What triggers eczema
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Triggers of Eczema: A Comprehensive Overview
Genetic Factors and Skin Barrier Dysfunction
Filaggrin Gene Mutations
One of the primary genetic factors implicated in eczema is mutations in the filaggrin gene. These mutations can lead to impaired skin barrier function, making the skin more susceptible to irritants and allergens4. This genetic predisposition is a significant trigger for atopic eczema (AE) in many individuals.
Epidermal Barrier Impairment
A genetically predetermined impaired epidermal barrier is a leading cause of AE in a subgroup of patients. This barrier dysfunction allows for increased penetration of allergens and microbes, exacerbating the condition1 3.
Immune System Dysregulation
Th1/Th2 Paradigm and Beyond
Initially, AE was thought to be primarily driven by a Th2 immune response. However, recent studies have expanded this understanding to include other T helper cell subsets such as Th17 and Th22, as well as specialized dendritic cells. These immune changes contribute to the chronic inflammation seen in AE1.
Role of Regulatory T Cells
Regulatory T cells, particularly those expressing forkhead box P3 (Foxp3), have been shown to play a role in modulating the immune response in AE. Activation of the vitamin D receptor (VDR) has been found to increase these regulatory T cells, thereby improving skin barrier function and reducing inflammation in a mouse model of allergen-triggered eczema10.
Environmental Triggers
Allergens
Environmental allergens such as pollen, house dust mites, and microbial products are well-known triggers for AE. In some patients, food allergens like cow’s milk and hen’s eggs can also provoke eczema flares, particularly in sensitized infants1 5 7.
Irritants
Common irritants that can trigger eczema include soaps, detergents, and certain fabrics like nylon. Exposure to these irritants can exacerbate the condition, especially in individuals with an already compromised skin barrier2 9.
Seasonal and Environmental Factors
Seasonal variations, dust exposure, and unfamiliar pets have been identified as significant triggers for eczema flares. Cold weather can increase the effect of certain irritants like shampoo, highlighting the importance of environmental factors in disease exacerbation2.
Lifestyle Factors
Smoking
Tobacco smoking has been associated with an increased risk of chronic hand eczema, particularly when combined with other allergic and irritant factors. This suggests that lifestyle choices can significantly impact the severity and frequency of eczema flares8.
Stress
Psychological stress is another important trigger for eczema. Stress can exacerbate the condition by affecting the immune system and skin barrier function, leading to more frequent and severe flares2.
Microbial Factors
Malassezia Yeast
The yeast Malassezia, a member of the normal skin microbiome, has been identified as a trigger for AE. The higher pH levels found on the skin of AE patients can stimulate the release of Malassezia allergens, contributing to the inflammatory response4 6.
Conclusion
Eczema is a multifactorial disease triggered by a combination of genetic, immune, environmental, and lifestyle factors. Understanding these triggers can help in developing more effective management and prevention strategies for those affected by this chronic condition. By addressing both the internal and external factors that contribute to eczema, it is possible to reduce the frequency and severity of flares, improving the quality of life for patients.
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Most relevant research papers on this topic
Immunology of atopic eczema: overcoming the Th1/Th2 paradigm
Atopic eczema's pathogenesis involves immune changes beyond Th2, with specialized dendritic cells and T helper cell subsets playing roles, and trigger factors expanding beyond classical allergens to microbial products and self-antigens.
Highly CitedFlares in childhood eczema.
Combinations of environmental factors, such as nylon clothing, dust, unfamiliar pets, sweating, and shampoo, can exacerbate childhood eczema flares.
Systematic ReviewAtopic eczema: a disease modulated by gene and environment.
Atopic eczema is a complex disease influenced by multiple factors, including gene and environmental factors, affecting 15%-20% of children and 1%-3% of adults worldwide.
Eczema and Dermatitis
Eczema and dermatitis are common skin diseases characterized by itching, scaling, and epidermal edema, with a variety of causes and triggers.
Allergic triggers in atopic dermatitis.
Eliminating food and environmental allergens can significantly improve atopic dermatitis in some patients, with diagnostic tests and allergen-avoidance measures being beneficial.
Higher pH level, corresponding to that on the skin of patients with atopic eczema, stimulates the release of Malassezia sympodialis allergens
Higher pH levels, similar to those found in atopic eczema patients' skin, stimulate the release of Malassezia sympodialis allergens.
Observational StudyEczematous reactions to food in atopic eczema: position paper of the EAACI and GA2LEN
Food allergy and atopic eczema can coexist in the same patient, with food-induced eczema being a significant trigger factor and requiring thorough diagnostic procedures to determine sensitization and clinical relevance.
Highly CitedSmoking is associated with combined allergic and irritant hand eczema, contact allergies and hyperhidrosis
Smoking is associated with various types of hand eczema, contact allergies, and hyperhidrosis, potentially triggering chronic hand eczema in non-occupational settings.
Rigorous JournalAetiology and prevention of eczema
Water hardness may be associated with eczema, and promoting healthy skin development in early life may help prevent its onset.
Systematic ReviewVitamin D receptor activation improves allergen-triggered eczema in mice.
Systemic vitamin D receptor agonist treatment significantly improves allergen-triggered eczema in mice, potentially enhancing skin barrier function and antimicrobial defense mechanisms.
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Animal Study