October is Eczema Awareness Month — and if you have eczema, or care for someone who does, you already know that awareness alone isn't enough. What people with eczema need isn't more awareness of the condition's existence. They need a clearer understanding of what's actually driving it, why it keeps coming back, and what approaches exist beyond the treatments that have dominated the conversation for decades. This guide covers all of it — what eczema is, how the different types work, what triggers flares, and how the skin microbiome connects to everything. At Treats Lab, our Ato Biome Care philosophy starts with exactly this kind of understanding — because you can't support a system you don't understand.

TL;DR

• Eczema is not one condition — it's a family of inflammatory skin disorders, each with different causes, triggers, and microbiome profiles
• 31.6 million Americans have some form of eczema — making it one of the most common skin conditions in the US, and prevalence is rising
• Atopic dermatitis is the most common type and is driven by a combination of immune hypersensitivity, barrier dysfunction, and skin microbiome dysbiosis — specifically Staphylococcus aureus overgrowth
• The skin microbiome plays a central role in eczema — not just as a consequence of inflammation but as an active driver of the itch-inflammation cycle
• Common eczema triggers include stress, environmental factors, certain foods, skincare ingredients, and — critically — topical steroid cream itself in some cases
• Understanding which type of eczema you have and what's driving your specific flares is the foundation of effective long-term management
• A steroid-free approach focused on barrier repair and microbiome support addresses the underlying drivers of eczema rather than suppressing symptoms
• The Calm & Restore Duo was formulated specifically for eczema-prone and sensitive skin — barrier-first, microbiome-supportive, and steroid-free
• Always work with a dermatologist to confirm your diagnosis and discuss treatment options

In This Article

1. What Is Eczema?
2. What Are the Different Types of Eczema?
3. What Causes Eczema?
4. What Triggers Eczema Flares?
5. How Does the Skin Microbiome Connect to Eczema?
6. What Are the Main Approaches to Managing Eczema?
7. What Does a Steroid-Free Approach to Eczema Look Like?
8. FAQs About Eczema

What Is Eczema?

Eczema — also called atopic dermatitis in its most common form — is a chronic inflammatory skin condition characterized by dry, itchy, red, and irritated skin that flares unpredictably and is difficult to manage with conventional approaches alone.

Eczema affects approximately 31.6 million Americans — about 10% of the population — making it the most common inflammatory skin condition in the United States Globally, 204 million people live with atopic dermatitis and prevalence is rising — a 2026 study published in the Journal of the American Academy of Dermatology found US child prevalence increased significantly from 10.7% in 2021 to 12.7% in 2024. Atopic dermatitis ranks first among skin conditions as measured by disability-adjusted life-years — meaning it has a greater impact on quality of life than any other skin disorder.

Despite how common it is, eczema is frequently misunderstood — by the people who have it, by the people who treat them, and by the products marketed to them. The most important thing to understand is that eczema is not a surface problem. It's a systems problem — involving the immune system, the skin barrier, and the skin microbiome simultaneously. Managing it effectively requires addressing all three.

Learn more: 7 Types of Eczema: Microbiome Guide

What Are the Different Types of Eczema?

Eczema is an umbrella term covering several distinct conditions. Understanding which type you have is the foundation of effective management — because the same approach doesn't work for all of them.

Atopic Dermatitis — the most common type, affecting 16.5 million US adults and 9.6 million US children Driven by immune hypersensitivity, barrier dysfunction, and Staphylococcus aureus overgrowth. Typically appears in skin folds, face, and neck. Often associated with asthma and hay fever.

Seborrheic Dermatitis — driven by Malassezia yeast overgrowth in oil-rich areas — scalp, face, and chest. A different microbiome imbalance from atopic dermatitis requiring a different approach. Dandruff is a mild form.

Contact Dermatitis — triggered by allergen or irritant exposure. Primary intervention is identifying and removing the trigger. Learn more: Atopic Dermatitis vs Seborrheic Dermatitis

Perioral Dermatitis — inflammatory rash around the mouth and nose, most common in women. Frequently triggered or worsened by topical steroid use on the face. Learn more: Perioral Dermatitis: What It Is, Why Steroid Creams Make It Worse

Dyshidrotic Eczema — small, intensely itchy blisters on palms, fingers, and soles. Triggered by stress, sweating, and seasonal allergies.

Nummular Eczema — coin-shaped patches on arms and legs. Associated with very dry skin.

Neurodermatitis — intense localized itching leading to thick, leathery skin patches through repeated scratching. Driven by the itch-scratch cycle.

