Posts in category: Dating Tips, Guide and Advice

Atopic dermatitis (AD), frequently referred to as eczema, can appear for the first time in adolescence and young adulthood, but can also sneak up in late adulthood. More often than expected, AD can lead to confusion and frustration when navigating the dating world. Intimacy requires exposure and vulnerability, which can be a challenge for people with AD when the physical and emotional symptoms of their skin condition are top of mind.

These symptoms can negatively affect their self-esteem and ability to relate to potential romantic partners. Learn how AD can make it challenging for people to thrive in romantic relationships.

Shame and Rejection

Misinformation about atopic dermatitis can lead to rejection that’s more painful than the itch. “A lot of times, people make judgments about hygiene or things that are really irrelevant,” said Anna Chacon, MD, FAAD. 

Shelby Smith, 33, shares how eczema appeared in her romantic life during a formative moment in middle school. Smith’s crush was about to make a move but paused when he saw visible symptoms of eczema on her wrists. “He was about to grab my hand, and he stopped,” she told us during an interview. “His commentary towards me was ‘What is the alligator skin on your wrist?’” she adds, mimicking a disgusted tone.

The insult stung even worse when he began ignoring her in the hallway and reported what he saw to their peers. “Afterwards, a nice little rumor went around school about me having alligator skin,” Smith continued. 

The experience changed how Smith presented herself to the world as she got older. “My initial thought was to cover it up. You can’t say anything about what you don’t see,” says Smith.

Self-Image and Self-Esteem Issues

“Eczema started rearing its ugly head when I started dating,” says Ryan Parker, 26. “I became very insecure about my skin.”

In addition to actual rejection, atopic dermatitis can lead to the fear of rejection. Self-image and self-esteem issues are associated with this condition. According to the Journal of Clinical and Experimental Dermatology, 29% of patients with eczema (which includes AD, eczema, and hand eczema) report sexual problems. Previous studies have also found that almost 1/4 of 3,485 patients report that the appearance of their skin impaired their sex life.

Regardless of how we might be perceived, talking about your AD can help. Instead of assuming you know what your partner will say, it’s important to speak about your experience. Parker, who was misdiagnosed until he was 20, was pleasantly surprised by his husband’s reaction when they were dating. 

“Those little things just didn’t matter to him at all,” says Parker. 

Licensed professional counselor Lakendra Weaver considers discussing health challenges with a partner as a chance to connect on a deeper level. “I definitely think it’s an opportunity for two people to get closer,” she explains.

Practical Tips for Managing Atopic Dermatitis

Managing atopic dermatitis might require going against some of your romantic instincts. For example, you might want to pass on that special designer fragrance you’re counting on to set the mood and head to the drugstore instead. “I suggest bland, bland, bland, non-fragranced items that are usually not very expensive,” advises Chacon. 

If you’re tempted to turn towards natural oils as an alternative, beware. “I wouldn’t recommend it at the moment,” says Chacon. She says people have reported allergies and irritations even from ‘botanical items’ that contain fragrances. “I would recommend using non-scented things like Vaseline for moisturizer,” she adds.

“The easiest piece of it that people don’t think about is just creating a better skin barrier,” says certified physician assistant Mimi Oliff. Oliff mentions selecting “detergents that are all free and clear” as a helpful option. “During a flare, it is also important to avoid using harsh exfoliants like scrubs, dry brushing, and active ingredients like retinol, BHAs, and AHAs on affected areas,” adds dermatologist Melanie Palm, MD, MBA.

The dainty necklace or chandelier earrings you were counting on to set off that little black dress might not be a great idea, either. The British Journal of Dermatology cites nickel as a risk factor for certain kinds of eczema. “I couldn’t wear a lot of pretty things that I saw other girls get to wear,” says Smith. 

When to Seek Professional Help

Eczema treatment has come a long way in recent years. Powerful treatments—such as creams, oral medications, and injections—have empowered those who are facing AD. When symptoms start affecting your everyday life, talk to your healthcare provider.

For mental health treatment, Weaver recommends seeking therapy to fortify your relationship with yourself before starting a new relationship. “It’s essential to have that self-acceptance before you start a relationship,” she says. “If I’m fully at a place of self-acceptance when I communicate with this partner about the eczema, I can talk about how it’s impacting me and decide, ‘Hey is this person gonna be someone who’s able to support me?’” 

Building Confidence in Your Love Life

Seeing other people in her life deal with alopecia, hyperpigmentation, and other visible health challenges normalized what Smith was going through. 

Instead of hiding herself, Smith believes in taking a “head-on” approach to talking about her eczema with potential partners. “Whoever is going to love me is going to love every part of me. And I don’t have to constantly explain myself for why I am the way that I am just like I wouldn’t want friends to have to explain why their body does what their body does,” said Smith. 

“I looked at people, and I noticed that everybody has something.”

My eczema doesn’t just show up on my skin—it reflects what’s going on beneath it.

One of my earliest memories is sitting on the edge of my mom’s bed, crying as she gently rubbed lotion onto the itchy, stinging rash behind my knees. I was five. And that was the moment I realized that something as “small” as a skin condition could make everyday life feel a lot harder.

Atopic dermatitis (AD)—the most common form of eczema—is a chronic skin condition marked by dryness, itchiness, and inflammation. It also happens to be something I’ve lived with for most of my life. 

And while the physical symptoms are frustrating enough, the mental toll can be just as difficult.

When Your Skin Makes You Self-Conscious

At 5 years old, you don’t expect to think much about the backs of your knees. But for me, AD made it painful to do simple things, like sitting cross-legged at story time, climbing the jungle gym, or wearing long pants. Shorts and skirts were more comfortable, sure, but came with their own challenge: I didn’t want anyone to see my skin.

