What does Eczema Itch?
Eczema itch is a complex phenomenon influenced by various factors involving the skin, the immune system, and the nervous system. Understanding why eczema itch occurs requires delving into the intricate interplay of these factors.
- Skin Barrier Dysfunction: Eczema is characterized by a compromised skin barrier. The outermost layer of the skin, known as the stratum corneum, acts as a protective barrier. It prevents irritants and allergens from entering; it also retains moisture and prevents transepidermal water loss (TEWL). In individuals with eczema, this barrier is weakened, allowing allergens to penetrate the skin more easily. The compromised barrier also leads to increased water loss, contributing to dryness and eczema itch.
- Inflammatory Response: Eczema is fundamentally an inflammatory skin condition. The immune system in individuals with eczema is hypersensitive, leading to an exaggerated inflammatory response to various eczema triggers. During an eczema flare up, mast cells release histamines, which further contribute to the itch.
- Nerve Fiber Activation: Itchiness is ultimately a neural response. Nerve fibers in the skin, called C-fibers and A-delta fibers, play a crucial role in transmitting itch signals to the brain. In eczema, the inflammatory environment activates these nerve fibers, sending signals to the brain that result in eczema itch. The more severe the inflammation, the stronger the itch.
- Histamine Release: Histamine, a chemical released during allergic reactions, is a well-known contributor to itching. In eczema, elevated levels of histamine can occur due to immune system activation. Histamine promotes vasodilation and increases the permeability of blood vessels, contributing to the inflammatory response and intensifying the sensation of itchiness.
- Dry Skin: The compromised skin barrier in eczema leads to increased water loss, resulting in dry skin. Dry skin is inherently more prone to itching, as it lacks the moisture necessary for maintaining skin suppleness and comfort. The itch-scratch cycle can further exacerbate dryness, creating a self-perpetuating loop.
- Neuroimmune Cross-talk: The communication between the nervous system and the immune system is intricate. Immune cells release signaling molecules that can directly stimulate nerve fibers or sensitize them, making them more responsive to itch signals. This cross-talk between the immune and nervous systems contributes to the heightened itch perception in eczema.
- Psychological Factors: The relationship between stress and eczema itch is well-documented. Stress and emotional factors can trigger or exacerbate eczema itch. An exam or presentation tomorrow or a fight with your spouse will most certainly upregulate neural pathways involved in itch perception.
- Allergen and Irritant Exposure: An eczema flare up is often triggered by exposure to allergens or irritants. Allergens like dust, dander or certain foods can stimulate the immune response, leading to increased itchiness. Irritants such as harsh soaps or synthetic fabrics can further compromise the skin barrier, intensifying the itch sensation.
- Microbial Factors: The skin microbiome, the community of microorganisms living on the skin, also plays a role in eczema itch. Dysbiosis, an imbalance in the microbiome, can contribute to inflammation and itching. Additionally, certain microbes may release substances that activate itch-inducing nerve fibers.
- Itch-scratch Cycle: Eczema often triggers what is known as the itch-scratch cycle. It begins with the sensation of itchiness, leading to scratching. While scratching may provide momentary relief, it exacerbates skin damage and inflammation, perpetuating the cycle. In an eczema flare up, scratching can lead to microtears in the skin, making it more vulnerable to irritants and microbes, further intensifying the inflammatory response and itchiness.
How to Manage Your Itch During Eczema Flare Up
Now that we have covered what does eczema itch, let’s proceed with 5 top ways to keep your hands off yourself!
- Keep fingernails short
- After moisturizing a lesion, you can cover it with gauze dressing, which acts as a barrier as well as a counterirritant
- Wear gloves over hands
- Line body with body-hugging clothing
- Learn to pat the lesion instead of scratching it – easy to say, hard to do.
Tools to Prevent Scratching:
Here are some tips:
- Use Tubifast: This was the original ‘protective’ gear for eczema patients, especially for the inner elbow lesions. When there is an eczema flare up, it prevent the fingernails from having direct contact with the skin. This lessens recurring damage that stalls recovery.
- Use Bamboo Gloves:Gloves that are not made of synthetic materials will always benefits skin patients. Bamboo and tencel are known to be more breathable than cotton (which is also good) and are eczema-friendly textiles to consider..
- Use Eczema Mittens: This brand is founded by a Singaporean eczema sufferer. The outer layer of mittens will prevent you from scratching unconsciously at night. There are adult sizes as well as kid sizes, and some patients at our clinic have reported reduced scratching after starting to wear these eczema mittens! The good thing about cotton and tencel is that they are less liable to breaks, as opposed to bamboo.
Arm Sleeves for Eczema Itch
Arm sleeves are often useful to cover the lesion. It reduces the damage done by scratching during a flare up.
