Atopic eczema (also known as atopic dermatitis) is an inflammatory condition that affects people of all ages. Image of young black women moisterising her face.

Atopic eczema: causes, triggers and natural treatments

Atopic eczema (also known as atopic dermatitis) is a chronic inflammatory skin condition that can affect people of all ages, although most commonly presents in early childhood. It is one of the most common chronic skin diseases, thought to affect up to one-fifth of the population1 and its prevalence is rising, particularly in developed and fast-growing countries.

Our latest blog looks at the underlying causes of this condition, what factors can trigger it and the natural treatments, including nutritional and lifestyle approaches, that may help.

Eczema is the most prevalent in early life, with symptoms typically presenting in the first five years of life and in adults, the condition has usually been present for decades2. In the majority of cases eczema will improve or resolve with age; however approximately 10% of patients experience symptoms into adulthood3. The condition can affect people of all ethnicities and has a significant psychosocial impact on patients and their relatives.

The pathophysiology is complex and can involve a strong genetic predisposition, epidermal dysfunction and inflammation, and those with eczema are at an increased risk of comorbidities, including food allergy, asthma and allergic rhinitis4.

Atopic eczema

The word ‘atopic’ is defined as relating to, or caused by, a hereditary predisposition towards developing certain hypersensitivity reactions, where the immune system over-reacts such as asthma, hay fever and in this case, eczema. The “atopic march” is an epidemiological phenomenon which refers to the time progression which commonly occurs from eczema to asthma and allergic rhinitis, suggesting that eczema is an “entry point” for subsequent atopic disease5 although this theory has been questioned by some.

Common symptoms of eczema include:

  • itching of the skin
  • warm, tender skin
  • skin that becomes scaly and raw
  • burning sensation or pain on the skin
  • red bumps on the skin that may weep and crust
  • skin that becomes dry, red, or rough
  • inflammation of the skin

Skip to Key Takeaways

Common causes behind the onset of atopic eczema

Atopic eczema has a complex, multifactorial pathogenesis, including genetic, immunological and environmental factors that cause skin barrier abnormalities and immune dysfunction. These processes trigger dysbiosis of the cutaneous microbiome, which further aggravates skin barrier damage and immune imbalances and increases the risk of secondary infections, complicating the course of the condition6.

We’ll take a closer look at the most common factors that contribute to the development of atopic eczema and discuss how to support skin health in those affected by the condition.

Skin barrier function and formation 

It is important to briefly look at the structure and function of the skin, which provides an effective barrier between the internal and external environments of the body – acting as an interface between the inside/outside and therefore providing protection and support to the body.

The epidermal barrier serves three primary functions: limiting passive water loss, restricting environmental chemical absorption and preventing microbial infection. The epidermal barrier protects against mechanical, chemical and microbial injury through the formation of differentiated keratinocytes. This process is known as keratinization, where epidermal mature from basal epidermal cells to form the flattened cells of the stratum corneum; the outermost layer of skin7.

The stratum corneum is the primary mediator of the epidermal permeability barrier, accounting for over 90% of the functionality of the skin, therefore proper development and maintenance of this layer are essential for maintaining its ability to defend the body against both chemical and microbial attacks and dehydration.

Epidermal barrier dysfunction is increasingly recognised as a key determinant in the pathogenesis of eczema8 and epidermal permeability, predisposed by individual genetics and exacerbated by environmental exposures, is believed to contribute to the disease process in eczema as:

a weakened skin barrier is more susceptible to topical infections that also trigger an immune response9.

 Genetics – filaggrin 

A major genetic risk factor for eczema is loss-of-function mutations in the FLG gene, which encodes the skin protein filaggrin.  Filaggrin is essential for the alignment of keratin in the stratum corneum, and filaggrin breakdown products act as natural moisturizing factors, important for proper skin hydration10.

Natural moisturising factor components are essential for skin barrier integrity, i.e. for skin hydration, skin pH modulation, immunosuppressive properties, antimicrobial defence, photosensitivity and skin elasticity11. Thus, we can see that filaggrin is important for maintaining a functional skin-barrier.

It is important to note, however, that FLG mutations are neither necessary nor sufficient to cause eczema; in fact, approximately 60% of sufferers do not have this genetic mutation12 which again highlights the multifactorial aspect of eczema pathogenesis. 

Skin microbiome 

As mentioned, the skin is an important first-line defence against pathogenic microbial invasion, with tight connections between cells in the stratum corneum forming a physical barrier, while antimicrobial peptides and lipids secreted from keratinocytes and glands provide a chemical barrier13.

The skin microbiome represents an ecosystem composed of numerous microbial species interactive with each other, as well as with host epithelial and immune cells. This skin microbiome can support healthy skin function and inhibit the colonisation of pathogenic bacteria, but a disturbance of this microbial balance can result in dysbiosis and contribute to skin diseases such as eczema14.