Stasis Dermatitis — occurs in lower legs due to poor circulation. Vascular in origin rather than immunological.

For a comprehensive breakdown of each type and its microbiome connection, see our full guide: 7 Types of Eczema: Microbiome Guide

What Causes Eczema?

Eczema doesn't have a single cause — it develops from the interaction of genetic predisposition, immune system function, barrier integrity, and environmental factors. Understanding these interconnected drivers is more useful than looking for one root cause.

Genetic factors. People with eczema often have mutations in the filaggrin gene — a protein essential for maintaining the skin barrier. Filaggrin deficiency makes the barrier more permeable, allowing irritants and allergens to penetrate more easily and triggering immune responses that healthy barrier skin would handle without incident. This genetic predisposition doesn't cause eczema on its own — it creates a vulnerability that environmental and microbial factors then activate.

Immune system dysregulation. Atopic dermatitis involves a Th2-skewed immune response — meaning the immune system overreacts to stimuli that shouldn't trigger significant inflammation. This dysregulation produces elevated levels of inflammatory cytokines — particularly IL-4, IL-13, and IL-31 — that directly drive the inflammation and itch that characterize eczema. The immune component explains why eczema is so closely associated with other atopic conditions like asthma and hay fever — it's a systemic immune predisposition, not just a skin problem.

Barrier dysfunction. The compromised barrier that results from filaggrin deficiency creates a self-reinforcing problem. A permeable barrier allows more irritants and bacteria to reach the immune system, triggering more inflammation. That inflammation further damages the barrier. Which allows more penetration. The barrier-inflammation cycle is one of the central dynamics that makes eczema so persistent.

Microbiome dysbiosis. This is the component that gets least attention in conventional eczema education — and arguably the most important for long-term management. The skin microbiome in atopic dermatitis is characterized by dramatically reduced diversity and Staphylococcus aureus overgrowth. S. aureus directly triggers immune overreaction, damages barrier proteins, and amplifies the itch signal. Addressing the microbiome — not just the inflammation it produces — is central to breaking the eczema cycle.

What Triggers Eczema Flares?

Understanding your specific triggers is one of the most powerful tools for managing eczema — because avoiding or managing triggers reduces the frequency and severity of flares before they start. Common triggers include:

Skincare and personal care products — fragrances are the most common contact allergen. Sulfates strip the barrier. Alcohol dries and disrupts the microbiome. Even "natural" ingredients can trigger reactions in atopic skin. Fragrance-free, sulfate-free formulas are non-negotiable.

Topical steroid cream — one of the most important and least discussed triggers. Topical steroids can provide short-term relief but with repeated use, they disrupt the skin microflora and can trigger rebound flares — particularly on the face, where perioral dermatitis is a common consequence. Learn more: What Are Topical Steroids? How They Work, Why They Help, and What They Cost Your Skin

Environmental factors — dry air, cold weather, heat, humidity, air pollution, and seasonal allergens all influence eczema severity. Indoor heating in winter removes moisture from the air and worsens barrier compromise.

Stress — one of the most consistently documented eczema triggers. Stress dysregulates the immune response, activating the same inflammatory pathways that drive eczema flares. Managing stress is a clinical recommendation, not just lifestyle advice.

Sweat and exercise — sweat can irritate eczema-prone skin, particularly in skin folds. Rinsing and applying a barrier-supportive moisturizer after exercise helps manage this trigger.

Dietary factors — certain foods trigger eczema in some individuals, particularly common allergens like dairy, eggs, gluten, and soy. The relationship is highly individual — food allergy testing with a dermatologist or allergist can identify specific triggers.

Hormonal changes — perimenopause, menstrual cycles, and hormonal fluctuations all affect eczema severity through their impact on immune regulation and the skin microbiome. Learn more: How to Calm Itchy Skin Without Steroids

Fabric and clothing — wool and synthetic fabrics can irritate eczema-prone skin. Soft, natural fabrics like cotton and bamboo are generally better tolerated.

For a more detailed guide to identifying your specific triggers: [Eczema Flare Triggers: How to Identify What's Making Your Skin React]([URL: eczema-flare-triggers])

Learn more: How to Support Your Skin Microbiome for Healthy, Balanced Skin

How Does the Skin Microbiome Connect to Eczema?

The skin microbiome is not a passenger in eczema — it's one of the central drivers. Understanding this connection is what fundamentally changes how you approach the condition.

