Common Triggers of Skin Flare-Ups: Allergens, Irritants, Stress & More

Top Categories of Cutaneous Flare Precipitants

1. Allergens (Type I / IV Hypersensitivity)

• Environmental: pollen, dust mite, pet dander, mold.
• Contact: nickel, fragrance, preservatives (MI/MCI), formaldehyde, hair dye (PPD).
• Food: IgE-mediated (urticaria) or delayed (eczematous).

2. Irritants (Non-Immune)

• Soaps, detergents, solvents, alcohols, acids/alkalis.
• Occlusion (wet work, gloves, diapers).
• Friction, extreme temperatures.

3. Infections

• Bacterial: S. aureus (impetigo, folliculitis), streptococci.
• Viral: HSV (eczema herpeticum), molluscum, warts.
• Fungal: dermatophytes (tinea), Malassezia (seborrheic dermatitis).

4. Endogenous Factors

• Hormonal: menstrual flare (premenstrual), pregnancy, menopause, thyroid.
• Stress: HPA axis → cortisol → barrier disruption, mast cell activation.
• Genetics: filaggrin mutations (atopic dermatitis), psoriasis loci (PSORS1).

5. Systemic Disease

• Autoimmune: lupus, dermatomyositis, scleroderma.
• Metabolic: diabetes (necrobiosis, infections), renal/hepatic failure.
• Malignancy: paraneoplastic (acanthosis nigricans, dermatomyositis).

6. Medications

• Fixed drug eruption, DRESS, SJS/TEN, lichenoid, photosensitivity.

7. Environment

• Low humidity (winter), high heat/humidity (miliaria), UV exposure.

8. Nutrition

• Deficiencies: zinc, biotin, essential fatty acids, vitamins A, D, B₁₂.
• Excess: sugar (glycation), alcohol (vasodilation).

Management Principle

Identify & eliminate triggers → repair barrier (ceramides, moisturizers) → anti-inflammatory (topical steroids, calcineurin inhibitors, PDE4 inhibitors) → maintenance.