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Triggers and Tracking

Why tracking matters

Tracking helps parents move from guesswork to patterns. It does not need to be perfect, but it should be clear enough to answer a simple question: what tends to happen before this child's eczema gets worse or better?

Common trigger areas

Irritants and products

  • Soaps, shampoos, and body washes (especially those with fragrance or SLS)
  • Laundry detergent and fabric softener
  • Wet wipes (many contain preservatives that irritate)
  • Disinfectants and hand sanitisers
  • Bubble bath and bath additives
  • Sunscreen (chemical/organic filters more likely to irritate than mineral/zinc oxide)
  • "Natural" products with essential oils or complex botanical ingredients

Fabrics and clothing

  • Wool and rough synthetics are common irritants
  • Soft 100% cotton or cotton blends are generally best
  • Tight-fitting clothing increases friction and sweating
  • Silk therapeutic garments (DermaSilk) showed no benefit in clinical trials; save the expense
  • New unwashed clothes may carry finishing chemicals

Climate and environment

  • Low humidity and cold weather: dry indoor heating in winter is one of the most common flare triggers
  • Heat and sweating: sweat irritates eczema skin; keep the home cool, especially at night
  • Mediterranean/summer context: moderate sun and sea bathing may help some children, but sweating and overheating in hot weather can worsen things
  • Seasonal patterns: many children flare more in winter (dry air) or during seasonal transitions
  • Air conditioning: can help by reducing sweating but may also dry air; a humidifier can offset this

Humidity management

  • Indoor humidity of 40-60% is generally recommended
  • A bedroom humidifier during dry months is one of the most commonly cited helpful interventions by parents
  • Both very low humidity (drying) and very high humidity (sweating, mould) can be problematic

Skin contact irritants

  • Saliva and drooling (very common trigger in babies and toddlers)
  • Urine and stool contact (nappy area)
  • Food residue around the mouth
  • Chlorinated pool water (manageable with proper routine; see swimming section)

Illness and infection

  • Viral infections and fever can trigger flares
  • Bacterial superinfection (weeping, crusting) worsens eczema rapidly
  • Teething (often coincides with drooling-related flares)
  • Vaccinations may occasionally be followed by mild flares

Food and diet

  • Important context: the 2025 AAP clinical practice guideline on atopic dermatitis emphasises that foods typically do not cause eczema, even though up to 35–40% of children with moderate-to-severe AD develop food allergies. The relationship runs primarily in the other direction: early-life skin barrier disruption facilitates food sensitisation through the skin.
  • Broad food blame is easy to overestimate. If food is suspected, structured evaluation with a clinician is much better than removing many foods at once
  • Elimination diets carry real risks: nutritional harm in growing children, stress on families, and potential loss of tolerance to previously tolerated foods
  • When food allergy should be suspected: if the child has immediate reactions (hives, vomiting, swelling) after eating specific foods, not just worsening eczema hours or days later
  • Peanut introduction: for infants with eczema and/or egg allergy, early structured introduction of peanut-containing foods before 11 months is now recommended to reduce the risk of peanut allergy — based on the landmark LEAP trial (Du Toit et al., NEJM, 2015) and confirmed by the LEAP-On and EAT studies. The 2023 NIAID Addendum Guidelines updated this from a conditional to a strong recommendation for high-risk infants.

Swimming and chlorine

For detailed practical guidance on swimming, pool and sea water, pre- and post-swim routine, and the evidence, see Everyday Life.

Sun and sunscreen

Chemical sunscreens (avobenzone, oxybenzone) and fragrance-containing sunscreens are among the more common irritants for eczema-prone skin. Mineral sunscreens with zinc oxide or titanium dioxide are generally better tolerated.

For full guidance on sun exposure, sun protection, and tolerated sunscreen brands, see Everyday Life.

What is worth writing down

A useful short entry can include:

  • date
  • body areas affected
  • itch level (0-10) and sleep impact (wakenings, total sleep)
  • visible changes: redness, oozing, crusting, scratching, bleeding
  • important exposures from the last 24 to 72 hours
  • treatments used (product, amount, time)
  • what happened next

Keeping tracking practical

Good tracking should be simple enough that parents will actually do it. A short note kept consistently is better than an ideal template used once.

Useful questions to ask yourself:

  • Did the same trigger appear before several flares?
  • Did this happen right after a new product or routine?
  • Did the skin improve after stopping something?
  • Was there any sign of infection rather than a simple flare?
  • Is there a seasonal or time-of-day pattern?

A simple parent template

Date:
Body areas:
Itch / sleep (0-10 / wakenings):
What changed recently (products, food, environment, illness):
What we used (treatment + moisturiser):
What happened in the next 1 to 3 days:

Detailed log template (for more thorough tracking)

Date / time:
Areas involved (face, neck, trunk, arms, hands, legs, feet):
Signs (dryness, redness, oozing, crusts, pustules, bleeding, thickening):
Itch 0-10 (day / night):
Sleep: bedtime, awakenings, total sleep, caregiver sleep:
Treatments used (product + time + amount; note if missed):
Bathing (yes/no; duration; cleanser used):
Clothing / detergent changes:
Environment (temperature, humidity, sweating, daycare exposures, pets):
Diet notes (new foods; suspected reactions; GI symptoms):
Illness / stress (viral symptoms, vaccines, routine changes):
Result next morning / 24h change:

Interpreting patterns carefully

Try to separate:

  • Observation: what you actually saw or recorded
  • Connection: what you think may be linked
  • Hypothesis: what you want to test next

This reduces confusion and helps clinician visits go better. Bring your tracking notes to appointments: clinicians value organised observations more than vague impressions.

Key references

  • Du Toit G et al. "Randomized trial of peanut consumption in infants at risk for peanut allergy (LEAP trial)." NEJM 372:803–813, 2015.
  • NIAID. "Addendum Guidelines for the Prevention of Peanut Allergy in the United States." J Allergy Clin Immunol 139(1):29–44, 2017.
  • Thomas KS et al. (BATHE trial). BMJ 342:d1306, 2011.
  • Ridd MJ et al. (SWET trial). JAMA Pediatr 175(5):477–486, 2021.
  • AAP. "Atopic Dermatitis: Clinical Practice Guideline." Pediatrics, 2025.
  • Langan SM, Irvine AD, Weidinger S. "Atopic dermatitis." Lancet 396:345–360, 2020.