The Flare Plan
The Flare Plan
What to change at home in the first 72 hours, when your skin has turned on you and nothing you own seems to help.
Twenty years of looking for cancer cells taught me to ask what changed
In diagnostics you are never allowed to guess. You look at what is in front of you, you work out what changed, and you rule things out one at a time until the answer is the only thing left standing. Skin is no different, and almost nobody treats it that way.
You have probably already tried a lot of things. You have a drawer of half used pots, and somewhere in there is the one that stung, and the one that everyone swore by, and the one that worked for a fortnight and then did not.
So this is not a ten step routine and it is not a list of products to buy. Most of what follows costs nothing. It is about water, temperature, fabric, what you take off your skin rather than what you put on it, and how to work out what set this off in the first place. That last part is the one everybody skips.
Read it once now. Keep the card near the end for three in the morning.
Your barrier, in one minute
The outer layer of your skin is built like a brick wall. Cells are the bricks. A mixture of fats holds them together like mortar. When that mortar thins out, two things happen at the same time.
Water leaves faster than it should, which is the tightness. And things that should have stayed outside get in, which wakes up your immune system, which is the redness and the heat. Then the itch arrives, you scratch, the scratching thins the mortar further, and the whole thing tightens into a loop that feeds itself.
Everything below aims at one of three points in that loop. Lose less water. Let less in. Interrupt the scratching.
In a Cochrane review of 77 trials, using a moisturiser meant fewer flares, a much longer gap between them, a median of 180 days compared with 30, and less topical steroid needed to get the same result.
The same review found no reliable evidence that any one moisturiser beats another. I would rather tell you that than pretend mine is the only thing that works. What matters far more is that you use something suitable, and that you use considerably more of it than you think.
Start with the shower, because that is where most of the damage happens
People change their moisturiser twelve times and never change how they wash. The shower is where you strip out the mortar, and then you spend the rest of the day trying to put it back.
Turn the temperature down
Warm, not hot. If your skin is pink when you get out, it was too hot. Heat dissolves surface lipids and heat drives itch, so a hot shower feels wonderful for four minutes and costs you the rest of the evening.
Keep it short
Five to ten minutes. Long soaks in hot water leave skin more permeable, not more hydrated. If you love a bath, keep it warm and brief, and get moisturiser on within minutes of getting out.
Do not scrub anything
No flannels on inflamed skin, no exfoliating mitts, no scrubs, no loofahs, no dry brushing. Not while you are flaring. You are trying to rebuild a wall and scrubbing takes bricks off the top.
Hands only, and only where you actually need to clean.Look at what is in the bottle, not the word on the front
The problem is not soap as a word. It is what a cleanser actually does to your skin. Three things cause most of the trouble: harsh sulfate detergents that strip lipids, a high alkaline pH that pushes your skin away from the slightly acidic state it needs, and fragrance.
During a flare, the safest choice is to wash the affected areas with an emollient or a very gentle non foaming cleanser, and to save anything foaming, scented or strongly alkaline for when the skin has calmed down.
Bubble baths, bath bombs, shower gels and heavily fragranced bars are the first things to go. Not forever. Just now.Pat dry with a soft towel
Do not rub. Rubbing with a rough or stiff towel undoes the whole shower. Use the softest towel you own, keep it for yourself, wash it in the same non biological detergent as everything else, and skip the fabric conditioner on it.
Leave the skin very slightly damp. That is on purpose. See the next section.Straight out of the shower
This is the single highest value habit in the whole plan and it takes no extra time. Skin that is still slightly damp holds far more of what you apply. Wait twenty minutes and you have lost the moment.
- Apply within three minutes of getting out, onto skin that is patted, not dried.
- Smooth downwards, in the direction the hair lies. Never rub in circles. Rubbing against the hair can block follicles and give you a spotty, sore folliculitis on top of everything else.
- Use more than feels normal. The skin should feel slightly greasy for a few minutes. If it vanishes instantly and feels dry again, you have not used enough or the product is too light for a flare.
- Scoop with a clean spoon or use a pump. Fingers put bacteria into the pot, and the pot goes back onto broken skin.
- Reapply every two to three hours on the worst areas while you are flaring, and keep going for a week after it looks better. Stopping too early is the most common reason a flare comes straight back.
This is the one I would reach for at this point in a flare. It is waterless and concentrated, built around oleic, linoleic and gamma linolenic acids, the same fatty acids your own barrier is made of, so it is replenishing the mortar rather than sitting on top of the bricks.
