If you have eczema, you probably know that the itching can sometimes feel worse than the rash itself. Just a small area of dry or inflamed skin can become severely itchy, and once you scratch it, the whole process gets intensified.
But what makes eczema itch so much?
It is not only the dry skin that leads to the itching of eczema but a number of processes including skin barrier dysfunction, inflammation and changes in sensory nerves signalling. Some inflammatory mediators produced in the skin can trigger the activation of itch-sensing fibers, while damaged skin barrier can result in sensitization of the skin.
So the following cycle can be established:
Inflammation -> itching -> scratching -> more skin injury -> more inflammation -> more itching
This information is vital since when treating eczema, it is necessary to address not only the redness but also to treat the whole process.
Why Does Eczema Itch?
This means that eczema does not only affect the integrity of the skin but also the function of the nervous system that interacts with the skin.
Firstly, eczema causes problems with the barrier function of the skin. It may increase the loss of moisture in the skin or allow irritants to act on the skin.
Along with that, there is an activation of inflammation in the area of the lesions. Some of the mediators of inflammation can have an effect on sensory nerves associated with itch.
The majorpathway that is associated with the itch in eczema is mediated by interleukin-31 (IL-31). IL-31 is known to activate itch fibers and play a significant role in causing the sensation of itching in atopic dermatitis.
There are other inflammatory and neuronal pathways that participate in eczema, which explains the fact that patients experience an increased level of itching beyond the visible rash.(1)
Thus, when patients ask the question “why do I scratch from eczema”, the answer is not limited to “dry skin”.
What Causes Eczema Itching?
Various mechanisms may be responsible for itching in eczema.
1.A Compromised Skin Barrier
The skin serves as a barrier that protects your body from its surroundings.
However, when you have eczema, this barrier can become damaged. The problems related to skin lipids, proteins like filaggrin, and structure of the outermost layer of skin could lead to excess loss of moisture and greater chances of irritation.
This means that in such cases, skin might feel:
Dry
Tight
Rough
Prone to irritation
More sensitive to various substances and external influences
But this doesn’t mean that all the patients with eczema have this same skin barrier defect. Eczema is a complicated disease and includes various factors: genetic, immune system, environment and barrier.
And in case you suffer from constant dryness or skin sensitivity, you could find our article about sensitive skin in an Indian climate helpful. It looks at how heat, humidity, dust, pollution and everyday environmental exposure can affect the skin barrier.
2. Inflammation
Inflammation plays a huge role in eczema.
When eczema flares up, inflammation occurs in the form of activation of immune pathways and release of inflammatory mediators in the skin. This causes changes like redness and swelling of the skin, but can also stimulate the nerves that cause itching sensation.
One of the reasons why dryness treatment alone isn't sufficient in eczema.
3. Itch-Sensing Nerves Become Involved
Your skin has sensory nerves that sense touch, temperature, pain and itch.
When you have eczema, this pathway can become more sensitive. The inflammatory chemicals can stimulate the sensation of itch in nerve fibers, leading to discomfort even from regular sensations.
That’s how itchy skin affected by eczema can respond to stimuli that should not cause irritation.
4. Scratching Damages the Skin
Scratching provides only temporary relief since it alters the process of sensory signaling. But it is only temporary.
The repetitive act of scratching leads to damage to the outermost layer of the skin, increases inflammation, and causes small cracks on the skin. This further increases the urge to itch.
That creates the classic itch-scratch cycle.
What Is the Itch-Scratch Cycle?
The itch-scratch cycle is one of the largest contributors that lead to eczema being a challenging condition to manage.(2)
It might go as follows:
Eczema Inflammation
↓
Itchiness
↓
Scratching
↓
Damage of the skin barrier
↓
Inflammation and irritation
↓
More Itchiness
With time, constant scratching may also lead to thickening of the skin, which is called lichenification, and occurs in cases of constant scratching of the eczema patches.
Therefore, breaking this cycle is crucial in the management of eczema.
Read More: Tired of Scratching? Top Anti-Itch Creams for Eczema Suggested by Dermatologists covers the itch-scratch cycle and approaches to dealing with the itchiness from eczema.
Why Does Eczema Itch More at Night?
We all notice that eczema itching becomes particularly troublesome at night.
The causes can be various.
