Itchiness (Pruritis) in Atopic Dermatitis

One common symptom of atopic dermatitis is itchiness. The medical term for itchiness is pruritis. Atopic dermatitis causes inflamed, dry, and sensitive skin. It is the most common type of eczema.^1,2

What is itchiness?

Itchiness is an uncomfortable feeling that triggers an urge to scratch. It is the most common symptom of atopic dermatitis. Some studies estimate that 85 percent of people with atopic dermatitis experience itchiness every day.¹

Itchiness often causes scratching. This can start the "itch-scratch cycle." This is the name for the cycle of itching and scratching. Scratching the skin irritates it more, which causes redness, swelling, cracking, and oozing. This can cause the skin to feel itchier, which continues the cycle.³

Itchiness can cause many unpleasant side effects. These may include:^1,3

• Distress
• Difficulty concentrating
• Difficulty sleeping
• Damage to the skin
• Increased risk of infection
• Increased inflammation
• Thickening and hardening of the skin that is itchy (lichenification)

Why does itchiness occur?

Experts do not know exactly how atopic dermatitis causes itchiness. People with atopic dermatitis can experience itchiness on skin that does not look inflamed. This means the itchiness is not solely caused by inflamed skin. Research has shown the itch may be caused by the relationship between the skin and the nervous system.⁴

The nerves in the skin send an "itch" message to the brain through chemical messengers. Researchers are studying the different mechanisms related to itch. For example, some people with atopic dermatitis may have skin sensitivity that causes other feelings, such as heat or pain, to be perceived as itch.⁴

Itchiness can also be triggered by other factors such as:²

• Dry skin
• Hot baths or showers
• Sweat, especially sweat left on the skin for long periods
• Working out
• Stress
• Warm environments
• Wool fibers or harsh fabrics
• Soaps or detergents
• Contact with irritants and allergens

How is itchiness treated?

One important way to prevent itching is to identify and avoid triggers. Different people may be more sensitive to certain triggers. This is why it is helpful to determine what triggers may impact your skin more.^1,4

Other treatments for itch with atopic dermatitis include:^3-5

• Medicine like topical steroids, non-steroidal topicals, and biologics
• Sticking to a regular washing and moisturizing routine
• Wet wrap therapy
• Phototherapy

Topical medications and biologics

A topical is the name of a medicine that is applied to the skin. Topical steroids are used to treat many skin conditions. They can come as a cream or ointment. They are similar to steroids you take by mouth.^3,5

Not all topical drugs contain steroids. Other topical drugs may be used to treat atopic dermatitis. These include calcineurin inhibitors and phosphodiesterase-4 inhibitors. Like topical steroids, they work by calming skin irritation and rash, which can help reduce itching.^3,5Biologics are a newer type of drug with many uses. They treat atopic dermatitis by targeting immune pathways. Atopic dermatitis is impacted by an overactive immune system, so biologics may be able to address the root cause.^1,4

Moisturization

A key factor in atopic dermatitis is the disruption of the skin’s moisture barrier. This makes it hard for the skin to lock in moisture and can cause irritation and itchiness. Washing the skin reduces the risk of infection and can help provide moisture. Moisturizing with a non-irritating lotion can help lock in moisture and soothe the skin.^3,5

Wet wrap therapy

Your doctor may recommend you go one step further and use wet wrap therapy. This involves coating the skin in medicine or moisturizer and then wrapping with wet bandages. This helps lock in the moisture and creates a barrier against scratching.^3,5

Phototherapy

Phototherapy is the use of ultraviolet A or B light waves to treat symptoms. This is typically only used for serious cases of atopic dermatitis that have not responded to other treatments.^3,5

Lifestyle changes and home remedies

Lifestyle changes and home remedies can also provide temporary relief from itching. This includes methods like:⁶

• Treating your scalp with over-the-counter medicated shampoos
• Reducing stress and anxiety through techniques like yoga, meditation, or journaling
• Using a humidifier
• Keeping your fingernails trimmed prevent scratching
• Taking showers or baths in warm, not hot, water
• Staying well-rested

Talk to your doctor about what treatments for itchiness are right for you.