Adult Onset Eczema: A Growing Phenomenon in Adulthood

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For as long as I can remember, eczema has been treated as something that belongs to childhood. A condition that starts early, flares unpredictably, and, in many cases, fades with age. That story is still repeated in clinics, online, and in everyday conversations.

But that narrative isn’t technically correct anymore

More and more adults are developing eczema for the first time, often with no personal or family history, and often at a point in life where they feel otherwise relatively well. Others who had mild symptoms as children are now facing something very different, more persistent, more localised, and often harder to understand.

This is not just anecdotal. A growing body of research suggests that Adult Onset Eczema (AOE) is not simply delayed childhood disease, but something with its own pattern, its own drivers, and its own set of challenges [1].

Rethinking what causes eczema in adults

Much of what we think we know about eczema comes from studies in children. In that context, genetics, particularly changes in the filaggrin gene, play a significant role in weakening the skin barrier and increasing susceptibility to irritation and inflammation.

But when researchers began looking more closely at adults who develop eczema later in life, this pattern didn’t replicate. Those same genetic markers were either less common or far less predictive [2,3].

For adults, the environment is what appears to have a primary role.

Adult onset eczema appears to be shaped less by inherited risk, and more by what has happened over time. Long term exposure to pollutants, repeated contact with irritants, changes in lifestyle, and the cumulative effect of stress and internal health all seem to play a far more prominent role.

In other words, in children eczema is more nature led and in adults it is more nurture.

There is even evidence that certain genetic variations do not directly cause eczema, but instead make the body more sensitive to environmental exposures. For example, variations in the arylhydrocarbon receptor can dramatically increase the impact of air pollution on eczema risk, effectively amplifying the effect of the environment on the skin [3].

So, you aren’t imagining it. Your eczema didn’t appear out of nowhere, you reached a tipping point that meant that your potential tendency to eczema started to be expressed.

The role of modern living – Environmental Exposures

Modern living provides multiple potential factors that could trigger this expression.

Air pollution is one of the clearest examples. Large population studies have consistently shown that exposure to fine particulate matter is associated with an increased risk of eczema in adults, both in terms of developing the condition and experiencing flares [4,5].

This is not just a correlation. Studies have shown that pollutants can directly affect the skin by increasing oxidative stress, disrupting the barrier, and triggering inflammatory pathways.

While exposure to air pollution is often unavoidable in modern life, we can focus on what we can control.

So better, to focus on what we can control.

The jobs we do may contribute to the flares we experience

There are other more tangible, occupational and everyday exposures that can be avoided if really necessary.

Repeated contact with water, detergents, cleaning products, fragrances, or industrial chemicals can gradually wear down the skin barrier. In some professions, such as healthcare, hairdressing, cleaning, and manufacturing, this exposure is constant.

One of my clients is a nurse, the constant requirement to wash her hands before, during and after visits crippled her hands. By changing her hand-soap as well as ensuring that her daily meals contained all of the healing nutrients her skin needed, she was able to continue her activity, whilst protecting her fragile skin.

Studies have shown particularly strong associations between eczema and chemicals such as acrylates and isocyanates, with risk increases that are difficult to ignore [6].

But it is not just about what touches the skin.

It is also about what the body is dealing with internally.

It’s more than skin deep

When an adult is diagnosed with AOE, they are often encouraged to focus solely on external treatments like continuous moisturising, as if the condition were purely a surface problem.

Nutritional status, immune regulation, metabolic health, and the microbiome all play a role in how resilient the skin is, and how it responds to stress.

For example, research has shown that higher levels of omega 3 fatty acids are associated with a reduced risk of eczema, particularly when combined with certain genetic profiles [7]. This does not mean omega 3 is the single solution, but it does highlight how internal factors shape the skin’s response.

Similarly, studies of the gut microbiome in adults with eczema have found reduced diversity and shifts in bacterial composition compared with healthy individuals [8]. While it isn’t possible to say this is the cause, it reinforces the idea that eczema is part of a wider system, not just a surface issue.

No, it isn’t all in the mind, but the mind does matter

Then there is stress, most clients I see mention stress as playing a role in their chronic eczema. I know that despite my wedding day being one of the happiest days of my life, my hand eczema was so bad that every picture has me hiding my hands.

