Sweating and Eczema: How to Manage Flare-Ups

Eczema and Sweat | Symptoms of eczema | Physiology | How Sweating Affects Eczema | Triggers for Eczema | Related conditions | Managing Sweat to Prevent Eczema Flare-Ups | Treatment

Key Takeaways

Eczema, also known as dermatitis, causes irritating kind of an itchiness, inflammation and accounts for 20% of all new patients referred to dermatology clinics.^[1] It flares up with certain triggers, one of which is sweat. Sweating is a thermoregulatory mechanism that protects your body. However, individuals with eczema should understand the relationship between sweat and eczema in order to reduce the harmful effects of sweat on their skin. This article discusses how sweat affects eczema and how to prevent eczema flare-ups during sweating.

Understanding Eczema and Sweat

Eczema (also called dermatitis) is a group of conditions that cause inflamed, itchy, and irritated skin. The most common type is atopic dermatitis (AD), which affects up to 20% of children in some Western countries and around 2–10% of adults worldwide.^[1],[2]

People with eczema often notice that sweating makes their skin worse. Sweat contains salts and other substances that can sting or irritate already inflamed skin. When sweat dries, it leaves behind salt crystals that further disrupt the skin barrier, leading to redness, itching, and even flare-ups.

Eczema develops when the skin barrier doesn’t work as it should. This may be due to genetics (inheriting a tendency for barrier weakness), an overactive immune system that reacts strongly to everyday triggers, or a combination of both. People with atopic tendencies may also have related conditions such as asthma, hay fever, or food allergies.

Because of this fragile barrier, sweat, heat, and other irritants can more easily penetrate the skin, leading to itching, discomfort, and reduced quality of life.

Symptoms of eczema include:

• Itchy skin
• Dry, scaly areas
• Red rashes
• Small, rough bumps
• Dark brown, purple, or greyish areas of skin
• Warm and swollen skin
• Scratch marks
• Bumps or rashes leaking fluid
• Blisters that ooze and crust over^[1]

Over time, the skin becomes thick, scaly, and cracked.

The Physiology of Sweat

Sweat production and evaporation from the skin involve three main types of sweat glands:

1. Eccrine sweat glands: Most numerous.
2. Apocrine sweat glands
3. Apoeccrine sweat glands

Each gland consists of a secretory coil deep in the dermis and a duct that conveys the sweat to the surface.^[2] The main function of sweat glands is thermoregulation. Evaporation of sweat during exercise and exposure to hot environments helps liberate heat from the body. Additionally, sweat glands help maintain skin health, perform excretory functions, and play a role in maintaining bodily micronutrient balance. However the chemical compounds found in sweat can become irritants for an eczema prone skin.

How Sweating Affects Eczema

Sweat is one of the triggers for eczema according to American Academy of dermatology. Let’s look at the composition of sweat before understanding how it affects eczema.

Sweat primarily consists of:

• Water (Majority)
• Sodium (10-90 mmol/L)
• Chloride (10-90 mmol/L)
• Lactate
• Urea
• Ethanol
• Ammonia
• Bicarbonate
• Glucose
• Electrolytes (potassium, calcium, magnesium, iron, zinc, copper, vitamins, heavy metals)
• Antibodies and antimicrobial peptides
• Other proteins^[5]

In a eczema patient following multiple episodes of eczema, keratin plugs can obstruct sweat glands. This reduces sweating on the surface and causes it to leak into dermal tissue around the glands. Another theory suggests that histamine-induced sweat gland suppression also reduces sweating. Sweat glucose concentration may be higher than normal during acute atopic dermatitis.^[5]

During the summer season or vigorous exercise, your hypothalamus in the brain tries to maintain your body temperature in a optimal level. Signals from hypothalamus stimulate the sweat glands to sweat more to regulate body temperature. While water evaporates easily, the rest of the salty content remains on the skin and causes irritation. This repeated irritation causes eczema flare ups. However, not exercising is not an option because exercise is beneficial for the heart, muscles, bones, and overall health. Instead there are plenty of precautions to prevent sweat from causing unnecessary trouble.^[5]

Triggers for Eczema

Anything that causes dermatitis to flare is known as a trigger. Triggers can vary among individuals.

Common triggers for eczema include:

• Skin care products
• Weather (cold or hot) and sweat
• Wool clothing
• Dust mites
• Stress
• Allergens like perfumes and laundry detergents
• Infections^[4]

Related conditions

Heat rash– Also known as miliaria, occurs when your sweat glands get blocked and cause a rash with tiny, itchy bumps to appear on your skin. This occurs in hot humid climates, at any age.^[2]

Hyperhidrosis – is a medical condition that causes excessive sweating. This is caused by exercise, environmental heat or an illness. The distribution of sweating can be generalized or confined to palms soles and axillae. Hyperhidrosis causes visible sweating, which interferes with day to day activities, damage to the skin and peeling off the skin, skin infections.^[2]

If you are having one or both of these conditions on top of eczema, it will worst your ezema flare up more!

Managing Sweat to Prevent Eczema Flare-Ups

Find Cool Locations

During summer, work in air-conditioned rooms. Choose well-ventilated spaces with shower facilities and plenty of fresh, clean towels for workouts. If doing home workouts, turn on the AC and switch on fans. For outdoor workouts, exercise during dusk or dawn when sunlight is not intense.

Wear Breathable Clothing

Some fabrics can irritate your skin or make you sweat more. Avoid these fabrics and switch to breathable, loose, cotton clothing that helps keep your skin cool. Wear shorts and a loose-fitting t-shirt instead of covering your whole body during workouts.

Proper Hygiene and Showering After Sweating

Don’t let sweat stay on your skin for a long time. Shower immediately after a heavy workout. After bathing, follow your routine skincare to re-establish the barrier function of your skin.

Plan Your Workout to Burn More, Sweat Less

Take breaks during high-intensity workouts to cool down. During breaks, do low-intensity exercises. If you experience a flare-up during a workout, stop exercising and consult your dermatologist.

Additional Lifestyle Modifications

• Avoid know allergens as much as possible
• Stay hydrated to reduce the salt concentration in sweat, making it less irritating.
• Follow an eczema-friendly diet.
• Manage stress, which can induce both sweating and eczema flare-ups.^[6]
• Regular moisturizing, using a appropriate skin care routine

Eczema Treatment Goals

Treating your underlying skin condition is crucial to prevent it from causing trouble when you sweat. The aims of eczema treatment are:

• Reduce flare-ups
• Relieve symptoms
• Maintain the skin barrier to keep it normal, hydrated, and free from infections

Your treatment plan will be tailored to the severity of your condition. Skincare is essential for managing eczema. Your doctor will provide a skincare plan, including how to bathe, apply moisturizer correctly, and be gentle with your skin. Wet wrap therapy, which involves wrapping the treated skin in a layer of wet bandage, can help the skin absorb medications and stay hydrated. Avoiding triggers is also important. Treatment options may include corticosteroid cream or ointment, pimecrolimus cream or tacrolimus ointment, crisaborole ointment, and ruxolitinib cream. The treatment of choice will depend on your condition.^[4]

In summary, Sweat is an identified trigger for eczema flare-ups, affecting an individual’s quality of life. Adherence to eczema treatment is crucial. Although we cannot prevent the interaction between eczema and sweat, we can adapt our lifestyle to prevent eczema-prone skin from being irritated by sweat. If you find it challenging to prevent sweat from causing problems to your skin, consult your dermatologist to modify your treatment plan as needed.