It can also be used to cover up those areas affected by eczema lesions, which is very important for sufferers who do not like being thrown ‘the look’ for having skin that looks different.
What material is best for arm sleeves for TSW?
Cotton, bamboo, and tencel are all natural fabrics that are often recommended for eczema patients. They are all soft, breathable, and hypoallergenic, which means they are less likely to irritate the skin. However, there are some key differences between these three fabrics.
- Cotton is the most common fabric used in clothing, and it is also a popular choice for eczema patients. Cotton is soft, absorbent, and relatively inexpensive. However, cotton can also be scratchy, especially if it is not made from high-quality fibers. Additionally, cotton can trap sweat, which can irritate the skin.
- Bamboo is a newer fabric that is becoming increasingly popular among eczema patients. Bamboo is soft, breathable, and moisture-wicking, which means it draws sweat away from the skin. Bamboo is also hypoallergenic and antibacterial. However, bamboo can be more expensive than cotton.
- Tencel is another newer fabric that is often recommended for eczema patients. Tencel is made from wood pulp, and it is known for its softness, breathability, and moisture-wicking properties. Tencel is also hypoallergenic and biodegradable. However, tencel can be more expensive than cotton or bamboo.
The interesting thing about these arm sleeves, usually used to protect motorcyclists or cyclists from the burning sun, is that it is a synthetic material. Although cotton is usually recommended for eczema sufferers, many of our patients report these arm sleeves to be very helpful despite not being made of cotton. They allow you to scratch but not cause scratch trauma to the epidermis.
Disrupt Sensory Signals
There are many ways to disrupt the sensory signals associated with eczema itch.
Some sufferers love putting hot shower water on the itchy areas, but they pay the consequences later. This is because
- Hot water, on the other hand, works by increasing blood flow to the skin. This can help to flush out inflammatory chemicals and promote healing.
- Hot water can also irritate the skin and make itching worse. Heat is a great way to disrupt sensory itch signaling, but they also cause further trauma to the fragile skin barrier. This is why we are still hesitant about recommending excessive use of Red Light devices in the treatment of TSW.
Others using tapping, or even the Rollo Ball to ease the itch.
Ice away the Itch!
Another common tool is the use of ice. Most sufferers have tried putting a small pack of ice over the itchy areas, and it helps. There are two main ways that using ice helps to reduce itch sensation in eczema:
- Numbing the skin: The cold temperature from the ice causes the blood vessels in the skin to constrict, which reduces inflammation and numbs the nerves. This can help to break the itch-scratch cycle, where scratching the itchy skin only makes the itch worse.
- Reducing inflammation: Inflammation is a major contributor to eczema, and it can also trigger itchiness. The cold temperature from the ice can help to reduce inflammation by constricting blood vessels and slowing down the release of inflammatory chemicals.
How does Ice Reduce Itch?
In addition to these two mechanisms, ice may also help to reduce itch sensation in eczema by:
- Activating cold-sensitive receptors in the skin. These receptors send signals to the brain that can override the itch signal.
- Reducing the release of histamine. Histamine is a chemical that is released by the body in response to inflammation and other stimuli. It can cause a number of symptoms, including itching. The cold temperature from the ice may help to reduce the release of histamine from mast cells in the skin.
How to use ice to relieve eczema itch:
- Wrap an ice cube or ice pack in a thin towel or washcloth to prevent direct contact with the skin.
- Apply the ice compress to the itchy area for 10-20 minutes at a time.
- Repeat every few hours as needed.
- It is important to note that ice should not be used on broken or irritated skin. If you have any concerns, be sure to talk to your doctor before using ice to treat eczema itch.
- For those who prefer more nifty gadgets, there is the ice globe.
Scratch But Don’t Damage
When eczema flares up, inflammation occurs and it causes the patient to be itchy.
However, scratching the lesion will cause further damage to the skin. Hence, some tools are invented to prevent further damage due to scratching.
Firstly, a Singaporean has created The Rollerball Itch Relief. She was awarded with an international design innovation award for this product.
As a eczema patient herself, she understands that an eczema patient feels an unbearable itch and any minor scratch to the lesion may cause skin damage. Hence she created this rollerball that disrupts the itch and reduces the irritation. It can also be dismantled easily to clean the device itself, which greatly minimizes the chances of the patient exposing themselves to possible allergens that cause a flare.
Moisturizing after a shower replenishes the skin barrier with lipids that are easily depleted in individuals suffering from AD. This prevention of transepidermal water loss helps to reduce itch. In fact there is strong correlation between the degree of transepidermal water loss and itch intensity. It could be due to increased exposure of sensory nerve fibres in skin with barrier dysfunction.
Here we cover how some of the topical ointments/creams/lotions out there seek to address skin dryness, inflammation and itch.
