By Dr.Nirvana S.Pillay, Neuroscientist & Public Health Epidemiologist
Many people treat eczema as a purely skin problem.But if you’ve ever wondered why eczema improves and then flares again — often without a clear trigger — the answer usually lies deeper than the skin.
Eczema is not just a surface condition.
It is a biological loop involving the skin barrier, immune system, and nervous system.
Understanding this loop is key to breaking the cycle.
Eczema Is a Skin Barrier Problem — Not Just Dry Skin
Healthy skin functions as a protective barrier.
It keeps moisture in and prevents irritants, allergens, and microbes from entering.
In eczema-prone skin:
- The skin barrier is structurally weaker
- Moisture escapes more easily
- Irritants penetrate more readily
- The immune system becomes over-reactive
This leads to chronic inflammation, even when the skin appears calm on the surface.
The Role of the Nervous System in Eczema
The skin is directly connected to the nervous system.
This relationship is known as the brain–skin axis.
When the body experiences ongoing stress — physical, emotional, or mental — it activates the stress response system.
This results in:
- Increased release of cortisol
- Altered immune signalling
- Slower skin barrier repair
- Reduced healing efficiency
Over time, stress does not only trigger eczema.
It prevents the skin from fully recovering, making flare-ups more likely to return.
Why Eczema Improves… Then Comes Back Again
Many eczema treatments focus on calming visible symptoms such as:
- Redness
- Itching
- Inflammation
However, if:
- The skin barrier is not actively rebuilt, and
- The nervous system remains in a heightened stress state
then the underlying biology has not changed.
This is why eczema often:
- Improves temporarily
- Returns during stressful periods
- Worsens with illness, fatigue, or emotional overload
The skin is responding appropriately to a body that has not yet returned to balance.
Is Eczema an Immune Condition or a Nervous System Condition?
Eczema involves both systems.
- The immune system drives inflammation
- The nervous system regulates immune responses and skin repair
When nervous system regulation is disrupted:
- Immune responses become exaggerated
- Inflammation lasts longer
- Skin barrier recovery slows
This is why eczema is increasingly understood as a neuro-immune skin condition, not just a dermatological one.
Why Gentle, Steroid-Free Support Matters Long Term
Aggressive treatments can suppress symptoms quickly, but they may also:
- Disrupt the skin microbiome
- Thin the skin barrier over time
- Reduce long-term skin resilience
For eczema-prone skin, long-term management focuses on:
- Supporting barrier repair
- Minimising irritation
- Allowing the skin’s natural biology to recover
This is where gentle, non-steroid formulations play an important role — especially for sensitive skin and children.
Supporting Eczema-Prone Skin More Effectively
A biology-led approach focuses on three key areas:
1. Skin Barrier Repair
- Deep hydration
- Occlusive support to reduce moisture loss
- Ingredients that strengthen skin structure
2. Nervous System Calm
- Reducing chronic stress signals
- Avoiding harsh or sensitising products
- Creating consistent, gentle skincare routines
3. Long-Term Skin Resilience
- Supporting recovery over time
- Reducing flare frequency rather than chasing symptoms
Eczema care is not about quick fixes.
It is about restoring balance.
A More Sustainable Way to Think About Eczema
Eczema is not a failure of hygiene or willpower.
It is the skin communicating that its protective and regulatory systems are overwhelmed.
When skincare supports both:
- The physical skin barrier, and
- The biological environment the skin exists in
flare-ups often become easier to manage — and less frequent over time.
Frequently Asked Questions
Why does eczema keep coming back even after treatment?
Many treatments reduce inflammation but do not fully restore the skin barrier or address stress-related nervous system signals.
Can stress really cause eczema flare-ups?
Yes. Chronic stress alters immune responses and slows skin barrier repair, increasing the likelihood of flare-ups.
Is eczema only a skin condition?
No. Eczema involves the skin, immune system, and nervous system working together.
Is steroid-free eczema care effective?
For long-term management and sensitive skin, gentle steroid-free care focused on barrier support is often preferred.
Final Thought
Eczema is not just about calming the skin.
It is about supporting the biology that allows skin to heal.
Understanding the stress–skin connection is often the missing piece.
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