For most people itching is the worst symptom of having eczema and unfortunately it can often be the most difficult to treat. Itching can also lead to sleep problems for both the person with eczema and their family and this lack of sleep can make life even more miserable. There are lots of things that you can do to reduce itching and, if you do scratch, to do less damage to your skin. Hopefully you will find the following information a useful guide.
Why does eczema itch?
Unfortunately the whole answer to this is not known. Skin that is affected by eczema releases certain chemicals, which then stimulate your nerves. These nerves then pass on the sensation of itch to the brain and before you know it you are scratching. It used to be thought that the main chemical released by the skin was something called histamine, hence antihistamines were used to control itching. Many doctors now believe that there are other chemicals involved that may be more important.
Once your brain has told you that you have an itch the natural reaction is to scratch. This scratching is one of the main causes of the rash and the redness that occurs in someone who has eczema. It is scratching that does all the damage to the skin, not the itch. Once you have scratched then you will probably find that you start to itch again. This is something called the itch-scratch cycle. Once you or your child has got into this cycle it can be very difficult to break out of it again. Many people also find that scratching gives them a lot of pleasure and this can be another reason why stopping scratching can be so hard.
What does scratching do to the skin?
Scratching the skin at first produces redness and then a rash. If scratching continues then the skin can become broken and bleed. Once the skin has been broken you are at risk of infection and irritants and allergens can easily cause a reaction. This in turn will make the itching worse and may cause the eczema to flare up.
If someone has been scratching at the same area for a long time the skin will start to thicken. This is called lichenification. The skin looks like leather and can take a long time to return to its normal thickness. Lichenification can also cause changes in the skin colour, making it darker, and this can be distressing for people with darker skins.
When do you itch?
Try looking at when you or your child are tempted to scratch your skin the most. Does the itch occur at certain times more than others? Scratching can become a habit, something that unconsciously starts to happen at certain times – for instance, when watching TV.
What makes itching worse?
Almost all forms of eczema produce an itch and many things can make itching worse. The following are some of the main triggers:1
Changes in temperature can often cause the skin to itch. Some people find that removing clothing can make them more aware of the ‘itch’. This may be partly due to the sudden change in temperature. Speeding up the process may help, but not to the extent that overheating occurs! Move quickly and try to think about not scratching rather than concentrating on the irritation. A child with eczema will need distracting when undressing, to keep their attention away from the urge to scratch. Try to make bedtime and bath-time fun by playing a game, reading a story, or undressing them in front of the TV or a favourite video.
Overheating of the skin can be a cause of irritation and itch. Anyone with eczema will know that they are happier at slightly lower room temperatures than the majority of people. Some people find that the problem is accentuated in winter when coming into a warm house from the cold outside. Changing into cooler clothes as soon as possible and applying an emollient is often helpful.
Sitting on wool or nylon carpets, plastic seats, and sometimes leather, can all cause irritation and itchiness. If possible, a cotton covering should be used to prevent contact with the skin.
During the night, itching often disturbs sleep. If you or your child has a bath before bed-time, ensure that the water is only lukewarm. Keep the bedroom cool. It can be worthwhile considering the type of bedding you are using. Duvets may be more convenient but they can make it more difficult to regulate temperature, whereas layers of cotton sheets and blankets make it easier to throw off a layer rather than go without a covering completely.
When the itching is very bad, it is best not to toss and turn trying to ignore the itch and not scratch. This will only make you hotter and increase the itching. It is better to get up, apply your emollient and find something else to do, until the itch lessens.
Sweat is an irritant and when it touches the skin it can cause itching. People with eczema often find that they itch much more during and after sport.
Some clothing fibres can be very irritating to the skin. For example, wool has quite coarse and stiff fibres and these tickle the skin causing an itch. Rough seams and loose threads can have the same effect.
Many substances can irritate the skin and cause it to itch. Allergens such as the house-dust mite, pet dander and pollen make itching much worse. Other substances such as soaps and detergents can cause itching as can certain chemicals and foods. Many people will know which substances can affect their skin either through trial and error or by having allergy tests performed.
Some people find their emotions can have an effect upon their itching. Some people itch in response to certain feelings and, for children in particular, tiredness can make eczema more irritable.