The bacterium present in the highest percentage in atopic skin is Staphylococcus Aureus. It is able to produce toxins, enzymes and antigens capable of bypassing the immune system and the skin barrier. Its enterotoxins can initiate the production of pro-inflammatory cytokines, leading to inflammation and perturbation of the skin barrier as seen in eczema15.

S. aureus also causes displacement of other bacterial species, which disrupts the cutaneous homeostasis dependent on host-microbiome signallin167.

Immune dysregulation 

Eczema results from a combination of a skin barrier deficit and an immune dysregulation, and different hypotheses have been reported; the first suggesting that dysfunctional immunity occurs first, affecting skin barrier function, and the second one stating that a compromised epidermal barrier primarily leads to the onset of eczema and secondarily to immune dysregulation17.

The immunological pathogenesis of atopic eczema is complicated because its development is orchestrated by both the adaptive and innate immune systems. Skin-resident cells such as keratinocytes, dendritic cells, mast cells, macrophages, and innate lymphoid cells contribute to skin inflammation in eczema patients, and additionally T cells, monocytes and granulocytes are recruited from blood circulation and contribute to the condition.

Although a complex interaction of immune cells mediates eczema skin lesions, its immunopathogenesis is characterised by the tendency toward Th2-skewed responses. The Th2-type cytokines include interleukins 4, 5, and 13, which are associated with the promotion of IgE and eosinophilic responses in atopy. Raised T regulatory cells have also been observed in the lesions and peripheral blood of eczema patients18.

Immunoglobulin E (IgE) plays a central role in atopy. IgE binds to various immune cells and acts as both an effector for chemical mediator release and a regulator for pro-inflammatory cytokine production.

Skin barrier disruption increases its permeability to external antigens/allergens and facilitates Th2 immune response through antigen-presenting cells such as Langerhans and dendritic cells. This leads to an increase in the production of IgE, which mediates subsequent hypersensitivity responses to antigen exposures.

Hence, IgE plays an important role in the pathogenesis of atopic eczema and is present at increased levels both in the serum and skin of patients.

There is a significant association between higher levels of IgE and the severity of eczema19.

It has been observed that adults with atopic eczema are more frequently diagnosed with autoimmune diseases compared to those without eczema.

Autoimmune disorders involving the skin, the gut (such as Crohn disease, coeliac disease and ulcerative colitis), or the connective tissue (such as bones, tendons or ligaments) were most commonly associated with eczema.

In patients with more than one autoimmune disease, the association grew stronger with each additional disease which may support the idea of an autoimmune component and/or shared immune pathways in atopic eczema20.

Poor gut health 

Our gut microbiome is vital for immune system development and functioning, and an imbalance in microbial composition and function (dysbiosis) in both the skin and gut have recently been linked to alterations in immune responses and the development of atopic eczema21.

The increased prevalence of eczema, particularly in industrialised regions has been hypothesized to be due to excessive hygiene that accompanies the Western lifestyle and reduces exposure of the host’s immune system to a diverse range of microorganisms such as viruses, bacteria and fungi22.

Several recent findings in patients with atopic eczema reveal a dramatic change in microbial community structures compared to healthy volunteers23.

Gut health in infancy and early childhood

This is an important and vulnerable period in the development of the gut microbiome, which in turn shapes an individual’s disposition to eczema24. It was believed that infants were born sterile. This view is being challenged and it is now thought that the mother’s gut flora may start to populate the baby’s gut ‘in utero’25.

The infant then receives a ‘mouthful’ of bacteria as it passes through the birth canal and will continue to receive bacteria from the mother via breastfeeding. A number of factors may compromise this early development of a healthy gut flora – e.g. where the mother has a dysbiotic flora herself, the use of antibiotics during and/or after birth and caesarean births24.

Maternal prenatal nutrition and dietary diversity are crucial factors in a child’s development.

A growing body of literature points to how sufficient nutrition during the first 1000 days of a child’s life, from conception to their second birthday, is essential for proper brain development, healthy growth and immune system that impacts the entirety of the child’s life, and beyond. Indeed, it is proposed that the first 1000 days accounts for 70% of an individual’s future health26.

The intestinal microbiome also develops within this period, and therefore, factors that influence the development of the microbiome and reduce the risk of allergy are strongly emphasised: natural birth, breastfeeding, contact with nature, having pets, appropriate diets (e.g., high-fibre food, fermented products, home-made food), as well as the consumption of probiotics and prebiotics27.

For infants born by caesarean section, taking a swab of bacteria from the mother’s vagina and wiping these around the infant’s mouth is being used in some hospitals.

