Why Does Your Eczema Keep Coming Back?

By Dr. Parya Bahrampour, ND | EBL Naturopathic Clinic | Maple, Ontario

Maybe you finally got your eczema under control.

The redness settled down. The itching stopped. Your skin started to feel normal again.

And then suddenly, it's back.

Maybe it happened after a stressful week.

Maybe the weather changed.

Maybe you ate something different.

Or maybe absolutely nothing changed and you have no idea why you're flaring again.

If you or your child has eczema, you probably know this cycle all too well.

So Why Does Eczema Keep Coming Back?

The answer is that eczema is more complicated than dry skin.

And while the skin barrier is a major part of the condition, researchers are also learning more about how the immune system, environment, allergies, stress, and even the gut microbiome may influence eczema.¹

Eczema Is More Than Dry Skin

Eczema, also called atopic dermatitis, is a chronic inflammatory skin condition.

The skin barrier normally helps keep moisture in and irritants, allergens, and microbes out.

In eczema, that barrier doesn't function as effectively.

This makes the skin more likely to become dry, itchy, irritated, and inflamed.

Then comes the frustrating part.

The more it itches, the more you scratch. The more you scratch, the more damaged and inflamed the skin becomes.

This is often called the itch-scratch cycle, and breaking that cycle is an important part of eczema treatment.

This is also why good topical care matters.

Regular moisturizers, appropriate bathing practices, and prescription topical treatments when needed aren't simply "covering up" the problem. They're helping restore and control an important part of the disease process.

So, Where Does the Gut Come In?

Your gut and skin might seem completely unrelated.

They're not.

The microorganisms living in your digestive tract interact with your immune system and help influence immune development, particularly early in life.

Researchers call this relationship between the digestive system and skin the gut-skin axis.

Studies have found differences in the gut microbiome of some people with eczema compared with people without eczema. However, research has not yet established one specific "eczema microbiome" or proven that gut dysbiosis is the root cause of eczema.³

So does everyone with eczema have a gut problem?

No.

But if eczema occurs alongside persistent bloating, constipation, diarrhea, abdominal discomfort, or other digestive symptoms, it may make sense to consider digestive health as another piece of the picture.

Why Do Eczema, Allergies and Asthma Often Show Up Together?

If your child started with eczema and later developed food allergies, seasonal allergies, or asthma, you may have wondered why these conditions seem to travel together.

There is a recognized pattern called the atopic march.

Children with atopic dermatitis, particularly early or more severe eczema, have an increased likelihood of developing other allergic conditions.

But this doesn't mean that eczema automatically turns into asthma or allergies.

It also doesn't mean that "healing the gut" has been proven to stop the atopic march.

Instead, these conditions appear to share underlying genetic, skin-barrier, environmental, and immune factors.

Does Food Cause Eczema?

This is one of the biggest questions parents ask.

Sometimes food can matter, but not every person with eczema has a food allergy.

Food allergy and eczema are associated, particularly in children with earlier-onset or more severe eczema.⁴

But there's an important difference between a true food allergy and assuming that every eczema flare is caused by something in the diet.

Automatically eliminating dairy, eggs, gluten, soy, and other foods isn't necessarily the answer.

In fact, research suggests that broad elimination diets provide, at most, modest benefit for eczema overall and can carry nutritional and food-allergy risks, particularly in children.⁵

If a particular food repeatedly seems to trigger symptoms, or a child has moderate to severe eczema along with symptoms suggesting food allergy, that deserves proper assessment.

The goal isn't to remove as many foods as possible.

It's to figure out whether food is actually part of your eczema pattern.

What About Probiotics?

This is another area where the research gets interesting.

Because the gut microbiome interacts with the immune system, researchers have studied whether probiotics could help prevent or improve eczema.

Some studies and meta-analyses suggest certain probiotics or combinations may modestly improve eczema severity in some children.⁶

But probiotic effects are strain-specific, and results across studies aren't completely consistent.

