Why do I have eczema?’ is a question a lot of the young people we interviewed had thought about. Many knew their skin was often drier and more sensitive than other people’s skin, but they often weren’t sure why. A lot of people who had grown up with eczema couldn’t remember the causes ever being explained to them. Doctors may have told their parents but they may not have understood at the time. Unless they had since been told by a doctor or found out about it online, many young people didn’t know about the underlying causes. Sometimes they felt there just wasn’t enough information made available to them about causes and that it could be confusing when they looked it up themselves. See also ‘Getting a diagnosis and eczema changing over time‘.
The causes of eczema are complex and are not the same in all people with the skin condition. Research into understanding the causes of eczema continues. Thinking about the different layers and functions of the skin helps us to understand what’s happening in eczema. Normally the top layer (the epidermis) of the skin helps keep in moisture and natural oils. However, with eczema, there are changes in the surface of the skin which means it doesn’t work as well as a barrier. This makes it difficult to keep this moisture in, making the skin dry. Things which irritate the skin can add to this problem by damaging the skin further and make it more likely that the skin will react badly to any irritants. The immune system (which helps resist against infections) works differently in people who have eczema, by ‘over-reacting’ to normal things in the environment. A few people had heard about the ‘hygiene hypothesis’ – the idea that not enough exposure to germs in childhood limits the normal development of the immune system.
The exact reasons why some skins are prone to eczema are not fully known. It’s also unclear why some people’s eczema goes away as they get older, but stays for others. Some people we talked to had heard about scientific research looking into possible reasons for this. Genetics was also mentioned by people who knew other family members also had eczema or a history of other skin conditions like psoriasis. Some were the only person in their family to have eczema. Jessica’s vulval eczema came ‘out of the blue’ at age 20 as neither she, or anyone else in her family, had any eczema before.
Some people felt that understanding the causes of eczema was less important now they had come to accept having the condition. Instead, they were more interested in learning ways to treat and manage their eczema – including how to avoid or limit triggers.