Q : What Is The Scratch And Itch Cycle Of Eczema
The scratch and itch cycle of eczema can cause discomfort, disrupt sleep and affect quality of life:
- In people with eczema the skin does not retain moisture very well, which causes it to dry out easily.
- This makes the skin more open to allergens and irritants, which can trigger the skin to release chemicals that make the skin itchy.
- Scratching itchy skin causes more chemicals to be released, making the skin feel itchier.
- If eczema is well managed this can avoid the scratch and itch cycle. It is therefore important to keep skin that is prone to eczema well moisturised, by using moisturising creams on the skin every day.
Why Am I Itching At Night
Nighttime itching, also known as nocturnal pruritus, is a fairly common occurrence and can be caused by lifestyle factors as well as medical conditions.
Itchy skin during the night can often become an issue when you find yourself stuck in the itch-scratch cycle where the skin is broken and becomes inflamed and itchier, causing you to scratch more.
Carry on reading to find out more about the causes of nighttime itching and top tips for prevention.
Emollients For Treating Eczema
Emollient creams add moisture to the skin. Apply moisturisers each day to clean, dry skin. It is especially important to moisturise after showering and bathing, and when living or working in an air-conditioned or heated environment. You may need to try several different brands until you find the emollient that works best for you. Ask your doctor, dermatologist or pharmacist for advice.
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Reduce Allergens In Your Bedroom
- Turn the central heating down or off: and keep a window open or a fan running to manage air temperatures.
- Choose pyjamas in natural materials: this is a great natural remedy for night-time itching. Swap polyester sleepwear for cotton or silk alternatives that will help you stay cooler throughout the night.
- Swap your memory foam mattress for a heat-regulating alternative: natural fibres are more effective for keeping cool and deterring allergens.
- Keep your emollient cream to hand: it wont make your bedroom cooler, but it will help to quickly cool and soothe night-time itching if you do wake.
- Replace synthetic carpets with pure wool or hardwood flooring.
- Swap synthetic bedding for wool-filled alternatives, as dust mites cant live in the dry, cool environment created by a wool-filled duvet, pillows and mattress protector.
- Keep feather/down or synthetic-filled cushions out of the bedroom, or replace them with wool-filled versions.
Causes Of Atopic Eczema
The exact cause of atopic eczema is unknown, but it’s clear it is not down to one single thing.
Atopic eczema often occurs in people who get allergies. “Atopic” means sensitivity to allergens.
The symptoms of atopic eczema often have certain triggers, such as soaps, detergents, stress and the weather.
Sometimes food allergies can play a part, especially in young children with severe eczema.
You may be asked to keep a food diary to try to determine whether a specific food makes your symptoms worse.
Allergy tests are not usually needed, although they’re sometimes helpful in identifying whether a food allergy may be triggering symptoms.
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Increase The Use Of Moisturizers
Moisturizers can soothe your skin and calm the itchiness of your skin. It seals the moisture of your skin and helps you significantly in getting sound sleep. It also helps in avoiding eczema flare-ups. So, you should try applying petroleum jellies and other thick ointments that contain a greater quantity of oil.
Why Does Eczema Cause Itchiness
For most people, itchiness is the worst and most uncomfortable symptom of eczema and can often be the most difficult to treat. Itchiness may also lead to sleep problems for both the person with eczema and their family.
Skin affected by eczema releases certain chemical mediators messengers that stimulate the nerves. Additionally, the nerve fibres in people who have atopic eczema appear to be altered, with an increase in sensory fibres. This can cause even the lightest touch to produce a sensation of itch. These nerves then pass on the sensation of itch to the brain, and before you know it, you are scratching. This is called a neurogenic itch, due to nerve pathways being activated.
However, itchiness is not completely straightforward as there is another type of itch, called a psychogenic itch. This means that the itch is also stimulated by psychological factors these may be conscious or unconscious urges to scratch, brought about via habit or in response to stress.
Try not to say Dont scratch to children and adults who are scratching. This can create resentment and distress, and increase feelings of stress.
