The Surprising Link Between Stress and Eczema Flare-Ups

For Trisha Khanna, MD, her eyes would tell the story.

“When I am stressed, I will get eyelid eczema [and] I often wake up with itchy, red eyes,” says Dr. Khanna, fellow of the American Academy of Dermatology and a medical advisory board member at Codex Labs. She experiences what over 31 million people in the United States may already know — stress can severely affect eczema symptoms.

“Cortisol, the body’s primary stress hormone, plays a role in the body’s inflammatory response,” explains Megan Collins, MA, LMFT, ATR-P, founder of NeuroArts Therapy & Consulting. “When released during stressful situations, cortisol can disrupt the skin’s ability to stay hydrated and repair, leading to flare-ups. Then comes the redness, itching, and overall skin irritation, similar to having hives after an allergy.”

But the impact isn’t just physical. People with eczema can also experience mental and emotional challenges due to stress. Read on to learn more about the connection between stress and eczema flare-ups, practical tips for managing the condition, and steps you can take to alleviate stress and aggravated symptoms.

Common Triggers of Eczema Flare-Ups

“Eczema often begins in infancy or childhood, though it can develop at any age,” explains Janis Kosma-Covey, PharmD, owner of Kosmatology. “While the exact cause of eczema is not fully understood, it is believed to result from a combination of a specific gene mutation, environmental factors, and an overactive immune system that compromise the skin’s natural barrier, making it more sensitive and reactive.”

It can lead to itchy, red skin, dryness, and inflammation. It can also interfere with sleeping.

External triggers can be easier to manage. But when your mental state leads to flare-ups, it can require a different course of action.

The Stress-Eczema Cycle

Unlike many environmental factors, stress isn’t an exterior irritant to the skin. It causes a flare-up from the inside.

“When faced with a stressful situation, the body will go into a ‘fight-or-flight’ response,” notes Dr. Kosma-Covey. “During the ‘fight-or-flight’ response, stress hormones such as cortisol are released. When these hormones are released in large amounts or for extended periods of time, they suppress the immune system and increase inflammation throughout the body. The inflammation leads to worsening of eczema symptoms or a new flare-up,” she adds.

Studies show that stressful situations, like school exams, family issues, financial problems, and work challenges can all exacerbate eczema symptoms. 

“Stress can make the eczema more noticeable, with redness, itchiness, and dry patches becoming more intense. The emotional response to stress, like scratching, can worsen the symptoms, creating a vicious cycle,” Collins states.

Managing Stress to Alleviate Eczema Symptoms

Stress causes both internal and external issues for people with eczema. Taking care of your mental health and learning how to manage stress can help reduce skin breakouts and alleviate itching. It can also help curb any worry or anxiety associated with dealing with eczema.

“One client recalled how periods of high anxiety at work directly led to increased flare-ups, with itchy, raw patches showing up on her hands and neck. She found that her symptoms improved when she practiced mindfulness and took breaks to manage stress,” shares Collins.

Other strategies to manage stress include:

Lifestyle Adjustments for Eczema Management

We get it—changing your habits and behaviors that have been ingrained for years isn’t easy. But dealing with your eczema in a healthier way is a reward that’s worth it. Specific adjustments can help keep stress and eczema flare-ups at bay, including:

• Getting a good night’s rest. “Sleep is crucial for skin repair and immune function, and lack of sleep can increase cortisol levels and thus worsen eczema,” Dr. Khanna notes.
• Being mindful of what you eat. “Some people with eczema find that certain foods, such as dairy, gluten, or eggs, may trigger flare-ups. Keeping a diary can help pinpoint specific triggers you can share with your medical team,” advises Collins.
• Taking inventory of the products in your home. Everyday items, from makeup to carpet cleaner, can contain triggering chemicals.
• Finding a support group. People who understand your struggles and frustrations dealing with eczema, or who have experienced the impact stress has on the condition, can keep you encouraged on your journey. “Connecting with others who understand the struggles of eczema can lessen the mental toll,” Collins says.

Tips for Daily Management

Small actions can make a big difference in managing stress. Tips like avoiding long hot showers to keep your skin from drying out and wearing clothing that’s not too tight are beneficial. Keeping your skin well moisturized is also key.

“A good tip is to moisturize immediately after you shower while your skin is still damp. Ideally, you want to find a moisturizer that is thick, fragrance-free, and clean for sensitive skin. Another option is an over-the-counter hydrocortisone cream to help calm inflammation and treat patches of eczema. If your patches are persistent, then connecting with your dermatologist to get a prescription like tacrolimus is another option,” says Anna Chacon, MD, FAAD, board-certified dermatologist and founder of MiamiDerm.

Other tips include having a good water filter if you’re in an area with hard water, using an air purifier, and making your home as allergen-free as possible. You can also consult with a medical professional to help find a more customized approach for you.

Bottom Line

Stress can wreak havoc on the body in many ways. Eczema can cause problems from the inside out. Making the effort to remove potential flare-up triggers and usher in a more calming and relaxing atmosphere can be a worthwhile investment.

“Like any chronic health condition, managing eczema requires a holistic mind-body approach, and you shouldn’t have to go through it alone. Building a treatment team, utilizing coping skills, self-care routines and rituals, and garnering emotional support through the eczema community can effectively minimize flare-ups and promote overall well-being,” Collins concludes.