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ECZEMA
AWARENESS CENTER

Can Keeping Things Too Clean Raise the Risk for Eczema in Children?

Posted on March 09, 2022
Medically reviewed by
Kevin Berman, M.D., Ph.D.
Article written by
Kristopher Bunting, M.D.

Eczema, also called atopic dermatitis or atopic eczema, is a common skin condition in young children and many adults. Still, the causes of eczema are poorly understood.

Decades ago, the so-called “hygiene hypothesis” was proposed to explain eczema and related allergic diseases. The hygiene hypothesis suggests that atopic diseases (eczema, asthma, food allergies, and environmental allergies) could be caused if a child grows up in settings that were too clean and sterile. Not being exposed to bacteria, it was thought, impeded proper immune system development.

Over the past 20 years, however, research has shown that the hygiene hypothesis is not necessarily valid. Still, it has raised the idea that a person’s early life experiences may affect their risk to develop eczema and related disorders.

Does Eczema Come From Being Too Clean?

The answer is yes … and no. Eczema does not occur due to proper hygiene, but it may be influenced if a person lacks exposure to healthy bacteria and other organisms. The hygiene hypothesis is discussed frequently in both scientific literature and the media, but the concept of being “too clean” appears to have become misunderstood. The hygiene hypothesis, at its core, is not about a person who is too hygienic. Rather, it is about people who don’t get enough exposure to normal bacteria (and other things in our environments) that make our immune systems stronger.

Personal hygiene and cleaning — hand washing and keeping a clean home, for example — are essential to prevent the spread of infectious diseases, but these do not contribute to a person developing eczema. However, the products we use to keep ourselves and our environments clean may contribute to the condition. Exposure to certain chemicals in soaps and other cleaning products may irritate a person’s skin, disrupt their skin barrier, and contribute to their developing eczema.

Eczema and the Immune System

The cause of eczema is not fully understood, but its development is known to be influenced by both genetic and environmental factors.

The skin serves as a barrier between our bodies and the outside world. But in a person who has eczema, this barrier has broken down due to a lack of certain proteins. A broken barrier creates an abnormal exposure to the environment. Combined with abnormal immune function, a broken skin barrier can result in immune reactions — and reactions to things that your immune system was never meant to encounter.

Exposure during childhood can result in a person’s immune system becoming sensitized to allergens that are normal parts of our environment. Such exposure can also contribute to a person’s increased risk of developing autoimmune diseases.

Eczema, allergies, and asthma are known as the atopic triad. This triad can occur when a person’s immune system becomes overactive and creates inflammation. The immune system protects the body from disease by recognizing and attacking things that are potentially dangerous, such as viruses and bacteria. It is believed that eczema and related conditions occur when someone’s immune system reads a harmless thing in their body or environment as dangerous. Such an inappropriate immune response can result in chronic, damaging inflammation.

From birth onward, our immune systems learn to recognize what is “safe” and what is “dangerous” through exposure. In addition to what we encounter through our enviroment, we are also exposed to the bacteria and other organisms that live in and on our bodies.

Recent Eczema Research

The “old friends hypothesis” has been proposed as a refinement of the hygiene hypothesis. According to the old friends hypothesis, humans (and our immune systems) have evolved to exist in balance with the organisms in our natural microbiome. The microbiome is the collection of bacteria, fungi, and other microorganisms living on our skin and in our gut. These helpful or “good” bacteria are an essential part of having a healthy body and mind. Without exposure to these beneficial bacteria during early childhood, our immune system does not learn that these normal bacteria are safe and mounts an immune response against them.

According to the old friends hypothesis, a healthy microbiome contains a diverse population of different bacteria on the skin and in the gut. Research has shown that people with eczema tend to have an abnormally high ratio of Staphylococcus aureus (a bacteria that causes staph skin infections) to healthy microbes on their skin.

Recently, researchers have found that exposure to nature, including soil and plants, can help restore the diversity needed to have a healthy microbiome. Probiotics may also help maintain a healthy and diverse microbiome. A variety of probiotics containing different species of good bacteria have been proven to help restore a person’s microbiome to normality.

Early Environmental Exposures and Eczema

Several environmental factors have been linked to eczema, including exposure to some chemicals.

