For many people, the word “winter” conjures visions of magical holidays, snow, and cozy family gatherings. For people with atopic dermatitis, though, thoughts of winter evoke anxiety and memories of painful eczema flares. Atopic dermatitis flares can happen in any season, but many atopic dermatitis patients find that the frequency and severity of their flares increases in the winter.
Why does eczema worsen in the winter, and what can people do to prevent or manage cold weather flares? Atopic dermatitis is a multifactorial disorder, and conditions peculiar to winter affect all of its factors. In particular, inflammation and the skin’s barrier function are impacted.
Our First Defense Against Cold Weather Eczema Flare ups
The skin is our body’s largest organ. As our first defense against disease and injury, it provides both a physical and functional barrier to foreign antigens. This barrier depends upon lipids such as ceramides and proteins such as loricrin and filaggrin. The normal synthesis and breakdown of these lipids and proteins allows skin cells to draw in and retain moisture. This osmolarity is critical to the maintenance of optimal skin pH levels, a balanced microbiome, and exclusion of foreign antigens.
In people with atopic dermatitis, the production and/or breakdown of these lipids and proteins tends to be faulty. Their skin cannot adequately draw in moisture from the environment, and they experience faster transepidermal water loss.
Is Cold Air Worse For Dry Skin?
Winter weather can take a toll on the healthiest skin. Cold air contains less water vapor, and as a result, there is less water available to skin cells. Filaggrin breaks down rapidly in low humidity environments, leading to transepidermal water loss. For people with eczema, in whom filaggrin production and breakdown is often abnormal, these conditions have an even greater effect.
Unfortunately, this cannot be answered by simply avoiding the cold outdoors. Indoor heating systems offer comfortable warmth, but the air is still dry, and the humidity levels are far lower than what is ideal for eczema sufferers.
Additionally, dust mite populations thrive in the warm, dry air offered by indoor heating systems. People whose eczema is triggered by dust mites are therefore more likely to experience flares.
Inflammation and The Genes of the Season
Lower humidity and impaired barrier function only partially account for winter eczema flares. The innate immune system is more “excitable” in people with atopic dermatitis, leading to a heightened response to antigens. This is exacerbated by the fact that the inflammatory threshold is lowered by inadequate filaggrin production. As we mentioned earlier, filaggrin breaks down faster in low humidity environments–so eczema sufferers get a one-two punch of dryer skin and greater risk of inflammation.
Our genes might also play a role. A 2015 study published in Nature demonstrated that several genes associated with inflammation are only expressed during the winter. The study’s authors hypothesize that “molecular clocks” present within some tissues respond to the shortened daylight hours and lower temperatures of winter by sounding an alarm that “wakes up” these genes.
The scientists found that pro-inflammatory processes were more frequent in the winter (defined as the months of December, January, and February), suggesting that our immune system adapts to the environment based on instructions from our genes. This may give us an evolutionary advantage by providing an enhanced defense against pathogens; the study noted that some vaccines are more effective when administered in winter.
The study’s authors suggest that the increased expression of pro-inflammatory genetic modules might explain the increase in deaths from cardiovascular disease during the winter. It could also figure into winter increases of asthma and rheumatoid arthritis symptoms. This could have significant implications for atopic dermatitis, in which inflammation plays such a pivotal role.
What About Summer Eczema Flares?
The fact that winter conditions influence both barrier function and inflammation should not be taken to mean that atopic dermatitis flares do not occur in other seasons or that everyone with atopic dermatitis will experience winter flares. Pollen and other allergens that are more abundant in the spring or fall can trigger a flare. Summer heat and humidity provide ideal conditions for the growth of mold, which is a well-known eczema trigger.
Ironically, while the seasonal expression of genes associated with inflammation might influence winter flares, it might also influence summer flares. Researchers found a correlation between the suppression of pro-inflammatory processes during the summer and increased rates of staphylococcus infections. Staphylococcus is a significant factor in atopic dermatitis flares for many people. Here's a table highlighting the numerous factors responsible for positive flares. In particular, look at the positive seasonal change figures:
|Dry Skin||447 (79.8)|
|Seasonal change||427 (76.3)|
|Summer Season||282 (50.4)|
|Winter Season||224 (40.0)|
|Rainy Season||27 (4.8)|
|Emotional Changes||59 (10.5)|
|Cigarette Smoke||24 (4.3)|
|Skin Infection||5 (0.9)|
The above study was conducted by doctors in Thailand, which is useful because in general, Thailand has milder winters than certain places in the USA.
Is There a Solution to Weather Induced Eczema Flares
Eczema sufferers need not flee to warmer, more humid climates. There are steps that can be taken to prevent flares, as well as treatments that can bring relief to active flares.
Several different studies have demonstrated that good skin care practices, especially moisturization, offer some protection against eczema flares. Using gentle cleansing products, especially on the face, is important; CeraVeⓇ and CetaphilⓇ both offer highly recommended cleansers.
All cleansing should be followed by the application of an effective moisturizer. CeraVe CreamⓇ is Dr. Harlan's first choice, but CetaphilⓇ, CURELⓇ, and AveenoⓇ lotions are also good options. Ideally, skin should be moisturized twice a day. Because our faces and hands are exposed more to dry, cold conditions, they are frequently the sites of eczema outbreaks; special care should be taken to moisturize the skin there.
While good hygiene is important in the prevention of eczema flares, excessive bathing can strip away the lipids that help maintain the skin’s barrier function. A hot shower might bring a moment’s relief to itchy skin, but hot water can quickly remove important oils on the skin’s surface, leading to dryer, itchier skin.
Don’t let the cold fool you–sun exposure remains a risk factor for atopic dermatitis in winter. The use of a 30-50 SPF sunscreen is still recommended.
Hydration is important on dry winter days. Drinking plenty of water and other clear beverages helps restore moisture that is lost due to low humidity. Indoors, humidifiers can help keep the ambient humidity at a healthier level for the skin.
Numerous researchers have reported that using probiotics and prebiotics can improve atopic dermatitis systems. SmartLotionⓇ is formulated with a prebiotic that promotes the restoration of the skin’s optimal microbiome. When used according to Dr. Harland's instructions, SmartLotionⓇ can relieve red, itchy skin during an eczema flare and help restore its health without the user having to worry about TSW. Ninety-five percent of Dr. Harlan's patients have responded well to SmartLotionⓇ.
Armed with good preventative care and a plan for treating any flares that do occur, people with atopic dermatitis can still enjoy the magic of winter.