Experts are not sure what exactly causes eczema. However, most researchers believe there is a link between eczema and a combination of genes and triggers, such as stress.

People who have eczema often have overreactive immune systems that respond to a substance, or trigger, inside or outside the body. The body reacts to these triggers by causing inflammation. This in turn produces eczema symptoms, such as itchy, painful skin.

According to advocacy group National Eczema Association (NAE), stress is sometimes a trigger for eczema. Some people experience a flare-up of symptoms when they feel stressed. Others feel stressed because of their eczema, which worsens their symptoms. The result is a cycle of anxiety and eczema symptoms.

This article explores eczema and its causes. It also looks at prevention and treatment and when to contact a doctor.

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Although researchers have found strong links between stress and eczema, they do not fully understand the mechanisms underlying the connection.

However, there are several theories about why stress may worsen skin symptoms.

‘Fight-or-flight’ response

Stress may cause or worsen eczema as part of a person’s “fight-or-flight” response.

When a person is in a stressful situation, this triggers the fight-or-flight mode. The body responds by producing more stress hormones, such as cortisol and epinephrine.

However, too much cortisol can dysregulate the immune system and lead to inflammation of the skin. People who have eczema are especially susceptible to this inflammatory response.


Cytokines are small proteins that control the activity and growth of blood cells and affect immune and inflammation responses in the body.

According to some research, the connection between stress and eczema may involve cytokines, which in turn affects communication between inflammatory responses and depression or stress.

The immune system

Stress may lead to changes in the immune system, which may trigger eczema.

These changes involve the neuroendocrine pathways. These pathways are a hormonal system of communication between cells.

Allergic flare-ups

Research in animal studies has shown that inflammation in the nervous system can cause stress-induced flare-ups of allergy symptoms. The inflammation may lead to eczema.

Eczema, or atopic dermatitis, is a common allergic skin condition that usually starts in early childhood. The main symptom is itchy, dry skin.

If a person scratches the affected areas, their skin can become chafed and thickened, and red to purple discoloration may occur.

Half of all people with moderate to severe eczema also have hay fever, asthma, and food allergies.

Experts have linked eczema to a leaky skin barrier, which allows water to escape and dry the skin. A person can inherit leaky skin or develop it due to their environment.

A protein called filaggrin is essential to the skin’s barrier. If someone lacks this protein or if it is faulty, it can cause moderate to severe eczema.

A person may also develop eczema due to contact with bacteria, pollen, detergents, soaps, and animal dander.

While stress can also trigger eczema, there are differences between stress-related eczema and a typical stress rash.

A stress rash usually appears in the form of itchy, rounded welts, or hives. Hives can appear anywhere on the body and vary in size. While they often disappear within 24 hours, a bout of hives can last up to 6 weeks.

Anxiety disorder may trigger flare-ups of eczema. It can be difficult for a person with anxiety to manage the condition without medication.

Having anxiety may produce physical symptoms, including eczema.

If a person has a family history of anxiety or depression, they may need to address these issues first before managing their eczema.

Eczema is a complex condition. While researchers are not sure what causes it, they believe the following may play a role:

  • the immune system, stress, and inflammation
  • location
  • family history of eczema, hay fever, asthma, or allergies

There are also various potential triggers for eczema, including:

  • cold, dry air
  • cold or flu
  • dyes and fragrances in lotions and soaps
  • mold, animal dander, dust, pollen, and certain foods, for people with allergies
  • irritating chemicals or rough materials, such as wool

The NAE found that more than 30% of people with eczema are also living with depression, anxiety, or both.

If a person experiences these health issues, they should seek guidance from a mental health specialist, who will determine the most suitable treatment.

Managing stress

To manage stress that occurs due to eczema, a person can try the following:

  • Use relaxation techniques: Guided meditation, yoga, walks in nature, or creative activities, such as drawing, baking, or knitting, may help a person relax.
  • Exercise: Getting exercise is one of the best ways to manage stress. Researchers have linked the mood-lifting effects of exercise to the release of certain hormones and neurotransmitters. A person with eczema should wash using cool or lukewarm water and change their clothes after exercising.
  • Join a support group: Eczema is a common condition, affecting over 31 million people in the United States. Joining a support group of the Asthma and Allergy Foundation of America can help a person feel less alone.
  • Improve sleep quality: Sleeping in a comfortable and quiet bedroom, taking a warm bath or shower before bedtime, and avoiding caffeine and alcohol before bed may help improve sleep quality.

Changing routine

A person may be able to prevent eczema flare-ups by making certain changes to their routine, including:

  • Using fragrance-free skin products: Use unscented skin care products.
  • Moisturizing: Moisturize after bathing and whenever the skin feels dry with a fragrance-free lotion or cream.
  • Using lukewarm water: Take a 5–10-minute bath or shower daily in water that is lukewarm, not hot. Apply moisturizer within 5 minutes of bathing to help lock in moisture.
  • Wearing loose-fitting clothes: Wear 100% cotton clothing that is comfortable and loose. Cotton is less irritating than some other fabrics. Avoid wool directly touching the skin.
  • Avoiding extreme temperatures: Cold can dry out the skin, and heat can cause sweating, thus triggering eczema. Avoid extreme temperatures and protect the skin.
  • Using fragrance-free detergent: Wash clothes and bedding in a fragrance- and dye-free detergent.
  • Contacting a dermatologist: A dermatologist can help a person manage their eczema and prescribe treatment to prevent flare-ups.

A dermatologist may tailor a treatment plan to meet individual needs. However, most treatment plans include:

  • Skin care: A dermatologist can advise a person on bathing, applying the right moisturizer, and being gentle on their skin.
  • Trigger management: If a person knows what causes their eczema flare-ups, they should try to avoid the triggers, if possible.
  • Topical medication: Medication may help keep bacteria and irritants away from the skin and help lock in moisture. Medications may include corticosteroids, crisaborole ointment, and topical calcineurin inhibitors.
  • Phototherapy: Also known as light therapy, phototherapy involves exposing an individual’s skin to UV light. A person may need 2–3 treatments per week, usually for a few weeks to a few months.
  • Systemic medication: A dermatologist may prescribe oral or other medication to work throughout the body on the immune system.

A person with eczema should contact a doctor if:

  • over-the-counter medicines or home remedies have been ineffective
  • their eczema is affecting their day-to-day life
  • their lesions cover a large area of their body
  • their lesions appear infected and have red streaks or produce pus

Eczema is a common allergic skin condition that may cause discolored, itchy, dry skin.

Stress may trigger eczema due to increased cortisol levels, which leads to inflammation, causing eczema symptoms.

An eczema rash may result from anxiety or depression. If that is the case, a person should seek treatment for these underlying conditions to help manage their eczema.

There are various causes of and triggers for eczema, including family history, certain fabrics, scented products, and extreme temperatures.

Managing stress, moisturizing skin regularly, and using fragrance-free skin care products and detergents may help alleviate symptoms.

Dermatologists usually treat eczema with a combination of topical and other medication, trigger management, and phototherapy.

A person should contact a doctor if their eczema is severe or appears infected.