Leaky gut 

Dysbiotic bacteria, as well as detrimentally affecting immune function, can produce toxins that damage our gut lining, increasing gut permeability, known as “leaky gut”. Disruption to the intestinal barrier allows the penetration of poorly digested food, microbes, and toxins into the circulation to reach target tissue, including the skin, where they trigger Th2 immune responses resulting in further tissue damage28.

Several studies have also demonstrated increased intestinal permeability in those afflicted with atopic eczema, as well as a range of atopic conditions27.

Candida Albicans 

As discussed, the prominent colonisation of S. aureus in eczema lesions has meant that many of the studies have focussed on the analysis of the bacterial microbiome,

but emerging evidence suggests the involvement of a fungal microbiome (also known as the mycobiome)329.

A number of studies have identified higher rates of colonisation of Candida Albicans in those with eczema, when compared to healthy controls30,31, and patients have demonstrated improvements in their symptoms when treated with antifungal drugs.

Environmental factors affecting atopic eczema 

There are a number of different environmental factors that can cause an exacerbation in atopic eczema such as:

  • Increased hand hygiene – following the COVID-19 pandemic, hand hygiene using detergents has increased, which can affect the microbiome as well as the protective function of the skin barrier and increase the sensitivity of the skin to trigger substances in eczema.32,33
  • Indoor air pollutants such as formaldehyde and volatile organic compounds34. Air pollutants can interact with the skin by binding to the stratum corneum, becoming metabolised and potentially penetrating the epidermis35.
  • High heat and/or humidity may aggravate eczema symptoms by provoking perspiration; one of the most common aggravants reported in children with eczema35.
  • Tobacco smoke exposure can have a detrimental effect on immunity, cause oxidative damage and diminished skin barrier function, as well as having an irritant effect on the skin35.
  • …plus several others, a few of which we touch on below. 


If you have a genetic predisposition to atopic eczema, then exposure to certain environmental factors may cause the condition to flare up, such as certain allergens, including:

  • Pets
  • Pollen
  • Moulds
  • Dust mites


These are very specific to the individual in terms of causing eczema to flare up however some of the most common ones include:

  • Soaps and shampoos
  • Detergents
  • Disinfectants
  • Wool and synthetic clothing


It is believed that around one-third of children with eczema also have a food allergy. Some of the most common food allergies associated with eczema include:

  • Eggs
  • Nuts and seeds
  • Wheat
  • Dairy products
  • Soy
  • Citrus
  • Food colouring
  • Yeast containing foods


Sleep deprivation and stress are inflammatory and can also have a direct impact on the skin barrier function – which as we mentioned earlier is essential to preventing the onset of atopic eczema, or at least reducing its severity36,37. 

Therapeutic approaches to treating eczema


  • An anti-inflammatory diet that is high in vegetables (6-8 portions per day) and good quality fats (nuts, seeds, avocado, oily fish, olive oil). Sugary foods and inflammatory fats such as trans fats, sunflower and corn oils should be avoided.

Trial elimination diet:

  • If there are suspected food allergies and sensitivities a trial elimination diet removing eggs, nuts and seeds, gluten, dairy and soy can be considered to see if symptoms improve.

Support gut health:

  • Diets high in fibre, vegetables, fruits, antioxidants and prebiotics help to create a healthy microbial balance, whereas diets low in fibre, fruits and vegetables and high in sugar, refined carbohydrates, and processed foods can create dysbiosis38.
  • Fermented foods such as kimchi, sauerkraut and fermented vegetables are rich in probiotics (friendly bacteria), which can positively influence the metabolic activity of the microbiome39.
  • Consider taking a multi-strain probiotic. A recent meta-analysis demonstrated a beneficial effect of Lactobacillus-containing probiotics on the severity of eczema symptoms in infants40, and studies in adults have reported significant symptom improvements through the use of probiotic supplements including strains such as Lactobacillus Paracasei, L. acidophilus, L. salivaruys, Bifidobacterium animalis, B. breve41.
  • If leaky gut is suspected, consider drinking bone broths – make a broth from meat carcass (ideally organic) – this is high in the amino acid glutamine which supports the repair of the digestive lining. Other nutrients to support gut integrity include zinc, copper, vitamin A and collagen peptides.

Essential Fatty Acids:

  • Polyunsaturated fatty acids are divided into 2 families: omega-6 and omega-3. In the last several decades, dietary intake of omega-3 fatty acids has declined, while intake of omega-6 fatty acids has increased. In fact, omega 6-3 fatty acids are now consumed in a ratio of about 20–30:1 in the modern Western diet, relative to 1–2:1 traditionally. Research has suggested that this imbalance may result in increased mediators of inflammation42. Foods rich in omega-3 PUFAs include fatty fish, algae, flax seeds and oil, chia seeds, and walnuts, and studies looking at supplementing with omega-3 fatty acids have shown benefits to the severity of eczema43.
  • While some omega-6 fatty acids, such as linoleic and arachidonic acid, promote inflammation, gamma-linolenic acid (GLA) appears to reduce inflammation, and a deficiency in GLA in the skin may thus result in increased inflammation. It has been suggested that the enzyme responsible for converting linoleic acid to GLA may be deficient in patients with eczema42. Evening primrose oil is high in GLA and is an area of investigation in the management of eczema43.