Colloidal oat flour and aloe give it the cushioning texture. Colloidal oat is one of the few botanicals with a proper evidence base behind it: in a clinical study a 1% colloidal oat cream improved barrier function, skin pH and microbiome diversity, where the standard moisturiser it was compared against improved hydration alone.
A pearl sized amount, warmed between your hands first. Onto slightly damp skin, morning and evening, and more often on the areas that need it.
Calming skin that is hot, tight and furious
There is a difference between skin that is dry and skin that is inflamed, and they want slightly different things. Dry skin wants lipids. Angry skin wants lipids and cooling and to be left alone.
- Get cool. Turn the thermostat down. Lose a layer of bedding. Loose cotton, nothing tight, nothing wool against the skin.
- Cold, not ice. A cool damp flannel laid on, not rubbed, for a few minutes. Keep a pot of balm in the fridge if cold application helps you, and for a lot of people it really does. Never put ice directly on compromised skin.
- Stop introducing new things. One product at a time, or you will learn nothing about what is helping.
- Take the friction off. Wool, rough synthetics, tight waistbands, seams, labels. All of it, for a fortnight.
This is the one for irritation rather than dryness. Blue chamomile carries chamazulene, the compound that gives it that deep blue colour and the reason it has been used on angry skin for centuries. Ucuuba butter is unusually rich in the saturated fatty acids that sit comfortably on compromised skin. Tamanu oil and sea buckthorn round it out.
I made this one first, for my mother, during her treatment. It was never meant to be a product.
Emollients soak into fabric and make it far more flammable. Clothing, bedding, dressings and bandages hold the residue even after washing. Keep away from naked flames, cigarettes, gas hobs and open fires, and wash bedding regularly and hot. This has caused serious injuries and hardly anyone is told.
The night
If you fix one thing, fix this. In a study of American adults with atopic dermatitis, almost 80% reported trouble sleeping in the previous three days, and the analysis found that sleep disturbance was the thing carrying the link between how bad the skin was and how bad people felt.
In other words, the itch is not what breaks people. The not sleeping is. So treat sleep as part of the plan, not a side effect of it.
- Heavier layer of balm last thing at night than during the day
- Bedroom cooler than feels normal, somewhere around 16 to 18 degrees
- Cotton nightwear, cotton bedding, nothing wool, nothing brushed polyester
- Nails cut short and filed smooth tonight, not tomorrow
- Cotton gloves or long cotton sleeves if you scratch in your sleep, and most people do without knowing
- Tell your GP the flare is stopping you sleeping. It genuinely changes how seriously it gets taken.
What to do instead of scratching
“Stop scratching” is useless advice and everyone gives it. Scratching is half reflex and half habit, and by the time you notice you are already doing it. What actually works is having a specific thing to do instead, decided in advance.
Try this
- Press firmly on the spot for thirty seconds
- Pinch the skin beside it, hard enough to register
- Cool flannel, laid on, not rubbed
- Apply more balm. It gives your hands the job they wanted.
- Count it. Just noticing reduces how often you do it.
Not this
- Ice directly on the skin
- Hot water on an itchy patch. Four minutes of relief, a worse night.
- Scrubbing or exfoliating anything that is flaring
- Fragrance, essential oils or alcohol on broken skin
- Five new products at once
What set this off
This is the part I care about most, and the part generic advice always leaves out. A flare is almost never one thing. It is usually three or four things landing in the same week, and the skin only reacts once the load gets too high.
Flares also lag behind their cause by a day or two, which is exactly why memory is useless here and writing it down is not.
On your skin and around it
- Detergent. Biological washing powders contain enzymes. Switch to non biological, drop the fabric conditioner entirely, and run an extra rinse.
- Fabric. Wool, and tight synthetics that trap sweat. Polyester gym leggings, nylon tights, brushed fleece. Cotton and silk against the skin.
- Swimming. Chlorine is a very common trigger and nobody warns you. Rinse in warm water within minutes of getting out, then balm straight on. Do not skip it because you are cold.
- Heat and sweat. Hot yoga, saunas, sleeping too warm, a sudden change in weather. Sweat sitting on skin is an irritant in itself, so rinse and reapply after exercise.
- Hard water. If you have moved house or the flare started with no other change, it is worth considering.
- Fragrance. Not just perfume. Candles, plug ins, air fresheners, cleaning sprays, someone else's hairspray, the hand soap at work.
- Hands. Gloves for washing up and cleaning. Every time, not most times.
Inside
- What you ate that day and the day before. Write it down, do not act on it yet. Patterns take weeks to see and one bad day proves nothing.