Chronic stress alters immune signalling, increases inflammatory activity, and slows the skin’s ability to repair itself. Many adults can pinpoint a period of sustained stress, burnout, illness, or life change that coincided with the onset of their eczema.

Why adult eczema looks different

Another reason adult eczema is often misunderstood is that it does not always look like what people expect.

Rather than appearing in the classic flexural areas seen in children, adult eczema is more likely to show up on the hands, eyelids, neck, scalp, or face. It can be more localised, but also more persistent. I’ve noticed in the past 18 months a significant increase in clients citing agonising neck eczema as their hardest patch to manage.

It’s also worth remembering that in some cases, it can mimic other conditions entirely, from contact dermatitis to psoriasis or fungal infections, which can delay accurate diagnosis [1].

AOE is also less strongly linked to a personal or family history of allergies, which can make it feel even more unpredictable.

This is when you have to remember that AOE isn’t necessarily about a single trigger, and more like an accumulation of factors that all need to be identified and supported.

From overwhelm to understanding

This is where we need to concentrate on a different approach. Most people, understandably, respond to an eczema flare by trying to control it. Removing foods, changing products, searching for the one trigger that explains everything.

This may work for some types of eczema. I know my own atopic dermatitis is triggered by egg protein. I avoid eggs, I have no eczema. For most of my AOE clients, however, something so simplistic isn’t the solution and yet they come to see me having eliminated most of their foods, changed all their personal hygiene products, bought air purifiers and still not seen any improvement.

My work is to help them unravel which factors, in which combination, led to the tipping point I talked about at the beginning of this article. Environmental exposure, internal resilience, stress, immune activity, and skin barrier function all interacting over time.

Sometimes that starts with very simple things. Sometimes we do need to consider a food trigger, nutrient depletion, which creams, lotions and potions they use, but sometimes we just need to focus on eating skin supportive nutrients, eating regularly, reducing unnecessary exposure to irritants. Creating space for recovery.

What works isn’t the quick fix you’ve found on the internet. It’s the work to uncover which systems are affected that have an impact on your skin. This is the key for AOE.

A different way to see it

If you have developed eczema as an adult, it is easy to feel like your body has suddenly become difficult or unpredictable.

However, what if you start looking at it from a different angle? What if we consider that your skin is responding to a combination of factors that have built up over time, for some many decades, but which suddenly reached that tipping point.

I know that this knowledge doesn’t suddenly make resolving your eczema easy, but it does make it understandable. Once something becomes understandable, it becomes something you can begin to work with, rather than something you are constantly fighting against.

If you’re ready to start this work and uncover the combination of factors driving your AOE, I’ve created a short self-assessment that helps you identify your personal eczema patterns, so you can stop guessing and start focusing on what matters most.

Take the Eczema Trap® quiz here and discover your top drivers.

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References

1. Lee HH, Patel KR, Singam V, Rastogi S, Silverberg JI. A systematic review and meta analysis of the prevalence and phenotype of adult onset atopic dermatitis. J Am Acad Dermatol. 2019;80(6):1526–1532.
2. Abuabara K, Ye M, McCulloch CE, et al. Clinical onset of atopic eczema: results from two nationally representative British birth cohorts followed through midlife. J Allergy Clin Immunol. 2019.
3. Hüls A, Krämer U, Fuks K, et al. Eczema in the elderly, the impact of genetics and air pollution. Environ Health Perspect. 2018.
4. Hsiao YY, Chen YH, Hung W, Tang K. Outdoor air pollutants and atopic dermatitis in adults: systematic review and meta analysis. 2022.
5. Tang KT, Ku KC, Chen DY, et al. Adult atopic dermatitis and exposure to air pollutants. Ann Allergy Asthma Immunol. 2017.
6. Lopez DJ, Alif SM, Dharmage SC, et al. Occupational exposures and adult eczema. Occup Environ Med. 2023.
7. Mao R, Meng X, Zhang T, et al. Omega 3 fatty acids and genetic susceptibility in atopic dermatitis. Mol Nutr Food Res. 2025.
8. Liu T, Yang C, He J, et al. Gut microbiota in adult onset atopic dermatitis. Allergol Immunopathol. 2022.