Phygiogel and QV contain squalene, Physiogel also contains ceramide, together with other substances like olive and coconut. QV has petroleum jelly to lock moisture in the skin, as well as paraffin. Cetaphil and Eucerin can be lumped in the same category as Physiogel and QV because of a huge proportion of the ingredients being synthetic chemicals; both together with QV contain methylparaben.
Sebamed and Eucerin play on skin pH, Sebamed staying at a balanced skin pH of 5.5, while Eucerin goes down to pH5. Both are paraben-free.
Ceramide is one such lipid found naturally within the skin. The question is whether replenishing with ceramide is “the only way.” A-Derma contains Filaxerine, inducing substance of filaggrin and omega-6 to restore the cutaneous barrier. Robertson’s Skin Repair Ointment contains natural cod liver oil. Atopiclair contains other moisturizing elements like hyaluronic acid and shea butter.
Oatmeal Bath to Sooth:
Oats contain avenanthramides, which are moisturizing while being anti-inflammatory and anti-itch. Use 1 cup of oatmeal wrapped in cheesecloth can be placed in bathwater, and even placed on eczema patches as a compress for quick relief.
During an eczema flare up, you can use ceramides to support barrier function, you can use oatmeal to reduce inflammation. What about including antioxidants in moisturizers?
Rooibos is a caffeine-free tea that is abundant with antioxidants, flavonoids and phenolic acids, all beneficial. In particular, rooibos contains aspalathin, an antioxidant that, to my knowledge is unique to rooibos. Anecdotal reports of success have come by placing 2-3 rooibos tea bags in the bath to reduce eczema symptoms. Or take it internally as a tea.
Vitamin E and C are well-known antioxidants: the former is included as tocopheryl acetate in Sebamed’s product, while both together with grapeseed extract are included in Atopiclair’s cream. Other anti-inflammatory herbs likes Neem, Burdock, Bearberry are included in Derma E’s products.
Then comes the natural oils. For example, with Salcura Bioskin Derma Spray, we are spraying a host of oils that include sunflower, safflower, grape vine, sea buckthorn, eucalyptus, lavender, rosemary etc. The Home Apothecary’s Lemongrass Balm is similarly inclined, with all manner of oils mixed together with lemongrass for use. Four Cow Farm’s is similar, except that the two products are Tea Tree or Calendula.
Then, there is Moogoo’s ISB which is free of petroleum based chemicals, while its MSM Soothing cream contains organic sulphur in the form of MSM.
Last of all, there is also the option of just using natural oils on their own, e.g. coconut oil, rosehip oil, jojoba oil, sweet almond oil, emu oil etc. Some patients of mine report doing well with they own preferences. Some with just coconut oil. Others with a nice mix.
As can be seen, most of the creams out there include a moisturizing component as well as an anti-inflammatory component. Some of the herbal anti-inflammatories are also anti-microbial.
Baking Soda to Clean:
Like salt, baking soda is naturally antiseptic and cleansing. In many parts of the world, salts are used to dress and sterilize wounds, and baking soda can do that job in a much gentler way than traditional hard salts can.
Mixing baking soda with clean, warm water will create a mud-like paste. Work on the ratio of soda to water until you get a thick, heavy consistency that can be applied directly to a flare up.
Baking soda is a great way to cleanse and protect areas that may be too sensitive for scrubbing, especially during an acute eczema flare up. After 3-5 minutes, just rinse off the mixture and apply ointment to seal in the hydration.
Over the years, many patients have benefited from soaking their open weepy lesions in Apple Cider Vinegar (ACV).
Zinc Oxide is Mildly Drying:
Because of its anti-inflammatory properties as well as its ability to act as an antioxidant, zinc has been used to treat eczema. Topical applications were found to improve symptoms of eczema in study participants, easing severity and itching. Note that Zinc Oxide is in all the nappy rash creams too! Try the Stephanie Apothecary brand!
Eczema Powder for Weepy Lesions:
If you are on NMT (No Moisturizing Treatment), herbal powders like Eczema Powder are a very effective at soothing the skin.If you have wet weepy lesions, creams may be counter-productive. This is where the powders prove to be very effective.
You can also mix in the Eczema Powder with your existing creams for anti-microbial and anti-inflammatory effect.
If you want your eczema to get better fill out the form below to get a consultation with us:
To alleviate eczema itching during an eczema flare up, try:
- Applying cold compresses like chamomile compress
- Using menthol-based cooling lotions or creams
- Using eczema powder
- Having oatmeal baths or oat-based creams like aveeno
- Applying aloe vera gel (which can be calming but may also irritate the skin of some people)
- Epsom salt baths or dead sea salt baths
The approach used by GPs and dermatologists to stop eczema itch include:
- Application of Topical steroids
- Application of Protopic on areas with thinner skin, like the face
- Application of different moisturizers – moisturizing to help with barrier protection
- oral steroids like prednisolone and immunosuppressants like MTX
- UVB therapy
- Antihistamines like hydoxyzine or Atarax.