What can you do to relieve the itch?
The first thing to say is that there will always be times when you, or your child, feel unable to resist scratching your skin. Don’t beat yourself up about this and never shout at a child who is scratching or keep telling them to ‘stop scratching’. Instead you and your child can learn different techniques, which may help to relieve the itch.
Review your skin-care routine
Look again at you skin-care routine and ensure that the emollient you are using is suitable for your skin at the present time. You may need to consider whether you are using your cream more often than usual because your skin is particularly dry. If this is so, you may need to consider changing to ointment, or using a cream during the day and an ointment at night.
Consider if it is possible that you are reacting to any of the products you are using on your skin – remember that you can build up sensitivity to something you have been using regularly over a period of time.
Always pat your skin dry after bathing – a vigorous rub with a towel may be gratifying at the time, but it is also likely to activate the itch.
Treatments for itching
As well as the practical tips below there are some treatments from your doctor that may help to reduce or control itching. Remember also that using a good emollient routine and topical steroid if prescribed by your doctor will help to reduce irritation.
Emollients will help you to keep the skin well moisturised, reducing dryness and forming a layer of protection over the skin. There are some emollients that contain anti-itching ingredients that you may find useful. Ask your pharmacist or GP for further information. Oats contain a natural anti-itching ingredient that some people find helpful. There is a range of emollients that contain oats – ask your pharmacist for details. Alternatively you can add a handful of oatmeal to hot water in a jug. Stir it and allow it to settle then pour the milky liquid into the bath water 1
For most people, antihistamines will not help to reduce the itch itself, but they are quite often used to help people to get to sleep at night. Sedating antihistamines will make most people quite drowsy and can be used in children as well as adults. Talk to your GP for further information.
Wet-wrapping is a bandaging system used to control the symptoms of eczema. It helps to reduce the amount of itching and in turn helps you or your child to sleep. Warm, wet, tubular bandages are put onto the body over lots of emollient and sometimes a mild or moderately potent steroid ointment. A dry layer of bandage is then put on over the wet layer. Consult your dermatologist, dermatology nurse or GP about this treatment.
There are some creams – made by companies that produce emollients – that are specially made to reduce itching. Ask your pharmacist for details.
This treatment was first used at The Chelsea and Westminster Hospital in London, UK but is now available in other centres around the world. The program works well in older children and adults and is mainly for people with long-term atopic eczema. This treatment helps people to realise when and why they are scratching. People are encouraged to look freshly at the treatments that they are using and it helps them to reduce the amount that they scratch. In the long term this means less damage to the skin and therefore a reduced need for topical steroids and other treatments. Talk to your dermatologist or your GP for further details.
There have been some studies that have investigated the use of hypnotherapy to reduce itching in people who have eczema. There does seem to be some benefit for a number of people in helping them to ‘see’ their itch and then learn how to control it. Children can also use hypnotherapy.
Some people find that creams with the following herbs in them may help with itching: Calendula, aloe vera, borage or evening primrose oil. As with all new creams it is a good idea to test the cream on a small patch of skin before using it all over.
Itching and the scratching that it causes can be a difficult feature of eczema to come to terms with – especially for parents who may find that their children are scratching hard enough to bleed. You can use the information above as a starting point to help you control scratching and then talk to your doctor about some of the treatments that are available. Above all, don’t be hard on yourself – no one can resist all the time.
No matter how severe the itch becomes, never be tempted to use implements such as knitting needles, nail brushes or wire brushes to scratch with. You will do untold damage to your skin!2
Everyone has his or her own way of managing the itch. If you have a strategy that works for you, other members would be interested to hear about it. We would welcome a letter telling us about it so that we can pass the information on to other members via the letters from sufferers in the A-Topic News.
This Information Sheet is one of a series provided as a service by the Eczema Association of Australasia Inc to give up-to date, practical help on certain types of eczema or a particular aspect of its treatment. These sheets are part of our membership package.
ECZEMA ASSOCIATION OF AUSTRALASIA INC
PO Box 1784 DC
CLEVELAND QLD 4163
1300 300 182 or (07) 3821 3297