As I got older, the flare-ups didn’t disappear—they just relocated. By high school, the patches behind my knees had mostly faded, but new ones showed up on my neck, and the crooks of my elbows. Two highly visible areas. Two sources of daily discomfort and constant self-consciousness.

I’m not alone in my embarrassment. I spoke to two dermatologists—Amy Huang with Medical Offices of Manhattan, and Asmi Berry with BHSkin—both share that their patients often feel embarrassed and ashamed about their eczema.

“Many of my patients complain that their visible eczema plaques are very embarrassing in social situations, which can lead to social isolation,” Huang explains.  

“There’s also a sense of isolation when they feel misunderstood or judged by others,” says Berry. Judged is a good descriptor of how I felt. Because my AD was so visible, I’d often get advice from well-meaning friends, family members, and acquaintances. Just try aqueous cream. Just don’t use scented soaps. Just drink more water.

That little word—just—always felt so laden with judgment, like the solution was obvious and I just didn’t have the knowledge or wherewithal to carry it through. Just do this thing, as if I was silly not to do it, as if I could easily stop my suffering if I wanted to.

When Stress and Skin Flare Up Together

In my early 20s, I kept waiting for my AD to magically disappear. Instead, it got worse.

Sometimes, the burning and itching were so severe that I couldn’t sleep. Wearing collared shirts became impossible. Even working out was tough—sweat made everything sting, and applying medicated ointments felt like lighting my skin on fire.

Still, the advice came. “Just take omega-3s.” “Just cut out sugar.” “Just stress less.”

Ah yes. That one again.

More than one doctor told me my flare-ups were stress-related. By that point, I’d already noticed the connection. My AD flared up right alongside my anxiety and post-traumatic stress disorder (PTSD). Big life changes, bouts of illness, family emergencies—they all showed up on my skin.

“Stress induces the release of cortisol and other pro-inflammatory signaling molecules, and hormones in the body, which can trigger eczema flare-ups,” says Huang.

Berry explains that this can disrupt your skin’s barrier function and immune response. “For someone with atopic dermatitis, this can directly lead to increased inflammation, itching, and flare-ups, creating a challenging cycle between emotional stress and skin symptoms,” she explains.

And it’s not just fleeting stress that it causes: skin conditions affect mental health. A 2019 study, which included 526,808 adults with eczema, found that people who had eczema had a greater risk of developing anxiety and depression. Additionally, a 2024 review found that eczema can contribute to depression and suicidality.

A 2023 analysis, which surveyed 11,181 children, found that sleep could be partly responsible for the link between eczema and poor mental health. “The lack of sleep due to chronic itching can lead to increased daytime sleepiness,” Huang says. This sleeplessness could also affect mental wellness.

My doctor’s solution was to just stress less. The problem? “Just don’t stress” is not medical advice. 

I was already tired of PTSD’s debilitating effect on my life. It affected my career, my education, my friendships—why did it also have to affect my skin, of all things? Dealing with stress and mental illness is hard enough on its own. Adding an uncomfortable, sometimes painful rash into the mix felt unfair. 

Breaking the Cycle

The turning point came at 24, during a particularly difficult week. I was burned out, grieving, and struggling to sleep through the night. One early morning, I found myself crying on the porch—exhausted, overwhelmed—and felt an itch in my neck. Again, my AD was flaring up.  

That moment didn’t feel like a grand epiphany. But it was the moment I felt truly fed up with my situation. I knew I couldn’t “fix” everything, but I could try to make myself a little more comfortable.

So I went back to the basics.

The treatments that worked temporarily? I used them as often as possible. Every night, I took oat baths to soothe my skin. I then applied cortisone cream, sitting in front of a fan so that it’d sting less.  

I took doxylamine, a strong over-the-counter sleep aid that also happens to be an antihistamine. Not only did it make me sleepy, it also slightly reduced the itching. 

And since I was at a breaking point, I temporarily stopped caring about what others thought. I was in so much pain that I couldn’t care less. I ignored well-meaning “just try this” advice and started wearing huge dressings on my neck in public. I also stopped covering my AD with scarves, which just irritated my skin further.

Lastly, I stopped going to doctors who were unsympathetic or dismissive of my AD. I’ll never forget the kind, thoughtful look on my current doctor’s face during our first appointment. She didn’t tell me to just stress less but helped me figure out actionable ways I could take care of myself.  

These changes were tedious and time-consuming—and of course, none of it fully cured my eczema. But it helped. And more importantly, it made me feel like I had a little more control over my own care. 

Reframing My Eczema as a Signal

Today, my eczema still flares up when I’m sick or stressed. As I write this, I’m recovering from a stomach bug, and I have patches of AD in my neck and on my eyelids. 

But I’ve started to think of my AD differently.

When I’m burning out, depressed, or overwhelmed, I may be able to convince the world that I’m “fine.” But my skin tells a different story. It’s a physical reminder that stress affects more than just our thoughts and moods—it affects our entire bodies.

Sometimes, I still get frustrated. AD can be painful. It can be embarrassing. It can make daily life harder in small but meaningful ways.

But it’s also given me a direct line to my inner world. When my mind is struggling but I’m pretending I’m fine, my skin tells the truth. And for that, I’m learning to listen. 

Bottom Line

Throughout my experience, it helped me to remember that I’m not alone. Huang and Berry both strongly suggest looking for support groups, as connecting with others who have AD can help you feel less isolated. 

“Many people experience exactly what you’re feeling right now. Connecting with others who truly understand your struggles can make a huge difference,” Berry says. “Sharing your experience can help ease the burden and empower you in managing both your skin and your emotional well-being.”

