Eczema: Triggers, Barrier Repair, and Evidence-Based Care

Atopic dermatitis (eczema) is a chronic inflammatory skin condition characterised by intense itch, dry and sensitive skin, and periodic flares. It is not contagious, not caused by poor hygiene, and not something to simply push through. Understanding its mechanism makes managing it more tractable.

The barrier defect at the core

In eczema, a mutation or dysfunction in filaggrin (a protein critical to the skin barrier) reduces the skin's ability to retain water and keep irritants out. The result: a leaky barrier that dries out easily, allows environmental triggers to penetrate, and reacts with inflammation. This is structural, not a personal failing.

Common triggers

• Irritants — soaps, detergents, fragrances, wool fabrics, and some topical products.
• Allergens — dust mites, pet dander, pollen, and certain foods (especially in children).
• Temperature and sweat — heat, sweating, and sudden cold are common flare triggers.
• Stress — the cortisol-inflammation pathway directly worsens eczema severity.
• Infection — Staphylococcus aureus colonises eczema-affected skin at high rates and drives inflammation.

Evidence-based skincare for eczema

• Ceramide-rich moisturisers — multiple RCTs show ceramide-containing emollients reduce TEWL and flare frequency.
• Wet wrap therapy — for severe flares, applying a damp layer under dry clothing locks in moisture and reduces itch dramatically.
• Soap substitutes — simple emollients used as wash (not soap) protect the acid mantle during cleansing.
• Bleach baths (dilute) — 0.005% bleach solution baths reduce S. aureus colonisation; evidence-supported for moderate-severe eczema.