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Itching In The Anus Due To Skin Problems
Another reason why your anus may be itchy at night is because you have some kind of skin condition, therefore, you get this itchy feeling. There are certain diseases that can cause anal itching, the most common are the following:
- Seborrheic dermatitis
- You have fungi or bacteria in the area
All these conditions can cause the area of the skin around the anus to become irritated and, therefore, you feel intense itching that you can only relieve by scratching. However, you should be very careful because this area is very weak and can easily tear causing wounds, slight bleeding or swelling.
Other Causes Of Skin Itching At Night
- While eczema is often the cause of your body itching at night, there are a number of other conditions that can trigger similar symptoms too. These include short-term conditions such as sunburn, prickly heat and ringworm, as well as longer term conditions related to the kidneys, liver or thyroid. Both pregnancy and the menopause are also causes of itching at night. If you have not already been diagnosed with eczema, you should speak with your doctor about your night-time itching symptoms to rule out any other causes.
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How Can I Deal With Eczema
You may need a moisturizer to control the dryness and itchiness. Some people need stronger medicines called corticosteroids. Steroid ointment or cream rubbed on skin can help calm the inflammation .
Your doctor might suggest you try an antihistamine, a medicine thatâs either a pill to swallow or a liquid. It can help control the itching and help you sleep at night. If all that scratching leads to an infection, you may need an antibiotic. None of these eczema medicines will cure you forever, but they can help make your skin more comfortable and less red.
Here are some other important steps to take:
Questions To Ask Your Doctor
- What treatment is best for me?
- Should I use a steroid cream or ointment?
- What are the side effects from the steroid cream or ointment?
- Do I need to take any other medicines?
- What is the best way to prevent flare-ups from eczema and atopic dermatitis?
- Is there a certain type of soap I should use?
- My child has eczema. What kind of moisturizer is best for him/her?
- How can I keep my child from scratching the rash?
- I have eczema. Will my children have it?
- How should I care for the rash if I have a flare-up?
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Use Of Cold Compresses
Like the Wet Wrap Therapy, Cold Compress can also help a lot in calming the itchiness of the skin. Whenever you feel like itching, take a cold washcloth and hold it against the skin for a couple of minutes. It is better to use ice cubes inside the cloth as it gathers more coldness and can relieve the itching more efficiently.
Why Does Eczema Get Worse At Night
Is your baby scratching eczema at night? You might be surprised, but night itching is not restricted to just children and adults with dermatitis. Because certain key functions of the skin may be altered during sleepincluding thermoregulation, maintenance of fluid balance, and barrier functionnight itching is a common occurrence even among people with perfectly normal skin. Although the exact cause is unknown, there are several factors that may contribute to an increase in itchy skin once nighttime hits.
Body Temperature & Blood Flow. Body temperature and the blood flow to skin both increase in the evening leading to a rise in the warmth of the skin. A rise in skin temperature can make you feel more itchy. Fun fact: Sweat is one of the most common eczema triggers!
Skin Barrier Function. Trans-epidermal water loss a measure of skin barrier integrityis increased at night. Impairment of barrier function may contribute to irritation by facilitating the entry of substances that cause itching. In patients with dermatitis, increased TEWL has been associated with increased itch intensity.
Cytokines & Corticosteroids. At night, the body releases more cytokines which increase inflammation.Meanwhile, Corticosteroidhormones which help combat inflammationlevels are at their lowest, which leads to a decreased anti-inflammatory response .
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How To Reduce Eczema Itchiness
One way to reduce itchiness is to suppress the C-fiber nerve endings that give our brain the itch signal, and we can do this using different sensations.
Here are a few methods:
Ice, ice, baby.
Icing the area can numb the tiny C-fibers from transmitting itchy signals to the brain. If your eczema is itching at night, try holding an ice pack over the itchy area for 5-10 minutes or until its numb. You can also take an ice-bath or a really cold shower. This will make the fibers slow and they wont transmit itching signals as fast to the brain.
Get a massage.
Massages are a mix of pain and pleasure, which really distracts the brain. If the itchiness is bad at night, try massaging another body part to create a sensation away from the part that itches. If you have a child who scratches themselves for long periods at night, try to put them to sleep with a massage, away from the eczema-infected area.
Focus on another sensation.
