Eczema Care: 10 Skin-Care Ingredients to Avoid

Eczema is a group of conditions that cause inflamed, irritated and often itchy skin.^[1] Three main categories of eczema are atopic eczema, contact dermatitis and stasis dermatitis. Eczema severity varies from person to person, so the treatment should be tailored to individual needs. While one product used in treatment may suit one individual, it might cause severe reactions in another. It is important to know which products to use as well as which products to avoid and why? Understanding which ingredients to avoid can help manage and prevent flare-ups. This article will guide you through different skin care products that potentially worsen the eczema-prone skin.

Understanding Eczema and Skin-Care Products

Eczema affects the barrier function of the skin in genetically susceptible individuals. Epidermal barrier dysfunction combined with dysregulation of the immune system causes your skin to be easily damaged. Proteins like filaggrin  transglutaminase , keratins, and intercellular proteins are crucial in epidermal function. Defects in these proteins allow allergens and microbial to enter the skin, leading to harmful consequences. The activation of bodily immune system, further impairs the epidermal barrier. Thus, the mainstay of eczema management is re-establishing the normal barrier function as much as possible.^[2]

Daily skin care routines are vital, but with new products constantly entering the market, it’s essential to be aware of eczema-friendly and harmful ingredients.

What are the eczema friendly products then? Most eczema treatment plans prescribed by your dermatologist will include;

• Skin care during bathing, applying moisturizer, and being gentle with your skin
• Trigger management
• One or more of the medications such as: corticosteroid cream, topical calcinurin inhibitors, crisaborole ointment, JAK inhibitors
• Light therapy
• Systemic medications when needed^[3]

While the above steps being taken, it is important to protect your skin from irritant skin care products to prevent flare ups.

Skincare ingredients to avoid if you have eczema

The irritants for eczema can vary by individual, but here are some scientifically identified irritants that may worsen you eczema symptoms:

1. Glucocorticoids(steroid)

You might wonder why a treatment is listed as potentially harmful! Let me explain, Steroids in topical form can reduce the inflammation in the skin and speed up healing. They make the skin less hot, itchy and sore. During an eczema episode, your dermatologist may prescribe a topical steroid, either as a cream or an ointment. There are mild,(eg: 1% hydrocortisone) ,moderate, and high potency steroids. Using a mild steroid for a short period of time helps control eczema symptoms successfully. However, using very potent steroids for longer than prescribed duration can harm your skin. Harmful effects include:

• Topical steroid withdrawal – If you stop using topical steroids abruptly after a prolonged use you will experience a reaction called topical steroid withdrawal ,where you will experience symptoms worse than the original symptoms. To prevent that your dermatologist will advice you to slowly taper off the topical steroid, shift from high to mild potency ones, or every other day therapy.
• Skin thinning– If you use topical steroids over a long period of time, it can cause thinning of the skin, making it apparently transparent, fragile and prone to bruising. Blood vessels become visible, skin develops stretch marks, and increased hair growth. To prevent this from happening you should use high potent steroids under the supervision of a dermatologist.
• Suppressed natural steroid production– If high potent topical corticosteroids get absorbed into blood trough the skin, they can supress body’s own steroid production. But the occurrence of this is rare with mild steroids and short term use.
• Allergic reactions– Allergic reactions to some steroids or the additives in the preparation can occur in some individuals. Symptoms worsening after using topical steroids could indicate an allergic reaction, requiring a switch to a safer option. To identify which component triggered an allergic reaction your dermatologist will offer you patch testing. Where main ingredients in the ointment or cream will be tested with your skin to see what causes reaction.