Instead, I’m learning to meet it with care. My eczema may never go away entirely. But I’ve stopped seeing it as something to hide, and started seeing it as a reminder: my mental health matters, and my body always keeps the score.

Living with a chronic skin condition like atopic dermatitis (AD) is more than skin deep. Apart from managing flare-ups and working to stay clear of triggers, dealing with AD can come with a hoard of mental and emotional challenges. Research shows that one’s gut microbiome may also play a part in the development and severity of AD. Symptoms of AD often begin in childhood, but they can persist into adulthood and even develop later in life. 

AD is also not one-size-fits-all. “Skin tone, age, and individual triggers all play a role in how it presents,” says Sarah Sung, MD, FAAD, a board-certified dermatologist and founder of Perq Dermatology. On lighter skin, for example, eczema may appear red, while on darker skin, it often appears darker brown, purple, or even ashen. Some people with AD mostly deal with itching and dryness, while others must combat painful cracks, infections, and thickened skin from long-term scratching. Some only flare up in the winter, while others are triggered by heat and humidity, Dr. Sung explains.

Apart from the physical challenges of the skin condition, AD can also have a real impact on one’s mental health. “Constant itching can lead to sleepless nights, leaving people exhausted,” says Dr. Sung. “Flare-ups on visible areas like the face or hands may also cause self-consciousness, leading to anxiety about social interactions or even avoiding them altogether.”

With that in mind, I spoke to five people with AD about their experiences, what remedies have worked for them, and the self-care rituals they swear by, whether to manage their stress or affirm their beauty when dealing with a flare-up.

Bea: Hydration and Low-Impact Exercise 

Bea was first diagnosed with atopic dermatitis at age 12. In her case, her eczema is usually triggered by stress, weather changes, and sweat. “Typically it flares up around the joints—the area between the arms, the armpit, and behind the knees,” she explains. “I get dry patches around the skin that make it insanely itchy, and if I scratch it’ll leave scars around that area.”

For Bea, seeing a dermatologist and allergist has been life-changing for understanding her AD. It has helped her spot what is an allergic reaction versus what is an eczema flare-up, but “sometimes they go hand in hand, which is probably why transitional periods are when my AD flares up the most,” she says. “I learned that I’m allergic to certain types of pollen and those usually show up in the spring and fall. The allergy stresses me out and that triggers my AD.”

Apart from applying a tacrolimus ointment (shown to effectively treat moderate to severe atopic dermatitis, even more than low-potency corticosteroids) whenever she has a flare-up, Bea makes sure to keep her skin hydrated through a comprehensive shower routine that includes body oils and lotions. “I also use a humidifier every night when I sleep,” she adds.

Taking an antihistamine whenever she feels an itch is another preventative measure Bea takes to help her avoid scratching, and thus breaking skin. 

Chinenyem: Mindful Skincare

Chinenyem’s mother first noticed eczema-like dry patches on her daughter’s skin when she was a baby, but Chinenyem wasn’t officially diagnosed with atopic dermatitis until she was in elementary school. “I vividly remember having a large rash—literally shaped like a dinosaur—on my right leg. I told my mother, and before I knew it, we were on our way to the doctor’s office,” she says. 

Throughout childhood and adolescence, Chinenyem struggled with eczema flare-ups that left dark hyperpigmentation on her neck, arms, legs, and face. “It caused me a lot of emotional pain and seriously impacted my self-esteem.”

For Chinenyem, her AD is triggered by stress, certain dietary products like dairy and gluten, and sweat. She manages her symptoms and avoids flare-ups through a whole foods diet (research shows that eating processed foods is shown to increase the risks of AD), targeted skincare, and consistent self-care, which includes exercise and therapy. “I’ve committed to 1.5 hours of exercise during the week and 2.5 hours on weekends. Keeping my weight in check, staying strong, and maintaining flexibility help calm my immune system and reduce flare-ups,” she says.

As I apply them, I speak affirmations and Bible scriptures over my body and mind, reminding myself of my strength, beauty, and healing,” she says. “This daily self-care ritual and overall intentional lifestyle have been key to keeping my eczema under control.”

Mandi: Herbal Remedies

For Mandi, finding a solution that works for her AD has been a lifelong journey. “At a young age, I struggled with this chronic condition, and at age 12, I was prescribed strong steroids that led to substantial weight gain, which affected my self-image and self-worth,” she says.

Mandi’s triggers for her eczema include: dairy, sun exposure, and heat. “Summers were some of the hardest months for me over the years. Heat and sun exposure often triggered flare-ups and caused the eczema to spread to new areas,” she says. 

Over the course of her three pregnancies, Mandi began experiencing flare-ups in new spots, too, like her hands, neck, and face. Research shows that immunological changes in pregnancy can increase activity for those with known eczema or provoke onset AD for those with no prior history. “Currently, my neck is the most affected region and I continue to battle with flare-ups weekly,” she says.

Apart from adjusting her diet to eliminate dairy, Mandi has also turned to Herbal Face Food Soap to manage her AD. “This plant-only remedy has become a staple in my skincare routine,” she says. “It has been one of the only remedies to help flare-ups and reduce their frequency.” Mandi’s daughter, who also struggles with eczema, has also turned to the same herbal soap to manage summer flare-ups and minimize sun spots and hyperpigmentation. 

Laney: Being Kind to Yourself

Laney was diagnosed with atopic dermatitis as a baby, so AD has always been a part of her life. 

