Itchiness (Pruritis) in Atopic Dermatitis
Atopic dermatitis (AD), also known as atopic eczema, causes many symptoms of inflamed skin, but the itchiness is the most prevalent and distressing. Itchiness is medically known as pruritus, and it is defined as an “unpleasant sensation that elicits the urge to scratch.” Both the symptom of itching and the scratching it provokes significantly contribute to the burden of AD.
What is the itch-scratch cycle?
The “itch-scratch cycle” (the skin feels itchy, which leads to scratching, which then causes the skin to feel even more itchy) perpetuates the disease. The itching and scratching can lead to psychological distress, difficulty concentrating, disruption of sleep, and physical damage to the skin barrier which leads to increased water loss, increased risk of infection, increased inflammation, and lichenification (thickening of the skin that is constantly itchy).1
What triggers the eczema itch?
The itchiness of atopic dermatitis can be triggered or worsened by:
- Dry skin
- Hot baths or showers
- Sweat, especially sweat left on the skin
- Physical exertion
- Emotional stress
- Warm environments
- Wool fibers or harsh fabrics
- Soaps or detergents
- Contact with irritants and allergens1,2
Itching and scratching at night
The itching and scratching at night are the cause of significant sleep problems in infants, children, and adults with atopic dermatitis. People with AD may wake repeatedly during the night to scratch due to the excessive itchiness. The repeated waking and loss of sleep is one of the most distressing impacts of AD on children living with the condition, as well as their family members.3,4
What causes the eczema itch?
The exact disease processes that cause itch in atopic dermatitis are not completely understood, but the itch appears to start before the plaques or inflammation. Research has uncovered that itch in AD is related to the close relationship between the nervous system and the skin. The nerves in the skin send an “itch” message to the brain through chemical messengers called cytokines. Researchers are studying the different mechanisms related to itch, including how people with AD may have skin sensitivity that causes other sensations, such as heat or pain, to be perceived as itch.1,2
How is the eczema itch treated?
People with atopic dermatitis are advised to avoid the triggers for itch. In addition, there are several medications that are designed to reduce inflammation that may help relieve itch, including:
Wet wrap therapy
Wet-wrap therapy, with or without a topical corticosteroid, is another technique that can help moderate to severe AD. Wet- wrap therapy involves applying the medication (if using) and wrapping the affected area in a layer of wetted gauze, cotton, or bandages, followed by a layer of dry bandages. Wet-wrap therapy helps improve the moisture of the affected skin, improves the penetration of the topical medicine, and provides a physical barrier against scratching.5 Oral antihistamines are also sometimes given to help with itch.
Other therapies to reduce the itch
Other therapies that may help reduce itch include phototherapy, acupressure, and massage. (While more study is needed on alternative therapies like acupressure and massage in AD, researchers believe these therapies may address the role of the nervous system in itch perception.)1
Other symptoms of atopic dermatitis
In addition to the itch, AD can cause a rash, scaly patches, weepy sores, bumps or papules, blisters, and a change in skin color. Some people also experience eye symptoms or cracks behind the ears. Over time, the areas of skin affected by AD may become thickened.