That means grabbing a random probiotic from the health-food store because it says "50 billion CFU" isn't necessarily going to help eczema.

Probiotics may be one tool in selected cases, but they aren't a replacement for proper skin care or medical treatment.

What About Vitamin D?

Vitamin D is another interesting piece of the eczema puzzle.

Research has found associations between lower vitamin D levels and atopic dermatitis, and some randomized trials suggest supplementation may modestly improve eczema severity.⁷

But that doesn't mean everyone with eczema should automatically take high-dose vitamin D.

Vitamin D needs can vary significantly, especially in children.

When deficiency is suspected, testing can help determine whether supplementation is appropriate and what dose makes sense.

Stress Can Show Up on Your Skin Too

Have you ever noticed your eczema getting worse during an incredibly stressful week?

That isn't unusual.

Stress can influence immune signalling, skin-barrier function, itching, and scratching behaviour.

And then eczema itself becomes stressful.

You're itchy, you don't sleep well, you're frustrated with your skin, and the lack of sleep makes everything feel worse.

For parents, this can be particularly exhausting when a child wakes repeatedly at night scratching.

This is why eczema treatment sometimes needs to look beyond simply asking, "What cream should I use?"

So, What Is Triggering Your Eczema?

Instead of immediately cutting out foods or buying another supplement, start by looking for patterns.

Ask yourself:

Does eczema worsen during certain seasons?

Does it flare when the weather becomes cold and dry?

Does sweating make it worse?

What soaps, detergents, fragrances, or skincare products are being used?

Does stress seem to trigger a flare?

Is scratching disrupting sleep?

Are there symptoms suggesting environmental or food allergies?

Are there digestive symptoms happening at the same time?

Did the eczema begin or change after a medication, illness, or major life change?

Sometimes those patterns tell us much more than randomly testing everything.

Sometimes Further Investigation Makes Sense

Depending on the individual, further assessment might include evaluating for environmental or food allergy, checking vitamin D or other relevant nutritional markers, reviewing digestive symptoms, or considering additional medical investigation.

If significant digestive symptoms are present, digestive testing may sometimes be appropriate based on the clinical picture.

But not everyone with eczema needs a comprehensive stool test, food-sensitivity panel, SIBO test, or "leaky gut" protocol.

Testing should answer a specific question.

Don't Forget the Skin Itself

Looking at internal factors doesn't mean ignoring the skin.

A good eczema plan still needs to protect and repair the skin barrier.

That can include regular fragrance-free moisturizers, avoiding known irritants, appropriate bathing habits, reducing scratching, and using evidence-based topical medications when needed.²

Moderate to severe eczema may require prescription treatment or dermatology assessment.

Integrative care doesn't mean choosing between natural medicine and conventional treatment.

Sometimes the best approach uses both.

When Should Eczema Be Medically Assessed?

Seek medical attention if eczema becomes rapidly worse, extremely painful, develops significant crusting or pus, or is accompanied by fever or other signs of infection.

Prompt assessment is particularly important if you notice clusters of painful blisters or punched-out sores, especially with fever or feeling unwell, because eczema herpeticum can be a medical emergency.

Eczema that is widespread, severely disrupting sleep, causing significant distress, or not responding to appropriate treatment also deserves further assessment.

Your Eczema Is More Than a Flare

If you or your child has been caught in the cycle of:

flare → cream → better → flare again

it may be time to look at the bigger picture.

Not because every case of eczema "starts in the gut."

And not because you need to eliminate half your diet.

But because eczema can be influenced by several different factors, and those factors aren't identical for everyone.

Your skin barrier matters.

Your immune system matters.

Your environment matters.

Your allergies may matter.

Your stress and sleep may matter.

And in some people, digestive health may be another piece worth exploring.

The goal is to figure out which pieces actually matter for you.

Ready to take a closer look at what's contributing to your eczema?

Book a consultation at EBL Naturopathic Clinic

This article is for educational purposes only and does not replace individualized medical advice or assessment.

References

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