Trigger Factors

Trigger factors may be different in different people. Most children get worse when they get a cold or other infection. Most have worse problems in the winter; but others simply cannot stand the sweating during hot, humid summer weather.

Trigger factors that seem to affect every child with AD:

Dry Skin:

The skin’s main function is to provide a barrier against dirt, germs and chemicals from the outside. We don’t notice this barrier unless it gets dry, and then it’s scaly rough and tight. Dry skin is brittle – moist skin is soft and flexible. People with AD have a defect in their skin so it won’t stay moist. It is especially bad in winter when the heat is on in the house and the humidity drops. Other things that dry the skin are too much bathing without proper moisturizing . The challenge: Prevent skin dryness.

Irritants:

Irritants are any of the substances outside the body that can cause burning, redness, itching or dryness of the skin. The challenge: Avoid irritating substances.

Stress:

Emotional stress comes from many situations. People with AD often react to stress by having red flushing and itching. Special problems for children with AD include frustration, anger or fear. And, of course, AD itself, and its treatments, are a source of stress! The challenge: Recognize stress and reduce it.

Heat and Sweating:

Most people with atopic dermatitis notice that when they get hot, they itch. They have a type of prickly heat that doesn’t occur just in humid summertime but anytime they sweat. It can happen from exercise, from too many warm bedclothes, or rapid changes in temperature from cold to warm.

Infections:

Bacterial “staph” infections are the most common, especially on arms and legs. Such infections might be suspected if areas are weeping or crusted or if small “pus-bumps” are seen. A common virus infection of children, Molluscum sp., tends to be more severe in children with AD. Molluscum infections look like small bumps, often with a central white core. Herpes infections (such as fever blisters or cold sores) and fungus (ringworm or athlete’s foot) can also trigger AD. If some lesions look different ask your doctor. If they turn out to be infected, they can be treated with antibiotics or other, effective medications. These are generally benign, superficial infections for AD patients and they do not seem to be especially contagious for other people. The challenge: Recognize and treat pustules or crusted lesions in consultation with a physician.

Allergens:

Allergens are materials (such as pollen, pet dander, foods, or dust) that cause allergic responses. Allergic diseases such as asthma and hay fever, which flare quickly, are easy to tie to allergens. Allergic symptoms, such as itching and hives, appear soon after exposure to airborne allergens and last only briefly. But the slower, continuing, chronic eczema of AD may be difficult to tie to specific allergens. Food allergies can trigger flares, especially for children with moderate to severe AD. Pollens, dust mites, and pets can seldom be shown to trigger eczema in young children. Of the available tests for allergy, scratch tests and RAST tests are only brief reactions and do not diagnose allergen-triggered eczema. Patch tests, by contrast, can diagnose eczema response in some cases such as allergies to skin care products.

Are there other trigger factors?

Children with AD will be helped by reducing the major trigger factors described above. But individuals may be subject to other trigger factors, and it is important to be alert for these as well.

How can you avoid trigger factors?

  1. Keep the skin barrier intact. MOISTURIZE!
  2. Wear soft clothes that “breathe.” Avoid fabrics of wool, nylon, or stiff material.
  3. If sweating causes itching, find ways to keep cooler: Reduce exertion, especially during times of flare. Layer clothing and adjust to temperature change. Don’t overheat rooms, especially the bedroom. Use light bedclothes.
  4. When itching from sweating, dust, pollen or other exposures, take a cooling shower or tub bath, and don’t forget to moisturize afterwards, within 3 minutes after the child has been gently toweled. Refer to the Bathing & Moisturizing sections for more information.
  5. Learn to recognize signs of infection and treat early.
  6. If you suspect food allergy, be systematic. Likely offenders are eggs, milk, peanuts, soy, wheat and seafood, but any food can do it. Can you exclude the most likely offender for a week? Substitute hydrolysate (e.g. Alimentum® or Nutramagen®) for cow’s milk formula. Keep a food diary. When the skin clears up, try the food. Watch for signs of itching or redness over the next two hours. Eliminate a food group if it causes hives or face swelling. Don’t exclude multiple food groups at the same time – it’s rare to have more than one or two food allergies that impact the eczema, and your child can get malnourished with prolonged avoidance of many foods. Always make sure that any food manipulation is performed with the advice of a physician.
  7. With allergy-prone kids furry animals are a risk. If you must have pets, keep them outside or at least off beds, rugs and furniture where the child plays. Dust mites collect in bedroom carpets and bedding. Simple control measures include coverings for pillows and mattresses, removing bedroom carpets and frequent washing of bedclothes in hot water.
  8. Think about stress-causing events and ways to cope with them. Review problems with your doctor or a mental health professional. Consider clinicians who specialize in approaches including mindfulness. Try to make AD treatments part of a daily, family routine. Encourage children with AD to do what they can on their own.