Vitamin D3:

  • has immunomodulatory effects and there are many studies connecting vitamin D to allergic disease and describing a beneficial effect of vitamin D supplementation on eczema45,46.

Vitamin C:

  • Normal skin needs high concentrations of vitamin C, which plays many roles in the skin, including the formation of the skin barrier, the ability to counteract skin oxidation, and the modulation of cell signal pathways of cell growth and differentiation. However, vitamin C deficiency can cause or aggravate the occurrence and development of some skin diseases, such as eczema47.

Vitamin E:

  • may have therapeutic potential in eczema due to its antioxidant and anti-inflammatory properties48.


  • plays a number of roles in supporting skin health. A number of studies have demonstrated benefits in inflammatory skin conditions such as eczema49, with low zinc levels shown to increase the risk of developing the condition50.

Key Takeaways

  • Atopic eczema is a chronic inflammatory skin condition that commonly occurs in childhood
  • Atopic eczema has a complex, multifactorial pathogenesis, including genetic, immunological and environmental factors that cause skin barrier abnormalities and immune dysfunction.
  • Epidermal barrier dysfunction is increasingly recognised as a key determinant in the pathogenesis of eczema
  • The skin filaggrin is important for maintaining a functional skin-barrier, and a genetic dysfunction in the production of filaggrin may contribute to eczema
  • Dysbiosis in the skin microbiome and a dominance of Staphylococcus Aureus has been observed in eczema
  • The immunological pathogenesis of atopic eczema is complicated because its development is orchestrated by both the adaptive and innate immune systems
  • Gut dysbiosis, candida overgrowth and leaky gut have all been implicated in the condition
  • A number of different environmental factors can contribute to the development or severity of the condition
  • Exposure to a number of allergens can contribute to the pathogenesis of eczema
  • Irritants such as detergents and synthetic fibres can exacerbate symptoms
  • Stress and poor sleep can also contribute to the condition
  • Dietary considerations for those with eczema include removing suspected dietary allergens and sensitivities, eating an anti-inflammatory diet and supporting gut health
  • Specific nutrients that can support those with eczema include vitamins A, C, D, E, zinc, probiotics, omega-3 fatty acids and the omega-6 GLA.


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If you have questions regarding the topics that have been raised, or any other health matters, please do contact our team of Nutritional Therapists.
01684 310099


Last updated on 3rd January 2024 by cytoffice


8 thoughts on “Atopic eczema: causes, triggers and natural treatments

  1. Great blog! Thank you. Wish everyone suffering with eczema could read this and aware of what causes it and how it can be improved, instead of resorting to steroids and antibiotics as a sticking plaster.

    1. Thank you so much for your kind feedback – we are so pleased that you (and hopefully others) have found the blog helpful.

  2. Hi
    I’ve just finished reading your article on eczema. Having suffered with this condition since childhood ( I’m now 55 years old) I found it very interesting and informative. Thank you for taking the time to share this.
    I’ve tried many different approaches over the years including daily boiling up bundles of Chinese herbs from Dr.Lau in London in the ‘90’s… very effective but also rather impractical unfortunately. … I also found Tibetan medicine very effective when I lived in India although it’s not so accessible in this country .. you name it…. I’ve done it! Meditation also very helpful… stress and inflammation reducing ….and so much of what you mention rings true for me. I would like to say that an overall healthy approach to life, as per your advice re: nutrition and diet, stress management and good quality sleep has proved most helpful for me, together with higher doses of evening primrose oil. And so important.. engaging in activities that are enjoyable… creativity is so important…
    However reluctantly, I’ve also found that utilising antihistamines, as a short term measure essential for limiting the very harmful effects of a flare up.
    With regards allergies, I’ve found that if I’m really looking after my health, I’m less likely to fall prey to allergens.
    Finally, my most recent discoveries helpful for eczema ate EFT tapping and arnica.
    I hope the above is helpful in some way
    So theses are the things which sprung to mind after reading your article.

    1. Hi There – thank you so much for your kind feedback and it’s great to hear how you are managing to support your health naturally.

  3. This is a very informative article, my son who is 22 suffers with eczema and has done most of his life. He has all of the problems that you have talked about. He has been to the GP but they cannot seem to help. I have shared this article with him and I think it will help him alot in trying to understand what is going on with his body and how he can alleviate the conditions. Thank you so much.

    1. Thank you for your kind feedback, and we hope that he is able to put some of the recommendations into practice. He is also very welcome to get in touch with our nutritional therapists should he need any further support or tailored recommendations –

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