In healthy skin, the microbiome is diverse — dozens of bacterial and fungal species coexist in a balanced ecosystem that collectively regulates immune response, maintains barrier function, and protects against pathogens. In atopic dermatitis, that diversity collapses. S. aureus colonizes up to 90% of eczema-prone skin during flares — compared to around 5% of healthy skin. As S. aureus dominates, it produces toxins that damage barrier proteins, trigger the Th2 immune response that drives atopic inflammation, and directly activate the itch nerve fibers that create the itch-scratch cycle.

Topical steroids suppress this inflammatory response temporarily — but they don't address the microbiome dysbiosis driving it. When the steroid is stopped, the S. aureus is still there, the immune system is primed to overreact, and the flare returns. Research shows the skin microbiome remains measurably different from healthy skin even after steroid treatment reduces visible symptoms. This is why microbiome support is not optional in eczema management. It's one of the most direct ways to address what keeps the condition cycling.

Learn more: Prebiotics, Probiotics and Postbiotics in Skincare]([URL: prebiotics-probiotics-postbiotics-skincare
Learn more: Heartleaf Benefits for Skin

What Are the Main Approaches to Managing Eczema?

Topical steroids — the most commonly prescribed first-line treatment. Effective for acute flare relief. Do not address the underlying microbiome dysbiosis or barrier dysfunction driving the condition. With repeated long-term use, associated with skin thinning, microbiome disruption, and — in some cases — topical steroid withdrawal. Learn more: Topical Steroid Withdrawal

Topical calcineurin inhibitors (tacrolimus, pimecrolimus) — non-steroidal prescription immunomodulators that suppress the immune response without the skin-thinning effects of steroids. Useful for sensitive areas like the face. Do not address the microbiome.

Biologics (dupilumab/Dupixent) — injectable monoclonal antibodies that target specific cytokines driving atopic inflammation. The most significant advance in eczema treatment in decades for moderate to severe disease. Effective for immune dysregulation — do not address the microbiome directly.

Barrier repair — ceramides, lipids, and other barrier-supportive ingredients that address the structural compromise underlying atopic dermatitis. The American Academy of Dermatology recommends consistent moisturization as a cornerstone of eczema management alongside medical treatments.

Microbiome-supportive skincare — the most emerging and least discussed category in conventional eczema management. Addresses the dysbiosis driving the condition rather than suppressing the inflammation it causes. Includes botanical antimicrobials, postbiotics, and prebiotic ingredients chosen for their specific activity against the organisms driving eczema flares.

What Does a Steroid-Free Approach to Eczema Look Like?

A steroid-free approach to eczema is not a rejection of medical treatment — it's a complementary framework that addresses what steroids don't. For people managing mild to moderate eczema, or looking to reduce steroid dependence over time, it focuses on three interconnected priorities:

Barrier repair — ceramides, beta-glucan, and madecassoside rebuild the structural foundation that eczema chronically compromises. The ABC Microbiome Calming Lotion is built around these ingredients — alongside the Bi-Om Complex™ for microbiome support and copper tripeptide-1 for regenerative support of inflammation-damaged skin.

Microbiome support — Lactobacillus Ferment in the R+R Barrier Recovery Mist provides postbiotic support for the skin's microbial ecosystem. The Bi-Om Complex™ — Coptis Japonica, Scutellaria Baicalensis, Houttuynia Cordata (Heartleaf), and Dictamnus Dasycarpus — addresses the specific organisms driving eczema and seborrheic dermatitis flares through targeted botanical antimicrobial activity.

Consistency — steroid-free approaches work cumulatively. A consistent daily routine gives the barrier and microbiome time to stabilize — something that the flare-treatment-rebound cycle of steroid use actively prevents.

The Calm & Restore Duo — the ABC Microbiome Calming Lotion and R+R Barrier Recovery Mist — was formulated as a complete steroid-free daily system for eczema-prone and sensitive skin. The ABC Lotion carries the National Eczema Association Seal of Acceptance — confirming its suitability for eczema-prone skin. Free shipping is available on all orders now through October.

Learn more: Building a Steroid-Free Skincare Routine for Eczema-Prone Skin

FAQs About Eczema

Understanding Eczema Changes How You Care For It

Eczema Awareness Month is a reminder that awareness — real awareness, not just visibility — means understanding what's actually driving the condition. Not just that it exists, but why it persists. Why the flare always comes back. Why the same treatments that provide relief don't produce lasting change. And what a different approach looks like for people who are ready to stop cycling and start building.

The Calm & Restore Duo was built for exactly this — eczema-prone skin that needs more than symptom management. A complete steroid-free daily system addressing barrier, microbiome, and regeneration. The ABC Lotion carries the National Eczema Association Seal of Acceptance. Free shipping is available on all orders now through October.