Often called “the itch that rashes” – eczema is certainly uncomfortable and distressing. Trouble sleeping, infections and even hospitalisation can all be triggered by that pesky little itch. It’s time to put it under the microscope and find out exactly what causes the unpleasant sensation, what makes it worse and what happens when you actually give in and have a good old scratch!
Why is eczema so itchy?
There has been (and continues to be) extensive research into this and, frustratingly, there are still no complete answers. Eczema causes the affected skin to release chemical mediators – essentially messages to stimulate the nerves. Furthermore, people suffering from atopic eczema have increased sensory fibres in their nerves, which means even the slightest contact can produce the itch sensation. These nerves send messages to the brain and the result? Scratching. This is known as a neurogenic itch due to the activation of nerve pathways.
There’s another type of itch too – a psychogenic itch. This occurs when the itch sensation is triggered by psychological factors like stress or habit. To give you a practical example, try having a conversation about nits without suddenly feeling your scalp grow itchy!
Why does the itch cause skin damage?
It’s important to note that it’s not the itch that causes inflammation and damage to the skin – it’s the scratching response that it triggers. The scratching can actually become a subconscious reaction or ‘conditioned response’, especially in children who have suffered from eczema all their lives.
What aggravates the itch?
- Dry skin is itchy full stop. Eczema sufferers have a defective skin barrier which leads to what is known as trans-epidermal water loss (TEWL) – essentially water is lost through the skin, especially at night-time (which explains why it’s a prime time for itchiness!) This is why barrier creams and emolients are such a key part of any initial treatment.
- Sudden changes of temperature – especially coming out of the cold to a warm room – can cause the skin to itch. Dry heat is also aggravating which is why using a humidifier is often recommended.
- Overheating at night causes disrupted sleep, especially for young children (and their parents!) Sweat is an known irritant in itself. Be careful not to apply creams too thickly as this can block pores and make skin more uncomfortable.
Keeping emollients in the fridge and apply light layers at a time works well.
Low tog manmade fibre duvets and pure cotton sheets are your best option for bedding, along with a dust cover over the mattress to keep dust mites at bay. Avoid feathers.
Also keep bedrooms below 18 degrees where possible.
- Clothing can irritate the skin, especially rough textures like wool fibres, seams and labels. Synthetic fabrics can lead to overheating which as we’ve just established is a big issue for itchy little ones. Pure cotton layers are the best option.
- Eczema skin is very sensitive to surface irritants – whether that is in household products such as soap and shampoo, or from allergens like house dust mites, pet dander and pollen. Typically atopic eczema is part of the ‘atopic triad’ – eczema, allergies, and asthma, so called because they so often occur together. Up to 80% of children with eczema also have asthma or allergies to pollen, dust mites, pet dander, mold, or certain foods. Specialist allergy testing as part of an eczema diagnosis may be helpful.
- Psychological factors can also effect itchiness. In children especially tiredness is a trigger. Stress affects everyone in different ways, even those without eczema may suffer blotches and breakouts at stressful times, it stands to reason that stress will trigger eczema too.
What relieves the itch?
Firstly there is the doctor prescribed options. These are listed below:
Emollients help to keep the skin well moisturised and form a thin layer on the skin that helps to prevent the water loss through the skin barrier mentioned above. Emollients are completely safe to use and can be applied as often as is necessary. You should apply them at least twice a day – more often if the skin is very dry.
Many of are available on prescription. Some emollients contain anti-itching ingredients, called lauromacrogols, which are local anaesthetics. Remember, find an emollient that suits your child (a bit of trial and error may be required so be patient!) and use it every day to see results.
It is key to use emollients as soap substitutes for hand washing and in the bath or shower. Washing water should be tepid, as hot water can cause itching. If you would like to try a natural remedy in addition, a sack of oats can be attached to a running tap, for a soothing bath.
- Topical Steroids
If the eczema and itching fail to respond to emollients alone, an additional treatment – usually a topical steroid – may need to be prescribed as a short-term treatment to help reduce the irritation and control the flare.
Sometimes people are worried topical steroids may damage the skin and therefore will avoid using them even when they are prescribed by a doctor or specialist. Please be assured that before deciding which topical steroid to prescribe, the healthcare professional will take into account the age of the patient, the area of the body affected by the eczema, the severity of the eczema and other medications being taken. Usually they will start with the lowest strength required to bring the eczema flare back under control. Depending on the response, the steroids may be stepped down or up in potency. Used properly, topical steroids are safe to use if you are following the advice of a professional.
It is worth noting that refusing to use them if prescribed can lead to damage to the skin anyway from the eczema itself become so itchy it leads to excessive scratching.
- Paste bandages and wet wrapping
These can both be helpful in reducing the itch–scratch–damage cycle (especially at night, when scratching is often an unconscious action in sleep). They are intense treatments used for five to seven days and should only be used if recommended by health professionals. It is essential that you are given a demonstration of how to apply paste bandages and wet wraps.
Wrapping and bandaging should not be used to treat mild eczema or if the skin is infected.
Covering up the skin with bandages and wraps makes topical steroids more potent, so only use topical steroids under bandages and wraps if advised by your healthcare professional. Topical calcineurin inhibitors, tacrolimus (Protopic) and pimecrolimus (Elidel), should not be used under paste bandages and wet wraps.
- Topical immunomodulators or topical calcineurin inhibitors (TCIs)
These are secondline, non-steroid, treatments for both flares and maintenance. They are Elidel (pimecrolimus) cream and Protopic (tacrolimus) ointment.
Topical immunomodulators act on the cells in the body and the skin to dampen down the immune system, which helps to reduce inflammation and itch.
They are applied to the skin for six weeks to treat flares, and then can be used twice a week for maintenance, to try to prevent further flares. They are licensed for use in treating atopic eczema in adults and children of 2 years of age and over.
There are also things you can try at home. The Further Ideas section below contains links to some useful posts, but it is worth mentioning a few here too.
There are various studies that have shown that acupressure can help to decrease the dreaded eczema itch. Though it doesn’t work for everyone, the relaxation benefits are widely accepted.
Relaxation is an important element in the management of eczema and one of the most significant issues impacting quality sleep is stress. Stress is both a common trigger for eczema as well as hampering a quality night’s rest.
As lack of sleep makes us more vulnerable to infection as well as more sensitive to pain, it is vital for children with eczema to get enough good quality slumber.
- Habit Reversal
More suitable for adults and older children, this is a sort of mindfulness – becoming aware of scratching behaviours and consciously countering them. Little ones and babies won’t be up to this one but there is a useful link below if you’re interested in learning more:
Tapping the itchy area provides a surprising amount of relief. It confuses the nerve endings (in the same way a TENS machine does!)
- Cold Compresses
Keeping Mr Men gel filled “bump patches” in the fridge was a lifesaver. They aren’t too cold to hold in little hands but provide genuine relief.
All our blog posts are written with personal experience of eczema in mind and with input from qualified professionals. However, we ourselves are not doctors! That said we like to share what we have learned and you may enjoy these posts too.
Here at ScratchSleeves, we don’t just share our experiences of bringing up an eczema child and favourite allergy-friendly recipes, we also manufacture and sell our unique stay-on scratch mitts and PJs for itchy babies, toddlers and children. We now stock sizes from 0-16 years in a range of colours. Visit www.ScratchSleeves.co.uk for more information.