Pain and Itch in Atopic Dermatitis

Last updated: December 2018

Patients with Atopic Dermatitis (AD) know that itch is a common symptom of their condition. They also know that pain is a regular symptom too, and it often happens at the same time as the itch. Researchers are now realizing that the pain associated with AD has been a neglected area of assessment and they are taking the steps to make sure that pain is reported better so that patients can get the treatment that they need.

Research on eczema

A group of researchers from multiple institutions surveyed AD patients at their dermatology appointments both in the United States and in 11 international countries. 103 patients responded to the survey over a period of 19 months. The patients ranged from 5 years (answered with the help of their parents/caregivers) to 74 years old.

Does eczema hurt?

The survey asked questions about quality of life and how it was affected by AD, how often and severely patients experienced AD, what seemed to cause and relieve AD, and questions about the pain associated with AD. The questions about pain were about location, descriptions of the pain (burning, sharp, stinging, etc.), if the pain was related to itching and scratching, quality of life due to pain, and what makes AD pain better or worse.

Eczema pain Researchers linked the survey scores to the at the Eczema Area and Severity Index (EASI) scores from the visit where the patient answered the survey, to see if there was a relationship between the EASI scores and the pain that the patient was experiencing. They found that 78% of patients reported that they experienced both pain and itch, but only 20.6% had itch alone, and only 1% had pain alone. Types of painThis pain is mostly described as “burning” (about 75% of patients), “stinging” (more than half of the patients), and soreness or tightness (just under half of the patients). Time of painThe pain seems to occur most often in the evening (in about 75% of patients) and overnight (about half of patients), and seemed to cause problems with patients getting a good night’s rest (in about 80% of patients). Living with painThe pain also caused issues with patient’s leisure activities (almost 80% of patients) because sweat seemed to be a common cause of pain (about 75% of patients) as well as being too warm, and being stressed (about half of patients). Pain causesOther causes of pain were: hot baths/showers, rubbing, wearing wool or synthetic fibers, and moisturizers and topical medications. Pain reliefInterestingly, moisturizers also were one of the top factors in relieving pain, as well as exposure to cool temperatures (including cold packs/wet towels), stress relief, sufficient sleep and topical steroid use. Pain pointsPain was most commonly reported on the hands, fingers and forearms, around the mouth, and on the neck, on the toes, feet and legs, and on the buttocks. Problems with painThis is all very important information for physicians and researchers to understand. As you can probably see, many of these pain factors are interrelated. For example, a patient with AD pain may not sleep well, but a good night’s sleep seemed to relieve AD pain for many patients. Another example is moisturizers being relieving of pain and also causing pain in some patients. Physicians need to be aware that some moisturizers and topical medications may have ingredients that can make AD pain worse, especially on sensitive areas like the hand, face and neck. Talk to your doctor about painMake sure your physician is aware of any AD pain you are having. Be sure to tell them if a treatment seems to make pain worse, as there may be other treatments available that may work better for you. Keep the lines of communication open and let your medical team know if your AD pain is interfering with your quality of life. Your team should be able to work with you to find the best solutions for your specific AD symptoms.

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