It is really not so straightforward when it comes to stopping the eczema itch. The best way is to reduce the inflammation, which then stops the itch-scratch cycle from repeating ad nauseam. While steroids are great at rapidly bringing down inflammation, there are side effects which include thinning skin and possible rebound flares that are the hallmark of topical steroid withdrawal.
For this reason, it can be helpful to consider all the following approaches, which may not stop the itch completely, but help to reduce inflammation in a more sustainable manner.:
- Natural lotions, creams and ointments
- Treatment according to NMT principles – not adding on any more moisturizers
- Traditional Chinese herbal treatment for eczema and TSW
- Cold Atmospheric Plasma treatment
- Treatment with acupuncture for the skin
- Food elimination diet
- Supplements that help the gut and the skin
To prevent scratching eczema lesions:
- Keep nails short
- Use anti-scratch mittens
- Distract yourself with activities (like video games)
- Applying a cream or ointment that does not aggravate the itch, but calms it.
- Staying mindful of known triggers
- Try out behavioral techniques that might work
- Find way to reduce the general stressors of life.
To minimize eczema scars, focus on proper wound care during flare-ups. Repeated scratching in chronic eczema is bound to leave scars that are difficult to get rid of.
To get rid of eczema scars, use silicone-based scar gels, keep the area moisturized, and consider medical interventions such as laser therapy or microdermabrasion. Time and consistent care are essential for scar reduction in general, and this is true for eczema scars.
Eczema presents as red, itchy, and inflamed skin. Common signs include dryness, scaling, and sometimes oozing or crusting. A dermatologist can provide a definitive diagnosis and help differentiate eczema from other skin conditions.
Psoriasis often looks so much like Atopic Dermatitis that most patients cannot tell the difference. Everyone just calls it Eczema!
Although both Atopic Dermatitis and Psoriasis can manifest anywhere in the body, here are some useful ways to differentiate:
You are more like to find Psoriasis lesions on your hairline or your scalp, or in your butt crack. Additionally, Psoriasis tends to present at the kneecap or on the pointy parts of your elbows.
Atopic Dermatitis classically presents (especially in children) in the inner elbow or behind the knees. These are called the flexures, which are the parts of the limbs that fold and unfold.
Both Psoriasis and Eczema lesions commonly show up around the ears.
(2) Atopic Tendency:
Atopic Dermatitis is an atopic condition, and may be accompanied other atopic conditions Allergic Rhinitis and/or Asthma. It has a more complex etiology (including genetic causes, a compromised skin barrier and environmental/food triggers.
You seldom see Psoriasis patients having Asthma or Allergic Rhinitis. There is a chance that Psoriasis suffers also suffer from Rheumatoid Arthritis
(3) Auspitz Sign:
Psoriasis is an autoimmune condition characterized by excessive production of skin cells. What appears are these silvery/whitish scales that leave a small blood stain when peeled off. This is called the Auspitz sign.
(4) Itch Intensity:
Atopic Dermatitis is generally much more itchy than than Psoriasis, although there is a component of itch in both conditions.
To alleviate nighttime itching:
- Moisturize before bedtime
- Wear breathable sleepwear immediately after a shower, so as not to expose your skin to the air
- Immediately enter a cool bedroom environment
- Purchase and use a dehumidifier
- Drink a calming tea before bedtime
- No more stressors before sleep
- Use antihistamines
- Use Chinese herbs prescribed by a trained TCM which treats eczema and calms the body
To prevent eczema from spreading, avoid irritants, allergens, and potential triggers. Practice good hygiene, moisturize regularly, and seek prompt medical attention for severe or spreading cases.
The skin barrier is the outermost layer of the skin, composed of lipids and proteins.
It acts as a protective shield, preventing water loss and blocking out irritants and allergens. Maintaining a healthy skin barrier is crucial for preventing and managing eczema.
During eczema flares, intensify moisturizing, use prescribed medications, and identify and eliminate triggers. Consider wet wraps, avoid irritants, and manage stress.
During an eczema flare up, the usual advice is to:
- Intensify moisturizing – including use of wet wraps
- Use prescribed medications
- Identify and eliminate triggers
Eczema skin is characterized by inflammation, dryness, and a compromised skin barrier. It may appear red, scaly, and, in severe cases, can develop cracks or blisters. Identifying and addressing triggers are essential for managing eczema skin.
Common trigger foods for eczema include dairy, eggs, nuts, soy, wheat, and certain fruits. Adopting an elimination diet and keeping a food diary can help identify and avoid specific triggers. Consultation with a nutritionist or allergist is recommended for personalized guidance.