- Stress and sleep. Both are genuine physiological triggers, not an excuse people give you.
- Illness. A cold, an infection, a course of antibiotics.
- Hormones. Cycle, pregnancy, perimenopause. Very commonly involved and very rarely asked about.
Especially for a child. Unsupervised elimination diets carry real nutritional risk, and they make a genuine food allergy harder to diagnose properly later on. If you suspect food, that is a conversation with your GP or a dietitian, with your log in your hand.
The log
Two minutes a day. This is the thing that turns “nothing works” into an actual answer, and it is the single most useful thing you can bring to any appointment, including one with me.
| Write down | Why |
|---|---|
| Itch out of 10, morning and night | Gives you a trend instead of a feeling |
| Hours slept, and how many times you woke | The outcome that actually matters |
| Anything new touching your skin | Products, detergent, fabrics, water |
| What you ate | Record it. Do not eliminate anything yet. |
| Stress, illness, hormones, weather | All real, all easy to dismiss afterwards |
| What you applied and how often | Separates “it did not work” from “I used it twice” |
| A photograph, same light, same spot | Your eyes adapt. The camera does not. |
Where steroids fit
I am not going to tell you to stop your steroids, and I would be careful with anyone selling skincare who does.
An umbrella review of 38 systematic reviews found no evidence of harm when topical steroids were used intermittently as needed for flares, or twice weekly to prevent them. There was evidence of thinning with prolonged continuous use, which is worth taking seriously, but short appropriate courses are not the danger the internet makes them.
What the Cochrane evidence also shows is that a moisturiser used alongside an active treatment worked better than the active treatment on its own, and reduced how much steroid was needed. That is where barrier care actually earns its place. Not instead of what your doctor gave you. As the reason you need less of it.
If you are worried, say so to your prescriber, plainly. “I am worried about using this long term, can we talk about how much and for how long” is a completely reasonable sentence, and a good clinician will be glad you asked. Stopping suddenly without that conversation is where people come unstuck.
If you think this is topical steroid withdrawal
You have probably been told two opposite things already, so let me be straight about what is actually known.
It is described in the literature as redness and burning after stopping prolonged use of mid to high potency topical steroids. A UK hospital series reported redness, skin pain usually described as burning, sensitivity, heavy flaking, insomnia and severe itching, in mostly younger women who nearly all had eczema underneath.
There is no agreed diagnostic criterion. In a survey of dermatologists only about a third considered it a distinct condition and around half were not confident diagnosing it. I am not going to pretend that uncertainty away to sound more authoritative than the evidence allows.
What is not in doubt is that people in this position are frequently disbelieved, and that being disbelieved is what pushes them towards unregulated advice online. If you have felt dismissed, you were not imagining it. The research says so.
I cannot tell you whether you have this. Nobody can, from the internet, and anyone who does should worry you. I cannot tell you to stop a prescribed medicine. What I can say is that the barrier care in this plan is appropriate for skin in this state, that it is not a treatment for anything underlying it, and that you deserve a clinician who will sit down and have the conversation properly. Ask to be referred. Take the log with you.
The card
Print this page or screenshot this section, and put it where you will find it at three in the morning.
Tonight
In order
- Warm shower, five to ten minutes. No scrubbing. Nothing foaming or scented.
- Pat dry with the softest towel you own. Leave the skin slightly damp.
- Balm within three minutes. Smoothed downwards. More than feels normal.
- Nails short and filed. Cotton sleeves or gloves for bed.
- Bedroom cool. Cotton bedding. Lose a layer.
- Cool flannel laid on, not rubbed, if it is burning.
- Write down: itch out of 10, hours slept, anything new today, what you ate.
- Reapply every two to three hours tomorrow, and keep going a week after it looks better.
The printable version
The whole plan condensed onto a page you can keep by the bed. I will send it over, with two short emails afterwards: one about sleep, one about finding your trigger. Then I stop.
Book a skin consultation
Everything above is general. It is good general advice, and for a lot of people it is enough. But your skin is not general, and the reason most advice fails is that it was written for nobody in particular.
A flare is multifactorial. Your water, your detergent, your job, your hormones, what you eat, what you already tried and what it did. Working that out properly takes a conversation, not a leaflet.
A proper look at your skin, with me
Not a sales call. Thirty minutes with someone who spent twenty years finding cancer cells in tissue samples and now points the same eye at skin. We go through your history, your triggers and your routine, and you get a plan built for your circumstances rather than for nobody in particular.
- You book a thirty minute slot.
