are common, and in some cases, individuals with eczema may experience flare-ups after consuming nuts. Identifying specific nuts that may be problematic and eliminating them from the diet can be part of an elimination strategy.
  6. Soy Products: Soy is a known allergen, and some individuals with eczema may experience exacerbated symptoms after consuming soy products. Soy is present in various processed foods, so checking food labels for soy content is essential for those looking to manage eczema through dietary adjustments.
  7. Citrus Fruits: Citrus fruits like oranges, lemons, and grapefruits contain salicylates and amines that can cause an itch response for some individuals with eczema. The high acidity in these fruits may contribute to skin discomfort and itching. Eliminating or reducing citrus fruits in the diet can be considered as part of eczema management.
  8. Tomatoes and Nightshades: Tomatoes and other nightshade vegetables, such as eggplants and peppers, contain compounds known as alkaloids that may trigger inflammatory responses in some individuals. While research on the direct link between nightshades and eczema is limited, anecdotal evidence suggests that some people may experience relief by avoiding these foods.
  9. Shellfish: Shellfish, including shrimp, crab, and lobster, are common allergens that may contribute to eczema symptoms in sensitive individuals. Being mindful of shellfish consumption and considering elimination if a connection is suspected can be a part of managing eczema through dietary changes.
  10. Processed Foods and Additives: Highly processed foods, additives, and preservatives can contain artificial colors, flavors, and other eczema triggers in some individuals. Maintaining a diet rich in whole, unprocessed foods and minimizing the intake of processed and packaged items can be a beneficial approach.
  11. Histamine-Rich Foods: Some individuals with eczema may be sensitive to histamine, which is always implicated in an eczema rash. Histamine-rich foods, such as fermented products, aged cheeses, and certain cured meats, may contribute to eczema symptoms. Limiting the intake of histamine-rich foods might be considered in managing eczema for those with histamine sensitivity.

For anyone who comes to Chinese Doc Singapore for eczema treatment, it is wise to consider keeping a food diary to track your diet to see if certain foods are associated with flare-ups — this is more helpful in determining eczema triggers than IgA skin prick or IgE and IgG blood tests.

The relationship between diet and eczema is complex and varies among individuals. What someone else is particularly triggered by may not be a trigger for you at all. Hence the food diary is crucial – don’t wait to start it!

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FAQs

What food triggers eczema?

Eczema triggers can vary from person to person, but common food triggers include

  • dairy
  • eggs
  • nuts
  • soy
  • wheat
  • certain fruits.

It is crucial to identify personal triggers through an elimination diet or by keeping a food diary.

How to treat eczema?

The approach used by GPs and dermatologists include:

  • Topical steroids
  • Protopic
  • Application of different moisturizers
  • Consumption of oral steroids and immunosuppressants
  • Avoidance of triggers.
  • Phototherapy

Eczema treatment involves a multifaceted approach. Approaches you can consider if the usual approaches don’t work include:

  • Natural creams, ointments, fragrance-free moisturizers
  • NMT approach of not adding on any more moisturizers
  • Traditional Chinese Medicine herbs
  • CAP therapy
  • Acupuncture
  • Food elimination
  • Supplementation according to functional medicine principles

What triggers eczema?

Eczema triggers encompass a range of factors, including

  • Environmental irritants (like harsh soaps)
  • Allergens (such as pet dander, dust mites)
  • Stress
  • Climate conditions (e.g. excess humidity in topical countries, excess cold during winter, sudden changes in temperature).

Identifying and managing these triggers are essential for effective eczema management.

What foods trigger eczema flare ups?

Foods that commonly trigger eczema flare-ups include dairy, eggs, soy, wheat, nuts, and acidic fruits.

Individuals with eczema should monitor their diet and work with a healthcare professional to identify specific triggers.

How to identify eczema triggers?

Identifying eczema triggers involves keeping a detailed record of activities, foods, and environmental factors when flare-ups occur.

This information can help pinpoint specific triggers, the biggest of which are (1) foods that trigger eczema and (2) environmental triggers.

What are the seven triggers to eczema?

The seven common triggers of eczema include

  1. Genetics: Filaggrin gene defects remain the strongest identified genetic risk factors for atopic dermatitis
  2. Environmental Triggers: This includes the air, the water and even dust in the room.
  3. Irritants: This could be latex, polyester clothing, certain materials e.g. leather or even chemical detergents.
  4. Allergens: these could be dust, pollen or even perfumes that trigger an eczema rash.
  5. Stress: This is a universal trigger. it could be exam stress, stress in relationships, or even the stress of being unable to de-escalate an itch fest.
  6. Climate Conditions: It could be a cold and dry place that worsens your eczema; it could also be a hot and humid place. We see many people do badly in hot and humid places, who manage better in temperate climates. We also have people from temperate zones who actually do better in tropical Singapore.
  7. Certain Foods That Trigger Eczema: This varies from person to person, but is the most common culprit for triggering an eczema flare up.

In terms of which of the trigger is most easily to eliminate, in many instances it is food triggers. However, it requires a lot of discipline to stop eating certain foods which aggravate eczema but are also at the same time very hard to give up.

How to get rid of eczema on face?

To address eczema on the face, consider the following:

  1. Topical steroids or Protopic creams prescribed by a dermatologist can help manage inflammation. The question though is whether there will be a rebound flare when you decide to stop using these creams.
  2. The first thing you can do is to change to a gentle, fragrance-free cleanser and moisturizer. If possible, stop putting things on your face, in case any of these further aggravate your skin.
  3. Seek treatment from an experienced Traditional Chinese Medicine doctor. TCM administered by an experienced practitioner can clear up facial dermatitis and TSW on the face.

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