Antibiotics

Antibiotic use during the first year of life has been identified as a risk factor for eczema. Research also shows that if a person takes antibiotics during pregnancy, that can increase the risk of atopic disease in their child. Antibiotics kill not only harmful bacteria, but also some healthy bacteria. This leads to an imbalance of healthy bacteria that is believed to be a risk factor for eczema.

Antibacterial Soaps and Detergents

Triclosan is an antibacterial agent. Antibacterial and antimicrobial soaps and detergents containing triclosan do not prevent the spread of bacteria better than plain soap — and they may do more harm than good. Triclosan has been linked to a rise in antibiotic-resistant bacteria. It also is linked to allergies and hay fever through the way it affects your immune system.

Other Chemicals

Chemical additives, including dyes and fragrances found in soaps and detergents, can trigger eczema. Cleaning agents used at home may also trigger eczema by directly affecting a person’s immune system. Some cleaning agents, as well as chemical additives to foods and soaps, can act as irritants that trigger eczema.

What Can Help Prevent Childhood Eczema?

There are several things that you can do to help prevent or control eczema in children, starting with steps a person can take while they are pregnant. Things that may help reduce the risk of childhood eczema and related diseases include:

  • Breastfeeding — For at least four months
  • Probiotics — Taken during pregnancy and while breastfeeding as well as given to infants in families with a history of atopic disease
  • Solid food — Introduced to infants between 4 to 6 months old
  • Fragrance-free products — Opting for soaps and detergents with no added fragrances and dyes or other unnecessary chemicals

Talk With Others Who Understand

MyEczemaTeam is the social network for people with eczema and their loved ones. On MyEczemaTeam, more than 41,000 members come together to ask questions, give advice, and share their stories with others who understand life with eczema.

Are you or someone you care for living with eczema? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. Eczema — Cleveland Clinic
  2. The Hygiene Hypothesis in Allergy and Asthma: An Update — Current Opinion in Allergy and Clinical Immunology
  3. Time to Abandon the Hygiene Hypothesis: New Perspectives on Allergic Disease, the Human Microbiome, Infectious Disease Prevention and the Role of Targeted Hygiene — Perspectives in Public Health
  4. Microbial Exposures That Establish Immunoregulation Are Compatible With Targeted Hygiene — The Journal of Allergy and Clinical Immunology
  5. Atopic Dermatitis: A Disease of Altered Skin Barrier and Immune Dysregulation — Immunological Reviews
  6. Significance of Skin Barrier Dysfunction in Atopic Dermatitis — Allergy, Asthma & Immunology Research
  7. Atopy Defined — American Academy of Allergy, Asthma & Immunology
  8. The Old Friends Hypothesis — Graham Rook, University College London
  9. Regulation of the Immune System by Biodiversity From the Natural Environment: An Ecosystem Service Essential to Health — PNAS
  10. Skin Microbiome of Atopic Dermatitis — Allergology International
  11. Staph Infections — Mayo Clinic
  12. Biodiversity Intervention Enhances Immune Regulation and Health-Associated Commensal Microbiota Among Daycare Children — Science Advances
  13. Role of Nutritional Supplements in Selected Dermatological Disorders: A Review — Journal of Cosmetic Dermatology
  14. Probiotics Modulate the Gut Microbiota Composition and Immune Responses in Patients With Atopic Dermatitis: A Pilot Study — European Journal of Nutrition
  15. Triclosan Exposure, Transformation, and Human Health Effects — Journal of Toxicology and Environmental Health, Part B: Critical Reviews
  16. The Impact of Bisphenol A and Triclosan on Immune Parameters in the U.S. Population, NHANES 2003-2006 — Environmental Health Perspectives
  17. Guidelines of Care for the Management of Atopic Dermatitis — Journal of the American Academy of Dermatology
  18. Probiotics — American Family Physician
All updates must be accompanied by text or a picture.
Kevin Berman, M.D., Ph.D. is a dermatologist at the Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Learn more about him here.
Kristopher Bunting, M.D. studied chemistry and life sciences at the U.S. Military Academy, West Point, and received his doctor of medicine degree from Tulane University. Learn more about him here.

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