Since at night a person feels less distracted by other activities, they tend to pay more attention to the feeling of itchiness. Other factors affecting itch perception can be related to the body temperature fluctuations, sweating, dryness of air and changes in inflammatory and hormonal signals on a daily basis.
Itching itself can make the problem even worse.
Being tired due to frequent awakenings during the night due to the feeling of itchiness, it becomes harder for a person to cope with this condition.(3)
Another vicious circle arises here:
eczema -> itch -> sleep disorder -> fatigue -> difficulty in managing the itch
If the problem of nighttime itching makes you unable to get a good sleep, it would be reasonable to discuss it with your dermatologist.
What Can Trigger an Eczema Flare-Up?
There is no single trigger for eczema.
The factors which trigger itchiness for one eczema sufferer may have no effect on another.
The usual triggers may be:
-
Fragrances
-
Rough soap or cleaning products
-
Too much bathing
-
Heated water
-
Perspiration and over-heating
-
Dry air
-
Cold air
-
Certain fabrics
-
Friction
-
Other environmental factors
-
Stress
-
Irritants or allergens known
Individuals may suffer from increased eczema reaction when coming into contact with certain chemicals as a result of allergic contact dermatitis.
The reason for this is that there is no one type of rash, as all eczema rashes are not eczema.
Do not always think that your eczema is simply 'worsening' if a product causes you to burn, itch or develop a rash.
How Can You Stop Eczema Itching?
Unfortunately, there is no magic way of stopping eczema itching.
It all depends on the reasons for itching and activity of eczema itself.
1. Maintain a Healthy Skin Barrier
Maintaining skin barrier healthiness is essential in treating eczema.
The proper moisturiser will decrease the level of dryness and increase the capacity of the skin to maintain moisture. Usually creams and ointments give better barrier protection in comparison with lotions in cases of extremely dry skin.(4)
Apply your moisturizer regularly, especially after baths while skin is still a bit damp.
In case of very dry parts of the body like elbows, knees, or others, using a more enriched barrier care may help. The Replenishing Body Butter by TGHC, which includes such ingredients like shea butter, mango butter and rosehip oil and is specially formulated by dermatologist for dry skin of the body, is an excellent option. Here, the main point is not to take cosmetics for medications.
2. Avoid Unnecessary Irritants
It will be even more difficult to determine which products are irritating the skin when the skin is already irritated by introducing several new products into one’s skincare regime.
Think about minimizing your routine.
Don’t introduce unnecessarily:
-
Scent
-
Aggressive cleansers
-
Scrubs
-
Aggressive exfoliants
-
Hot water
-
Over-washing
-
FRICTION
It does not imply that every person with eczema should give up all scented and natural products completely. Different people have different tolerances to various ingredients. What should be done is to determine which ingredients are truly irritating.
For more information about selecting products when skin is highly sensitive, see Is Your Moisturiser Hurting Your Sensitive Skin?
3. Keep Showers Short and Comfortably Warm
Although hot water may give you temporary relief, prolonged use will only exacerbate irritation and dryness.
Use lukewarm water instead.
Once done, pat your skin dry rather than rubbing it vigorously.
4. Choose Cleansing Carefully
The process of cleansing should ensure that sweat, dirt and other materials are removed without compromising the skin barrier.
In case you have eczema prone skin or sensitive skin, excessive cleansing may cause dryness and irritation.
In case your body cleansing causes tightness or itchiness after cleansing, check the type of cleanser, temperature of water and frequency of washing.
More on this topic: Skincare Routine with Body Wash for Sensitive Skin covers the role of cleansing, water temperature and moisturizing in your simple skincare routine.
5. Keep Nails Short
This may sound obvious, but it could help. In cases where there is a strong urge to scratch, long or pointed fingernails could result in greater damage to the skin. Cutting the nails short could minimize the damage that occurs from the scratch.
For those children that suffer from serious cases of nighttime itchiness, there are steps which the parent can take to avoid scratching.
6. Use Prescribed Anti-Inflammatory Treatment When Needed
During active inflammation of eczema, using only moisturizing might not be sufficient.
According to dermatologists, topical steroids or other anti-inflammatory medicines will be recommended based on the individual’s age and body parts affected.
The medications target the inflammation causing the symptoms and not just the itch.
In case you have been prescribed treatment for eczema, follow the prescription of your doctor and do not discontinue the treatment once the itching subsides.
Does Moisturising Stop Eczema Itching?