- I send you a skin audit form to fill in beforehand, so we do not spend the call on basics.
- We talk. I ask a lot of questions. You ask whatever you like.
- You get a written plan afterwards, specific to you, including what to stop as well as what to start.
A consultation is skincare and barrier support guidance. It is not a medical appointment, I do not diagnose or prescribe, and it does not replace your GP or dermatologist. If what you describe needs medical assessment, I will tell you so and say why.
When to stop and ring someone
Most flares are miserable and not dangerous. A few are urgent. Please read this list once now, and again if anything changes.
- The skin is blistered, crusted, weeping or has spots filled with pus
- Any area is painful, swollen or hot to touch
- You have a high temperature or feel generally unwell
- It has suddenly become much worse or spread quickly
- You see clusters of small painful blisters, particularly if they came on fast. This can be a herpes infection of eczema prone skin and it needs looking at the same day.
Infection in broken skin is common and very treatable, but only if somebody looks at it. Please do not wait it out.
Long painful flares are exhausting in a way people who have not had them do not understand. A UK case series of patients with topical steroid withdrawal recorded a high burden of anxiety and depression, and some patients expressing suicidal thoughts. If you recognise yourself in that, please tell your GP, or contact Samaritans free on 116 123, at any hour.
You are not being dramatic. It is a documented part of this.
Who wrote this
For twenty years my job was to find cancer cells. I worked as a specialist scientist in cancer diagnostics, reading tissue down a microscope and running the molecular tests that tell a consultant what they are dealing with. You learn to look at a sample and see what is actually happening in it rather than what somebody hopes is happening.
I now use that same eye on skin. Barrier damage, inflammation, what is driving it and what is only a symptom of it. It is the same discipline pointed at a different problem, which is why I keep asking you what changed rather than what you have tried.
I did not come to skincare through beauty. I came through a laboratory, and then through my own family. My mother, during her cancer treatment, when we could not find anything that was both effective and felt like care. And my son, whose eczema arrived alongside a compromised immune system. Born of Necessity is named literally.
For the record: I am an HCPC registered Biomedical Scientist. That title is protected in UK law, so only people on the Health and Care Professions Council register may use it, and you are very welcome to check.
I make fragrance free botanical formulas in small batches in the UK, for skin that reacts to almost everything. None of them is a medicine and none of them treats a disease. They are built to support a barrier that is struggling, while you and your clinician deal with the rest.
Guided by science, perfected by motherhood.
This guide is general information and education. It is not a diagnosis, not personal medical advice, and not a substitute for assessment by your GP, dermatologist, pharmacist or specialist nurse. Do not start, stop or change any prescribed treatment on the basis of anything written here. Cosmetic products, including mine, are not medicines and do not treat, cure or prevent disease. If you are pregnant, breastfeeding, treating a young child, immunosuppressed or going through cancer treatment, please check any new product with your clinical team first. If your skin is broken, infected, or you are unwell, seek medical help rather than reaching for a new product.
Sources
Clinical references retrieved from PubMed. I would rather you checked them than took my word for it.
- van Zuuren EJ, Fedorowicz Z, Christensen R, Lavrijsen A, Arents BWM. Emollients and moisturisers for eczema. Cochrane Database of Systematic Reviews 2017. doi:10.1002/14651858.CD012119.pub2
- Axon E, Chalmers JR, Santer M, et al. Safety of topical corticosteroids in atopic eczema: an umbrella review. BMJ Open 2021. doi:10.1136/bmjopen-2020-046476
- Silverberg JI, Chiesa-Fuxench Z, Margolis D, et al. Epidemiology and Burden of Sleep Disturbances in Atopic Dermatitis in US Adults. Dermatitis 2021. doi:10.1097/DER.0000000000000731
- Capone K, Kirchner F, Klein SL, Tierney NK. Effects of Colloidal Oatmeal Topical Atopic Dermatitis Cream on Skin Microbiome and Skin Barrier Properties. Journal of Drugs in Dermatology 2020. doi:10.36849/JDD.2020.4924
- Brookes TS, Barlow R, Mohandas P, Bewley A. Topical steroid withdrawal: an emerging clinical problem. Clinical and Experimental Dermatology 2023. doi:10.1093/ced/llad161
- Topical steroid withdrawal: self-diagnosis, unconscious bias and social media. Skin Health and Disease 2025. academic.oup.com/skinhd
- NHS. Atopic eczema: treatment and when to get help. nhs.uk
- Health and Care Professions Council. Professions and protected titles. hcpc-uk.org
