Itching and scratching

Why does eczema cause itchiness?

For most people, itchiness is the worst and most uncomfortable symptom of eczema and can often be the most difficult to treat. Itchiness may also lead to sleep problems for both the person with eczema and their family.

Skin affected by eczema releases certain chemical mediators – messengers that stimulate the nerves. (There are many chemical mediators that are released into the skin and can make us itch. Interestingly, histamine, which makes insect bites so itchy, is not related to the itch in atopic eczema. Therefore, antihistamines do not help reduce the itch in such cases although sedating antihistamines are sometimes prescribed to help the person sleep.) Additionally, the nerve fibres in people who have atopic eczema appear to be altered, with an increase in sensory fibres. This can cause even the lightest touch to produce a sensation of itch. These nerves then pass on the sensation of itch to the brain, and before you know it, you are scratching. This is called a neurogenic itch, due to nerve pathways being activated.

However, itchiness is not completely straightforward as there is another type of itch, called a psychogenic itch. This means that the itch is also stimulated by psychological factors; these may be conscious or unconscious urges to scratch, brought about via habit or in response to stress.

Try not to say ‘Don’t scratch’ to children and adults who are scratching. This can create resentment and distress, and increase feelings of stress.

How can I cope with itchiness?

Here are some practical tips on how to cope with itchiness and reduce scratching:

• Use emollients frequently enough to prevent dry skin. Sometimes, thick applications of ointments can block skin pores and actually cause more itching, so apply often but lightly (but enough to make the skin glisten). Emollients will help to keep the skin intact and well-moisturised, reducing irritation from allergens and irritants. Re-apply before the skin becomes dry again.
• Always apply emollients in smooth, downward strokes. Do not rub them into the skin as this can make itchiness worse. For children, try to make putting on emollients a positive experience, encouraging them to stroke and soothe on their own emollients – use reward charts, sticking on stars for moisturising and not scratching.
• Children can decorate their emollient pots and dispensers to make them more fun to use.
• Keep nails short, and make sure there are no jagged edges.
• Avoid plain water for washing and bathing. Always use a soap substitute or your usual leave-on emollient to wash with and then rinse off.
• After washing and bathing, pat the skin dry with a soft towel rather than rubbing, and re-apply emollient.
• Use cotton sheets and blankets on beds, or low-tog (4.5) duvets filled with manmade fibre, not feathers, to prevent overheating in bed.
• Try cotton gloves or mittens, and for babies/children, use all-in-one sleep-suits with built-in mittens to reduce the damage from scratching the skin, especially at night. Sleeves with silk or cotton mitts can also be useful.
• Try to substitute some other action for scratching. You may find it helpful to press a nail onto the skin or pinch the skin gently instead of scratching. Clenching fists and counting to 10 also works well, especially for children. Parents and partners sometimes find that if they moisturise and massage the skin gently for their child or partner, it helps to cut down on potential skin damage.
• For very itchy patches of skin, some people find a bag of frozen peas or something similar wrapped in a towel and placed on the skin will help.
• Applying cool emollient creams or lotions (not ointments) that have been kept in the fridge may help, although some people find that warm emollients are the most soothing (but don’t warm in the microwave, on the hob or in the oven, or allow to get too hot!).
• Keep cool. Use several light cotton layers, rather than having one heavy and warm layer of clothing or bedding – that way, you can adjust the temperature to suit you. Keep bedrooms cool and ventilate rooms on a regular basis.
• Talk regularly to your dermatologist, GP or nurse about your treatments to make sure that you are using what is best for you at that time and that you are adequately treating your eczema flares.

For more tips and information on coping with itchiness, please see our Itching and scratching booklet