Her eczema is often triggered by a change in temperature, exercise, overheating, and even certain clothing items. “It’s safe to say I am always thinking about my skin and the world around me, all day, every day,” she says. She’ll recognize a flare-up because her skin will suddenly become intensely itchy, and once she starts to scratch, it’s hard to stop. “Imagine having intensely itchy skin and then not being able to touch or soothe it because you know it makes it worse,” she says. “It’s definitely a battle.”

Laney takes multiple medications to manage her AD, including two biologics and a topical called Zoryve. Apart from doing her best to stay away from her triggers, Laney also places a lot of importance on maintaining a good skincare routine, both for her physical and psychological well-being. “I am never far away from a good jar or bottle of moisturizer,” she says. 

In addition to keeping her skin hydrated by moisturizing throughout the day, Laney also works hard to be kind to herself when she can’t control her flare-ups. “I found that one of the most important self-care acts is giving myself grace. I can’t control my skin, and I can’t let it control me.”

Michael: Anti-inflammatory Diet

Michael was first diagnosed with atopic dermatitis 20 years ago, as an adult. Michael’s AD is triggered by stress and dirt. As someone who works in construction (“I own an audio, video, lighting design and installation company,” he says), he’s exposed to this latter trigger almost daily. He’s had to find effective ways to keep his eczema under control throughout his daily life. He’ll recognize a flare-up because he’ll get dry, cracked, and itchy spots on his hands that bleed if scratched.

For example, thanks to his wife, Michael discovered Ora’s Amazing Herbal Touchy Skin Salve, which he slathers on his hands and sleeps in using cotton gloves whenever he has a flare-up. Recently, the pair got a shower filter per Robin’s recommendation and Michael has noticed the difference. “My skin and hair are softer and my eczema is better,” he says.

Michael and Robin’s sons unfortunately inherited Michael’s AD, but thanks to Robin’s expertise, they have been able to keep their children’s eczema in check. “She has them on topical and supplement regimens as well as on a healthy diet, and their skin looks great!”

Eczema is so common that it has worked its way into a Megan Thee Stallion lyric, yet when it snuck up on me, I didn’t recognize it. It was the peak of a particularly humid New Jersey summer, and I assumed the irritation on the side of my foot was from the friction of it rubbing against my jewel-encrusted pool slides. 

But when the irritation went from barely noticeable to consistently annoying, I sought out medical advice. Also known as atopic dermatitis, eczema is a chronic skin condition that causes itching and dryness. It deeply impacts our self-perception and the way that we are perceived by others.

Self-Perception and Atopic Dermatitis

This was something that I had watched several kids face in classrooms while growing up, but I had no idea it could sneak up on you later in life. I was completely blindsided by its appearance.  

“It’s actually way more common than you would expect,” says dermatologist Dr. Hannah Kopelman. “I recently saw a patient in his 90s who had his very first flare of eczema. People think it just happens in young babies or kids.”

The discomfort was bad, but the visible symptoms were worse. I hated the way my skin was raised, interrupting the natural lines of my fingers and toes. I wondered, was everyone looking at my skin? 

Body Image Concerns

The presence of the symptoms felt like a shadow looming over my summer. Concerns about being seen as ashy swirled in my head. I felt embarrassed. The last thing I wanted was for people to think I had some sort of contagious rash. 

My sense of embarrassment was validated. According to The Journal of Allergy and Clinical Immunology: In Practice, “social embarrassment” can be caused by eczema, and “Individuals with atopic eczema may be more likely to experience depression and anxiety through the effects of itch and discomfort, disfigurement, and perceived social-stigmatization.”

“We always tell patients this is such a common disease, and so many people struggle with it,” says dermatologist Dr. Hannah Kopelman. Coping might be easier when you do it alongside others. Dr. Kopelman points out spaces where those with eczema can come together to discuss their challenges. 

“You’re not alone. There are support groups that you can connect with where other people can really relate to what you’re going through,” she says. She adds that there is always something a person can pick apart about their appearance. “Everyone has something. So it might not be this, but they have something else.”

Self-Consciousness and Social Interactions

A 2018 article in the BMJ Open Journal reports that “Patients with chronic skin disease can display a fear of negative evaluation and perceived stigmatization. Patients with visible skin lesions are reported to be more likely to have fear of social rejection together with fear of negative evaluation by others either within their peer group or from others.”

This can lead to self-isolation. Someone with eczema might decline an invitation when they are experiencing a flare-up for fear of being faced with awkward questions about visible or exhibiting signs of discomfort. Even if your eczema is mild, that unbearable prickly feeling it comes with does not help you serve the friendly cocktail party energy you’d like to.

According to The National Eczema Association, half of patients with moderate to severe atopic dermatitis admit that it significantly limits their lifestyle, and up to one-half of adults with atopic dermatitis avoid social interactions due to their appearance. Case in point: I would not attend something that required me to wear sandals if my eczema was bothering me—and being forced to chat about it was not something I was interested in. 

I was uncomfortable discussing my eczema until I couldn’t put it off anymore. I was even nervous to bring it up with my doctor. However, it’s important to be open with your healthcare provider so they can help you work on managing the condition. 

Psychological Effects

The psychological effects of eczema are significant. For example:

Sleep disturbances: According to the Journal of Investigative Dermatology, “Having eczema and concurrent sleep disturbance also significantly increases the risk of psychological disorders.” 

Emotional turmoil: A 2020 article in the Journal of the European Academy of Dermatology and Venereology reports that “anger, frustration and psychosomatic states have been found to affect atopic eczema symptoms.” Psychological issues can also exacerbate eczema.

Role of Healthcare Providers

Some people become so upset by their eczema that they opt out of participating in social activities and skip out on professional commitments. “I have seen people lose their job or not be able to go to school because of skin problems, and it’s important for me to make a patient feel confident that that’s not going to happen to them,” says Anna Chacon, MD, FAAD. 

