Why does sweat make my eczema worse?

Sweat can worsen eczema when it stickily sits on the skin. Bacterial biofilm, dead skin cells and chaffing, sweat-drenched clothes can all block sweat pores, which then leak into the skin causing that tingling itch. Eczema also interferes with the skin's sweating ability, which should help to moisturise the skin and maintain the body's temperature.

Sweating is good for the skin.

The body is designed with this fantastic ability to self-regulate, and this is called homeostasis. The body produces sweat as a way of releasing heat and regulating temperature, while its acidic pH keeps bacterial and fungal microflora in balance, protecting the skin from infection. Sweating is also a natty way of getting rid of unwanted stuff like water, urea and lactate which (ta-da!) can naturally moisturise the skin – such a clever mechanism when it works properly.

Eczema and sweat: What’s the connection?

Working up a 'healthy glow' is intended to cool us down and maintain healthy skin, but unfortunately sweating can make eczema worse for reasons that may not be the same for every person. Eczema (atopic dermatitis) is not a specific skin disorder but several conditions that have similar symptoms. It's complicated and frustratingly different for every individual, so an understanding of the structure of the skin and how the skin system works is the key to managing eczema. Know the enemy - minimise the symptoms.

To do this we must look at the situation from both angles, how eczema affects sweating ability, plus the effect sweat can have on eczema

How eczema affects sweat

Eczema weakens the skin's structure and sweating ability, therefore inhibiting the good moisturising action of sweat. When eczema is exposed to allergens (for instance dust mites), it triggers chemical reactions in the skin which can cause the sweat glands to leak below the surface. This can cause a tingling itch when sweat is produced. (1) As well as being itchy, this below-surface sweat is not able to act as a cooling or moisturising agent.
Eczema will cause poor sweat function and impact the skin's ability to withstand heat and as well as making it drier and itchier. (2) Heat intolerance and skin conditions such as eczema can develop or worsen later in life. Skin becomes thinner as it ages, affecting the sweat pore structure. (3) Eczema can worsen if we don't get enough sleep and for many other reasons which you can read about here.

Bacterial colonies live on the skin and are harmless, if not beneficial. However, it's estimated that up to 90% of people with eczema have specific bacteria that may form a biofilm blocking the skin's sweat pores. (4)
The sweat of some people with eczema has also been found to contain higher levels of glucose which can slow the healing of the skin and potentially promote infection and itching. (5)

How sweat affects eczema

Ideally, sweat will have a cooling and moisturising effect on the skin, but if the sweat pores are blocked, sweat will leak into the tissue of the skin causing itchiness that is not unlike the sensation of prickly heat. This can happen when sweat sits stickily on the skin, i.e., during exercise. Damp, sweaty clothes can worsen this effect by rubbing away at dead skin cells that can additionally plug sweat pores.

The skin gets a lot of its moisture from the atmosphere, and normally the skin's protective barrier prevents us from absorbing anything along with it that is dangerous or nasty. With eczema, the skin barrier function is impaired and environmental flotsam (i.e., pollen, dust mites, pet dander, mould spores, toxins) that dissolve on the skin's surface sweat may be absorbed. When that happens the immune cells in the skin react to the invasion by setting off a cascade of inflammation. This can make a person with eczema feel that they may have a weak immune system or are allergic to their sweat, but it may not be their sweat per se that their eczema is reacting to.

What will stop sweat from making my eczema worse?

Here is a list of suggested strategies that may stop sweat from aggravating eczema symptoms:

Wash frequently, especially before and after exercise and when feeling sticky. This will reduce exposure to any dissolved environmental irritants or naturally occurring glucose in sweat. Try to avoid washing habits that may dry out the skin like long, hot baths or harsh soaps. Quick, warmish showers with natural toiletry products are better.
Protect the skin from drying out with a natural and active moisturiser that will act as a protective barrier. Neem is a useful skin ingredient that has a long traditional use as an Ayurvedic remedy suitable for sensitive skin and for discouraging skin infection.
Drink plenty of water to avoid dehydration. If this is an alien concept that you feel like resisting, try starting with just an extra pint (500ml) a day for two weeks. Once you see how much better it makes you feel, you will want more.
Wear loose, airy natural fabrics or exercise clothes that are 'moisture-wicking' to avoid damp material chaffing against the skin
Don't give up on exercise. Activity, movement and time outdoors have so many positive benefits for our mental and physical health.

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Why does sweat make my eczema worse?