Despite the potential side effects, appropriate use of topical steroids under medical advice is beneficial for controlling eczema.^[4]

2. Preservatives: Methylchloroisothiazolinone (MCI) and Methylisothiazolinone (MI)

Preservatives are essential in personal care products to prevent microbial growth. After introducing methylisothiazolinone to cosmetic industry it was found to be a strong allergen, potentially causing allergic contact dermatitis. MI is found in various products including: products for children and babies, bath products,  makeup  (eyeliners,  makeup  removers, blush and face powder), hair care products (such as dyes and bleaches), nail and waxing products, moisturizing creams, sunscreen and baby wipes. Common side effects of MI include redness, itchiness, or flakiness on face or throughout the body. If you have a sensitive skin, checking the product information leaflets and using products approved by your health care provider is important.^[5]

3. Moisturizer: Propylene Glycol

Propylene glycol is a common ingredient in many moisturizers and other personal care products such as wipes, shampoos, Cosmetic creams, and body washes ,Prescription creams/ointments such as topical steroids, moisturizers, antibiotic creams, antifungal creams, acne creams, psoriasis creams, Some ears drops, nose drops, nose sprays, Some cooling fluids used in industry, Many e-cigarette/ vaping solutions, some tablets, Some wound dressings eg hydrogel, intrasite, Some foods such as salad dressings and sauces as a thickener/ sweetener…..And many more. Despite its widespread use, propylene glycol can trigger contact dermatitis, especially in individuals with sensitive skin. The American Contact Dermatitis Society recognizes it as an allergen. It’s essential to check labels before purchasing products and consult with your healthcare provider if you experience any adverse reactions.^[6]

4. Antibacterial: Benzalkonium Chloride

Benzalkonium chloride (BAK) is a detergent and preservative found in healthcare products like eye care solutions and antiseptic sprays, as well as in cleansers, hair care products, skin care products, and household items. While BAK is an established irritant, it is less commonly, but associated with allergic contact dermatitis.^[7]

5. Surfactant: Cocamidopropyl Betaine

Cocamidopropyl betaine is a synthetic detergent derived from coconut oil. It is commonly used in cosmetics and personal hygiene products, including shampoos, contact lens solutions, toothpaste, detergents, makeup removers, bath gels, cleansers, liquid soaps, antiseptics, and hygiene products. This ingredient can cause redness and flaking, particularly around the eyes and mouth, and may result in a delayed type hypersensitivity reaction.^[8]

6. Fragrance

Fragrances are among the most common allergens, causing reactions in a significant portion of the population. About 20% of the general population is sensitized to at least one allergen, with fragrances being a leading cause of allergic contact dermatitis. Fragrances can be found in personal care products labelled as “unscented” or “fragrance-free,” which may still contain masking fragrances. Common fragrance irritants include cinnamic alcohol, cinnamic aldehyde, eugenol, isoeugenol, geraniol, hydroxycitronellal, and oakmoss. Botanical oils like rose oil, vanilla, and sweet almond oil can cause skin sensitivity.^[9]

7. Balsam of Peru

Balsam of Peru is a fragrant resinous liquid harvested from trees grown in Central America. Not commonly used today, Balsam of Peru may still be found as a fragrance, flavouring agent or antibacterial ingredient in some products. It can induce a contact dermatitis with severe irritation.^[10]

8. Antibiotic: Neomycin Sulfate

Neomycin is an antibiotic used for the prophylaxis and treatment of superficial infections in wounds and burns. It is available over-the-counter in various formulations. While generally considered safe and effective, neomycin is a well-known cause of allergic contact dermatitis when applied topically.^[11]

9. Formaldehyde

Allergic contact dermatitis due to formaldehyde and formaldehyde releasers is not uncommon, especially among women with chronic hand and facial dermatitis, workers using cutting oils, hairdressers, and healthcare workers in contact with formaldehyde-containing creams or soaps. Sensitization often occurs through preservatives in cosmetics, toiletries, or cleaning products.^[12]

10. Lanolin

Lanolin is a wax derived from sheep’s wool and is found in many moisturizers, barrier creams, steroid creams, hand and face creams, lipsticks, soaps, Shoe and furniture polishes, and bath additives. While beneficial for many, lanolin can induce reactions in patients with eczema. This is a beneficial ingredient for many but can induce a reaction in patients with eczema.^[12]

For a full overview of eczema types, symptoms, and care options, see our eczema overview.