To address what is on the surface, there are multiple over-the-counter and prescription options to help manage eczema, such as oral medications, injections, and topical creams that can completely clear the skin in certain cases. Certain people have success with changing their diets and environments. Being honest with your healthcare provider can help you get the best combination of therapies for your specific eczema.

“[If] you’re not improving or you’re kind of hitting a plateau, then we have other options, and we can always change to other medications,” Chacon adds.  

“Reducing your exposure to potential irritants can go a long way in terms of managing your eczema and future flareups,” explains dermatologist Dr. Melanie Palm, MD, MBA. “Eczema triggers can vary from person to person, so it is important to understand what your specific triggers are.” 

If you have atopic dermatitis (AD), also known as eczema, then you know the struggle: You climb into bed ready to catch some zzz’s, but can’t sleep because of the intense, relentless itching. Thanks to my current flareup (courtesy of the dry, cold weather), symptoms that are usually just minor irritations during the day have suddenly become hard to ignore at night. It’s an exhausting, frustrating cycle.

As I’m drifting off, I feel that tell-tale irritation and urge to scratch. And while itching offers a brief reprieve, the cycle soon repeats (often more than once). The result? Problems falling and staying asleep, followed by daytime exhaustion.

According to Dr. Alex Dimitriu, a double board-certified psychiatrist and sleep medicine specialist, sleep and eczema have a bidirectional relationship. “Sleep and eczema are closely linked, and one can feed off of the other,” he explains.

Keep reading to learn more about why AD can make sleeping so tough, factors that might make your nighttime symptoms worse, and–last, but certainly not least–how to find a nighttime routine that will manage your symptoms and help you get the sleep you need to feel refreshed.

The Connection Between Atopic Dermatitis and Sleep

Research has shown that people with AD are more likely to have sleep problems–including trouble falling and staying asleep. Estimates suggest that between 33% and a whopping 90% of adults with atopic dermatitis also experience sleep disturbances as a result of their condition.

While falling asleep with eczema might seem like a losing battle (trust me, I’ve been there), the good news is that there are steps you can take to ease your symptoms and get a better night’s rest. “Good sleep and reduced stress can improve eczema. Improved eczema and reduced itching can improve sleep, creating a virtuous cycle,” says Dr. Dimitriu.

Trying to sleep when you have atopic dermatitis can leave you feeling like you’re waging a battle against your own body. The constant itching creates discomfort and irritation that leaves you tossing and turning–which is why so many people with AD report having sleep difficulties.

The itching that characterizes the condition is a major culprit behind such sleep disturbances, but AD can also affect sleep in other ways, including how much sleep you get and how restorative that sleep actually is.

How Eczema Affects Sleep Quality

Atopic dermatitis is an inflammatory disease. That means it doesn’t just affect the skin but the whole body–including sleep. The itching and discomfort make it harder to fall asleep. And even after you drift off, the urge to scratch may jolt you awake repeatedly throughout the night. 

Sleep deprivation can then increase inflammation, leading to further flare-ups and, you guessed it, even worse sleep. I’ve also noticed that as I become more sleep-deprived, I find myself increasingly bothered by my eczema symptoms during the daytime, too.

Common Sleep Disturbances Associated with Eczema

Folks with atopic dermatitis often deal with:

• Problems falling asleep, since itching and discomfort make it hard to relax
• Frequent waking due to skin irritation
• Decreased sleep quality: Even when we technically get the recommended hours of sleep, the irritation caused by our skin condition may prevent us from getting the deep sleep we need
• Daytime sleepiness and fatigue: A poor night’s sleep often leaves people feeling irritable, sluggish, and unable to concentrate the next day

It can be a frustrating cycle, the result of which is often chronic problems with sleep deprivation. This can create further issues with mood, energy levels, focus, and overall well-being.

Why Eczema Symptoms Worsen at Night

When my symptoms felt worse at night, I initially gaslit myself into thinking it was all in my head. It seems worse, I told myself, because you have less to occupy your thoughts. Of course, that unhelpful way of thinking did absolutely nothing to make my symptoms any more bearable. But, while lack of distractions does play some part, symptoms do actually peak at night, for a few different reasons.

The Body’s Natural Sleep-Wake Cycle

Your body’s circadian rhythm (that natural, internal clock that helps regulate your sleep-wake cycle) also plays a role in inflammation. During the night, your body’s cortisol levels naturally drop. 

Cortisol is a hormone that plays a role in the stress response, but it also has anti-inflammatory effects on the body. Cortisol production tends to peak in the morning, then decline gradually throughout the day, reaching its lowest point around midnight.

Increased Skin Temperature and Moisture Loss

“Hot sleeping environments can trigger sweating, which make itching worse,” says Dr. Amy Huang, board-certified dermatologist with Medical Offices of Manhattan.

Because body temperature rises at night–especially when lying under blankets–it can make irritated skin even itchier and more inflamed. If you get too hot while you’re sleeping, you may also wake up and then struggle to fall back to sleep as your AD-related itching intensifies. 

Being too hot can reduce sleep quality, but research has found that being too cold at night can cause problems. In one study, kids with lower nighttime body temperatures experienced more scratching while asleep.

“Environmental factors directly influence eczema symptoms, especially at night when the skin is more prone to water loss and sensitivity,” says Dr. Asmi Berry, a board-certified dermatologist in Los Angeles. “Low humidity and cold temperatures can dry out the skin, leading to increased itchiness and flare-ups, making it more difficult to sleep,” she says. “On the other hand, excess heat and high humidity can trigger sweating and irritation, making eczema-prone skin even more inflamed.”