Moisturizing can help especially where dryness and barrier dysfunction are playing a role in causing the itch.
Emollients can soften the stratum corneum of the skin and decrease water loss. Using them consistently can strengthen the skin barrier and lessen eczema flares in some people.
But the difference is this:
The moisturizer helps build the barrier but it does not help manage the inflammation associated with eczema.
If you experience severely inflamed, red, itchy, swollen, weeping or painful skin despite consistent moisturization, you should see a doctor for appropriate treatment.
For further reading on this aspect of eczema care, check out The Role of Body Moisturizers in Managing Eczema and Sensitive Skin.
Can Scratching Make Eczema Worse?
Yes.
Scratching can damage the skin barrier and increase mechanical irritation. Repeated scratching can contribute to thickened skin and may increase the risk of secondary infection when the skin becomes broken.
The challenge is that scratching can provide immediate relief.
That is why simply telling anyone with eczema to "stop scratching" is not always realistic. The underlying itch needs to be managed as well.
The aim is to make the itch less intense and the skin less vulnerable to damage, making the cycle easier to break.
Does Stress Make Eczema Itch More?
Not all cases of eczema have their origins in stress; however, it can have an effect on some patients.
The interaction between the nervous, immune, and integumentary systems is complicated. Psychological stress can have an effect on inflammation signaling and might exacerbate eczema in some individuals.(5)
Stress might also affect the development of eczema in an indirect way, through interfering with sleep or altering your behaviors and habits.
If your condition seems to get worse due to stress, then stress management should prove helpful.
Can Diet Cause Eczema Itching?
The topic of diet and eczema is often covered, but the correlation is not that simple as eliminating one kind of food and getting rid of the eczema.
Some foods may cause an allergic reaction in certain people, especially in children who have food allergies, but it does not mean that every occurrence of eczema is caused by food.
Restricting one's diet without any proof of allergies may lead to unnecessary diet limitations.
If you think that certain food is causing symptoms in you, then consult a physician before restricting your diet on your own.
When Should You See a Dermatologist?
Mild itching can sometimes be controlled with proper skincare measures and trigger avoidance, but chronic or intense itching is a sign that warrants medical intervention.
Consult a dermatologist if:
-
Itching is chronic or intense
-
Eczema is disturbing your sleep
-
Rashes are spreading
-
Your skin is painful, swollen, and warm
-
There is crust formation, pus, or discharge
-
You have recurrent eczema outbreaks
-
OTC skincare products do not provide relief
-
It is uncertain if you have eczema
-
Your skin is scratched to bleeding from continuous itching
Pain, warmth, swelling, pus, and sudden development of a reddened area on the skin can signify an infection, and medical evaluation is necessary.
Conclusion
So, what makes the itching from eczema so unbearable?
Eczema goes beyond just dry skin or skin irritation. Various factors like skin barrier alterations, immune inflammation, and sensory nerve signals may make eczema more itchy. Once you scratch your skin, you irritate it even more, thus creating the itch-scratch cycle.
Managing your eczema skin becomes more complicated than just dealing with the feeling of itching. You need to support your skin barrier, eliminate certain triggers and treat inflammation when it exists to alleviate eczema itchiness.
However, a well-thought-out approach to skincare may help you reduce the chances of irritating your skin. However, if your eczema continues to be extremely itchy, disrupts your sleep, and causes other issues like pain, swelling, bleeding or signs of infection, don’t change your skincare products one after another. Your dermatologist will see if your eczema requires any further treatment or you might have another skin disease alongside eczema.
References:
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What causes itch in atopic dermatitis? - 2008 July - https://pubmed.ncbi.nlm.nih.gov/18606082/
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The Itch–Scratch Cycle: A Neuroimmune Perspective - 2022 Mar - https://pmc.ncbi.nlm.nih.gov/articles/PMC8896504/
-
Stressors in Atopic Dermatitis - 2024 - https://pubmed.ncbi.nlm.nih.gov/38724786/
-
Guidelines of care for the management of atopic dermatitis in adults with topical therapies - 2023 Jul - https://pubmed.ncbi.nlm.nih.gov/36641009/
-
Impact of acute stress on itch sensation and scratching behaviour in patients with atopic dermatitis and healthy controls - 2019 Apr - https://pubmed.ncbi.nlm.nih.gov/29947106/
