Spring Eczema: Why Flare-ups Increase in Spring

Spring should be a season of relief for the skin: no more drying cold, no more central heating dehumidifying rooms. Yet, for many people with eczema, spring is a period of flare-ups, sometimes more difficult than winter. Pollen, fluctuating humidity, temperature changes, and contact with new plants create an environment that can trigger the underlying inflammatory mechanisms of eczema.

Eczema, or atopic dermatitis, affects about 15 to 20 % of children and 2 to 10 % of adults in Canada (Eczema Society of Canada, 2023). In adults, it often takes less typical forms than in pediatrics and may go undiagnosed for a long time.

Why does spring worsen eczema?

Pollen is one of the most frequent triggers for spring eczema flare-ups in atopic individuals. Sensitization to pollen, which causes allergic rhinitis, can also lead to skin manifestations through systemic activation of the immune system. This phenomenon, known as pollen-eczema syndrome, is well-recognized clinically.

Humidity variations also play a role. Too little humidity dries out the skin barrier, and too much humidity can promote maceration and secondary infections in folds. Warm days alternating with cool temperatures, typical of Quebec spring, create conditions that particularly stress an already weakened skin barrier.

The mechanisms of atopic dermatitis

Eczema is a chronic inflammatory skin disease characterized by skin barrier dysfunction and immunological hyperreactivity. The skin barrier of atopic individuals is structurally different: it allows allergens and irritants to pass through more easily and retains water less effectively. This increased permeability explains chronic dryness and vulnerability to environmental triggers.

The resulting inflammation is mainly mediated by Th2-type cytokines, including interleukins 4, 13, and 31. The latter is particularly involved in transmitting the itch signal to the nervous system, explaining the intense pruritus that characterizes flare-ups. The subsequent scratching worsens the inflammation and promotes secondary infections, creating the itch-scratch-worsening cycle characteristic of the disease.

Managing spring bursts

Intensive skin hydration is the most important basic measure in managing eczema in any season. Applying rich emollients, preferably without irritating fragrances or preservatives, twice a day outside of flare-ups and more frequently during flare-ups, maintains the skin barrier and reduces the frequency and intensity of inflammatory episodes.

For active flares, topical corticosteroids remain the first-line treatment. Their potency is adapted to the severity and location of the lesions. Topical calcineurin inhibitors, such as tacrolimus and pimecrolimus, are an alternative for sensitive areas like the face and folds.

For moderate to severe forms that do not respond to topical treatments, systemic options exist, including immunosuppressants and, more recently, targeted biotherapies like dupilumab, which has shown remarkable efficacy in moderate to severe adult atopic dermatitis.

Frequently Asked Questions About Spring Eczema

Is eczema contagious?
No. Eczema is a non-infectious inflammatory disease. It is not transmitted by contact. Bacterial superinfections of eczematous lesions, which are frequent and often caused by Staphylococcus aureus, may require antibiotic treatment, but they do not make the condition contagious.

Are natural products safer for eczema?
Not necessarily. Some natural products like coconut oil or manuka honey are used, with limited data. Some essential oils and plant extracts, on the other hand, can cause contact reactions in atopic individuals. The general rule is to opt for fragrance-free, alcohol-free products tested for sensitive skin.

Does eczema go away in adulthood?
For many children, symptoms improve in adolescence. However, about 30 % of adults with atopic dermatitis have persistent or recurring symptoms. Diagnosis and appropriate management allow for the maintenance of a satisfactory quality of life.

When to consult a healthcare professional

If your eczema flare-ups are frequent, widespread, or resistant to usual treatments, if you show signs of secondary infection such as warm redness, yellow oozing, or fever, or if your quality of life is significantly affected, medical consultation is necessary.

A doctor or a nurse practitioner can assess your lesions, adjust your treatment, and refer you to a dermatologist if necessary. An in-person or virtual consultation teleconsultation at one of our Omicron Clinic in Quebec gives you immediate access.

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