Environmental Triggers

Your environment also plays a big role in how well you sleep–especially if you have eczema. Common triggers that might make itching worse include mold, pet dander, dust mites, harsh fabrics, and detergent residue on your sheets and blankets.

Fewer Distractions Lead to More Scratching

Because there’s less to focus on at night, it’s only natural that our minds zero in on *every* possible irritation and discomfort. The quiet, distraction-free nighttime hours make all those dry, irritated, scratchy sensations on your skin stand out. Contrast that to during the day, when we’re inundated with all kinds of distractions since our minds are busy juggling work, school, family, friends, and other attention-grabbing activities.

Dr. Dimitriu notes that diminished sleep quality can affect the brain in ways that worsen both symptoms and sleep at night and during the day. “Poor sleep quality fundamentally increases impulsivity, so thoughts are more intense, more loopy, and more bothersome,” he explains. 

Preparing for a Better Night’s Sleep

Unfortunately, there is no easy way to control how your skin behaves. However, you can take steps to improve your chances of sleeping well, even when you have atopic dermatitis. A good skincare routine is a biggie, but it’s also essential to focus on other key areas, such as creating a conducive sleep environment and making minor lifestyle adjustments that promote better rest.

Create an Optimal Sleep Environment

The goal is to make your bedroom a place where your skin feels soothed, not irritated. Some fairly simple changes can go a long way toward easing skin irritation.

• Choose the right room temperature: Make sure you’re not getting too hot or cold at night. Experts suggest the ideal nighttime bedroom temperature is between 65–70°F (18–21°C) to help minimize itching.
• Use a humidifier: Dry cold air worsens eczema symptoms, often a major problem during the winter and for people in cold climates. Running a humidifier in your bedroom at night can help keep the air (and your skin) less dry. Dr. Berry recommends keeping the room between 40% and 50% humidity to prevent skin dryness. “Smart humidifiers can detect the humidity of the room and adjust to match a set humidity level,” she suggests.
• Limit dust and allergens: Dust mites can trigger eczema symptoms, so ensure you regularly wash your bedding in hot water with fragrance-free detergent. Dr. Berry also recommends using hypoallergenic pillowcases and mattress covers to reduce irritation.  
• Choose the right bedding: Choose bedding that helps minimize allergies. Soft, breathable fabrics including cotton and bamboo are a good choice. When washing your bedding, be sure to use a hypoallergenic, fragrance-free detergent.

While these changes won’t eliminate the problem, making your bedroom a comfortable place free of major triggers can help.

Stick to a Soothing Skincare Routine

For my own symptoms, nighttime skincare is a must. Avoid very hot showers and baths (which may trigger symptoms for some people), stick to a gentle cleanser, and keep your skin well-hydrated. Be cautious of sun exposure and be sure you are wearing adequate SPF that is made for sensitive skin.

“Apply moisturizer liberally to skin before bedtime, especially cooling and anti-itch moisturizers like Sarna lotion,” Dr. Huang recommends.

And since moisture loss naturally accelerates at night, it’s more important than ever to make sure you have your hydration locked-in before you call it a day. A good moisturizer can help repair the skin’s barrier, protect it from irritants, and boost those hydration levels during sleep.

Recommended Products and Application Techniques

A word of caution: not all skincare products are friendly to eczema-prone skin. It’s no fun to invest in a hyped-up new cream or lotion only to suffer later when it leads to irritation, itching, and redness. 

While it might take some trial-and-error to figure out which products work best for you, here’s what typically works best:

• Skip the hot water: “Take a lukewarm bath or shower. Avoid hot water, which can strip the skin of its protective lipids. Adding colloidal oatmeal can help soothe irritation and support the skin barrier,” Dr. Berry recommends.
• Use gentle cleansers: Avoid any harsh soaps and stick to hydrating, fragrance-free products.
• Apply a thick moisturizer or barrier cream: Lotions often don’t have the staying power you need to relieve dryness and itching, so look for creams or ointments that can boost hydration.
• Apply moisturizers to damp skin: You also need to make sure you’re using products correctly. “Use an emollient-rich moisturizer within three minutes after bathing to lock in hydration,” Dr. Berry says. “Look for products that contain ceramides or shea butter, or use petrolatum-based creams.”
• Spot treatments for flareups: When you’re dealing with an active eczema flareup, consider using a medicated cream–such as a mild steroid cream like hydrocortisone or a prescribed treatment–before you apply your moisturizer. Dr. Berry suggests looking for a topical corticosteroid or soothing balm with ingredients like pramoxine or colloidal oatmeal.
• Be consistent: “A consistent, soothing nighttime routine can make a huge difference in managing eczema-related itching and improving sleep,” Dr. Berry says. While you might be tempted to skip your routine, particularly when you’re tired, doing so can lead to problems. Instead, try to make your routine a habit and stick to it consistently.

Dr. Huang also recommends keeping your fingernails trimmed short and applying a cool, damp towel to itchy areas instead of scratching.

Clothing Considerations for Sleep

If your nightly uniform consists of an old tee and sweatpants, you might want to reconsider your PJ options. If you have eczema-prone skin, spending the night in the wrong fabrics can lead to significant irritation and poor rest. On the other hand, the right sleepwear can help soothe the skin, regulate body temperature, and reduce irritation.

Best Fabrics for Eczema-Friendly Sleepwear

For a good night’s sleep, look for sleepwear made from:

• Cotton or bamboo: These fabrics are natural and breathable, which helps wick away moisture to keep your skin cool.
• Silk or silk blends: These smooth fabrics help reduce friction and irritation, which is a great option if you have very sensitive skin.
• Loose-fitting clothing: Tight clothing not only creates friction, it also traps heat. Stick to sleepwear that is looser fitting for greater nighttime comfort and rest.

What to Avoid

The following sleepwear options can contribute to poor rest:

• Wool and synthetic fabrics: Besides trapping heat, these materials tend to be rough and scratchy.
• Clothing with seams or tags: While it might not seem like a big deal, sleepwear with scratchy tags or rough seams can become a major annoyance when your skin is already sensitive and irritated.
• Excessive layers: Piling on heavy pajamas and thick blankets might seem cozy, but it also raises your body temperature and triggers the urge to itch. Stick to lightweight layers that you can easily adjust as needed.

Behavioral and Lifestyle Adjustments

In addition to making sure your skincare and sleepwear are on point, it’s also important to take a look at some of your daily habits. Lifestyle factors can play a *big* role in the symptoms of atopic dermatitis. 

Quality sleep habits, Dr. Dimitriu says, are key. “Healthy sleep hygiene as well as care for eczema symptoms is essential to ensure the best sleep you can get,” he explains.

That includes things like stress, nutrition, and even screentime can impact your skin and your sleep quality. If you regularly deal with irritating, uncomfortable nighttime flareups, a few small changes in your daily habits might help. 

Relaxation Techniques to Reduce Stress Before Bed

Stress is a known trigger for eczema symptoms. Because stress elevates the body’s cortisol levels and suppresses the immune system, it leads to increased inflammation. Not only can higher stress levels trigger eczema symptoms; having eczema symptoms contributes to high stress levels.

Easing stress is absolutely essential if you want to get a good night’s sleep. Strategies that can help include:

• Deep breathing or meditation: Before bed, spend a few minutes breathing slowly and deeply. This helps trigger the body’s relaxation response and may help reduce stress-related inflammation.
• Progressive muscle relaxation: This stress-relieving technique involves tensing and relaxing different muscle groups. When you practice this regularly, it feels like a wave of relaxation pouring through your entire body.
• Journaling: Expressive writing can be a valuable tool for combatting stress, so take a few minutes at the end of each day to jot down your thoughts and worries. Or, try writing a gratitude list to help clear your mind and focus on positive thoughts before you go to bed.
• White noise or calming music: As you wind down for the evening, try a white noise machine, soothing nature sounds, or a calming playlist to help signal to your body that it’s time to rest.

Avoiding Stimulants and Screen Time Before Sleep

What you eat, drink, and do before bedtime can either help or hurt your ability to sleep well.

• Limit your alcohol use: Even if alcohol makes you feel sleepy, it can also be dehydrating and tends to disrupt your sleep quality. Consider a cup of chamomile tea before bed instead.
• Watch your caffeine intake: You might not necessarily feel wired, but caffeine still lingers in your body for hours after you consume it. Skip caffeine in the afternoon, including coffee, tea, and energy drinks.
• Minimize screen time at night: The blue light emitted from phones and tablets interferes with your body’s melatonin production, the hormone that helps regulate your sleep-wake cycle. Try a book, podcast, or relaxing music instead.

Creating a Wind-Down Routine

A good night’s sleep often hinges on what you do before you go to bed. A consistent pre-sleep routine can help signal to your body that it’s time to wind down and relax. It’s not just about what you do right before you get tucked in–it’s a pattern that begins at least an hour before you go to bed. For example, you might dim the lights, put on your comfortable pajamas, and engage in a relaxing activity to help calm your mind and body.

The goal is to make your nighttime routine as soothing and stress-free as possible. It’s good for your body *and* it helps keep your skin calm and comfortable.

When to Seek Professional Help

If your eczema is still wreaking havoc on your ability to sleep, it’s time to get some help from the professionals. Skincare and lifestyle changes can help, but there are times when eczema-related sleep problems need medical treatment.

Signs That Eczema Is Severely Affecting Sleep

If you’re experiencing the following symptoms, it’s time to talk to your healthcare provider:

• Frequently wakings: Waking up multiple times each night and struggling to fall back to sleep is a sign that your eczema is not well-controlled.
• Bleeding or infections: Persistent nighttime scratching that leads to broken, bleeding skin or infections suggests other interventions are needed.
• Daytime tiredness: Fatigue that affects your mood, energy levels, and ability to focus can make it hard to function.
• Over-the-counter treatments aren’t getting the job done: If your fave moisturizers, hydrocortisone creams, and antihistamines aren’t helping, it’s a sign that you need a more potent treatment.

Treatment Options and Adjustments with Healthcare Providers

Your doctor or dermatologist can work with you to develop a treatment plan for your unique needs. That might include:

• Prescription creams and ointments: OTC options are often effective, but you may need a stronger alternative such as topical steroids, calcineurin inhibitors, or non-steroidal treatments that can help control skin inflammation.
• Oral medications: In some cases, your doctor may recommend immunosuppressants, antihistamines, or biological treatments such as Dupixent (dupilumab) to control your symptoms.
• Light therapy: Phototherapy, which involves controlled exposure to UV light, can sometimes be useful for stubborn eczema.

Your doctor may also talk to you about ways you can address underlying triggers that might be contributing to your flareups. Such triggers can include allergens or might be related to stress or diet. They can help you pinpoint which ones might be a problem for you and suggest steps you can take to manage them.

Takeaways

Struggling with eczema can be incredibly frustrating because even if your symptoms are manageable during the day, they can really take a toll at night. Between the itching, irritation, and constant waking, it’s perhaps not surprising that so many people with atopic dermatitis struggle to sleep. If eczema is making a good night’s sleep seem impossible, you don’t have to suffer in silence.

Understanding why eczema symptoms tend to flare at night is the key to finding an effective solution. You might need to adjust your sleep environment, or you might need to make some tweaks to your nightly skincare routine. 

“By making these small adjustments, many people with eczema find that itching decreases, skin stays calmer overnight, and sleep improves significantly,” Dr. Berry says. And if your symptoms are still making sleep impossible, don’t be afraid to talk to your doctor or dermatologist for extra support.

For Trisha Khanna, MD, her eyes would tell the story.

“When I am stressed, I will get eyelid eczema [and] I often wake up with itchy, red eyes,” says Dr. Khanna, fellow of the American Academy of Dermatology and a medical advisory board member at Codex Labs. She experiences what over 31 million people in the United States may already know — stress can severely affect eczema symptoms.

“Cortisol, the body’s primary stress hormone, plays a role in the body’s inflammatory response,” explains Megan Collins, MA, LMFT, ATR-P, founder of NeuroArts Therapy & Consulting. “When released during stressful situations, cortisol can disrupt the skin’s ability to stay hydrated and repair, leading to flare-ups. Then comes the redness, itching, and overall skin irritation, similar to having hives after an allergy.”

But the impact isn’t just physical. People with eczema can also experience mental and emotional challenges due to stress. Read on to learn more about the connection between stress and eczema flare-ups, practical tips for managing the condition, and steps you can take to alleviate stress and aggravated symptoms.

Common Triggers of Eczema Flare-Ups

“Eczema often begins in infancy or childhood, though it can develop at any age,” explains Janis Kosma-Covey, PharmD, owner of Kosmatology. “While the exact cause of eczema is not fully understood, it is believed to result from a combination of a specific gene mutation, environmental factors, and an overactive immune system that compromise the skin’s natural barrier, making it more sensitive and reactive.”

It can lead to itchy, red skin, dryness, and inflammation. It can also interfere with sleeping.

External triggers can be easier to manage. But when your mental state leads to flare-ups, it can require a different course of action.

The Stress-Eczema Cycle

Unlike many environmental factors, stress isn’t an exterior irritant to the skin. It causes a flare-up from the inside.

“When faced with a stressful situation, the body will go into a ‘fight-or-flight’ response,” notes Dr. Kosma-Covey. “During the ‘fight-or-flight’ response, stress hormones such as cortisol are released. When these hormones are released in large amounts or for extended periods of time, they suppress the immune system and increase inflammation throughout the body. The inflammation leads to worsening of eczema symptoms or a new flare-up,” she adds.

Studies show that stressful situations, like school exams, family issues, financial problems, and work challenges can all exacerbate eczema symptoms. 

“Stress can make the eczema more noticeable, with redness, itchiness, and dry patches becoming more intense. The emotional response to stress, like scratching, can worsen the symptoms, creating a vicious cycle,” Collins states.

Managing Stress to Alleviate Eczema Symptoms

Stress causes both internal and external issues for people with eczema. Taking care of your mental health and learning how to manage stress can help reduce skin breakouts and alleviate itching. It can also help curb any worry or anxiety associated with dealing with eczema.

“One client recalled how periods of high anxiety at work directly led to increased flare-ups, with itchy, raw patches showing up on her hands and neck. She found that her symptoms improved when she practiced mindfulness and took breaks to manage stress,” shares Collins.

Other strategies to manage stress include:

Lifestyle Adjustments for Eczema Management

We get it—changing your habits and behaviors that have been ingrained for years isn’t easy. But dealing with your eczema in a healthier way is a reward that’s worth it. Specific adjustments can help keep stress and eczema flare-ups at bay, including:

• Getting a good night’s rest. “Sleep is crucial for skin repair and immune function, and lack of sleep can increase cortisol levels and thus worsen eczema,” Dr. Khanna notes.
• Being mindful of what you eat. “Some people with eczema find that certain foods, such as dairy, gluten, or eggs, may trigger flare-ups. Keeping a diary can help pinpoint specific triggers you can share with your medical team,” advises Collins.
• Taking inventory of the products in your home. Everyday items, from makeup to carpet cleaner, can contain triggering chemicals.
• Finding a support group. People who understand your struggles and frustrations dealing with eczema, or who have experienced the impact stress has on the condition, can keep you encouraged on your journey. “Connecting with others who understand the struggles of eczema can lessen the mental toll,” Collins says.

Tips for Daily Management

Small actions can make a big difference in managing stress. Tips like avoiding long hot showers to keep your skin from drying out and wearing clothing that’s not too tight are beneficial. Keeping your skin well moisturized is also key.

“A good tip is to moisturize immediately after you shower while your skin is still damp. Ideally, you want to find a moisturizer that is thick, fragrance-free, and clean for sensitive skin. Another option is an over-the-counter hydrocortisone cream to help calm inflammation and treat patches of eczema. If your patches are persistent, then connecting with your dermatologist to get a prescription like tacrolimus is another option,” says Anna Chacon, MD, FAAD, board-certified dermatologist and founder of MiamiDerm.

Other tips include having a good water filter if you’re in an area with hard water, using an air purifier, and making your home as allergen-free as possible. You can also consult with a medical professional to help find a more customized approach for you.

Bottom Line

Stress can wreak havoc on the body in many ways. Eczema can cause problems from the inside out. Making the effort to remove potential flare-up triggers and usher in a more calming and relaxing atmosphere can be a worthwhile investment.

“Like any chronic health condition, managing eczema requires a holistic mind-body approach, and you shouldn’t have to go through it alone. Building a treatment team, utilizing coping skills, self-care routines and rituals, and garnering emotional support through the eczema community can effectively minimize flare-ups and promote overall well-being,” Collins concludes.