If your leg is itching, try to create another sensation on a different part of your body: like your arm for example. Doing an exercise, going for a walk, or creating a kind of strain on another part of your body will take your brain off the itchiness.
Blow or pat the skin.
Blowing or patting the itchy part of your skin creates a sensation that can disrupt the itching signal. If you have a child who is itchy at night, you can have them try to pat or blow their skin instead of scratching.
Try the Itch-stopper.
Fight fire with water
Prevent Skin Damage Caused By Scratching
Constant scratching can break the skin. To prevent bleeding and an infection, dermatologists recommend the following:
Keep your child’s nails short: Checking nails after your child’s bath lets you know when the nails need trimming.
Cover itchy skin: When skin is covered, children seem less likely to scratch. When dressing your child, be sure to:
Dress your child in lose-fitting clothes made from a soft, natural fiber-like cotton, a cotton blend, silk, or bamboo.
Consider using eczema mittens and eczema sleeves.
Eczema mittens can be effective when eczema flares on your baby’s face. Your baby may still scratch, but the scratching will cause less damage because the fingernails cannot dig into the skin.
Itch relief can be fickle
You may find that a technique works one day and not the next. If one technique fails, try another.
Related AAD resources
ReferencesEichenfield, LF, Tom WL, et al. Part 2: Guidelines of care for the management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014 Jul 71:116-32.
Sidbury R, Tom WL, et al. Part 4: Guidelines of care for the management of atopic dermatitis. Part 4: Prevention of disease flares and use of adjunctive therapies and approaches. J Am Acad Dermatol. 2014: 71 1218-33.
All content solely developed by the American Academy of Dermatology
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The Main Causes Of Skin Itching At Night
- Being too warm in bed: leaving the heating on, using a memory foam mattress and sleeping under synthetic bedding can all contribute to making your body overheat while you sleep. This in turn further irritates eczema, resulting in body itching at night and forcing you to stay awake.
- Dust mite allergens: while there are many different allergens that can cause eczema, from pet hair to pollen, one of the most common triggers is dust mites. If you frequently find your eczema symptoms are worse at night, then dust mite allergens may well be the cause. This is because most bedding provides the ideal environment for dust mites to thrive in one thats warm and moist exposing you to increased allergens while you sleep.
- Less distractions: children in particular can become more aware of their skin itching at night, simply because they have fewer distractions to keep them occupied.
Ultraviolet Radiation Therapy For Eczema
Exposure to ultraviolet radiation can help reduce the symptoms of chronic eczema. Exposure under medical supervision can be carefully monitored with the use of specially designed cabinets the person stands naked in the cabinet and fluorescent tubes emit ultraviolet radiation.A person with stubborn eczema may need up to 30 sessions. The risks of unsupervised ultraviolet radiation therapy can be the same as for sunbathing faster ageing of the skin and greater risk of skin cancer.
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Eczema Coping Tips Good Hygiene
Skin affected by eczema is more vulnerable to a range of infections, including impetigo, cold sores and warts. The bacterium Staphylococcus aureus may cause a secondary infection of impetigo, and possibly contribute to the symptoms of eczema.Suggestions for washing include:
- Take lukewarm baths or showers, and avoid really hot showers.
- Dont use ordinary soap, as the ingredients may aggravate your eczema. Wash your body with warm water alone. For armpits and groin, use soap-free products, such as sorbolene cream.
- Bath oils can help to moisturise your skin while bathing.
- When towelling dry, pat rather than rub your skin.
Eczema Coping Tips Reducing Skin Irritation
People with eczema have sensitive skin. Irritants such as heat or detergents can easily trigger a bout of eczema.Suggestions for reducing skin irritation include:
- Avoid overheating your skin. Wear several layers of clothing that you can remove, as required, instead of one heavy layer. Dont put too many blankets on your bed and avoid doonas.
- Dont use perfumed bubble bath or bath products labelled medicated.
- Wear soft, smooth materials next to your skin, preferably 100% cotton. Avoid scratchy materials, such as pure wool, polyester or acrylic. You could try a cotton and synthetic mix material this is fine for some people with eczema. Remove labels from clothing.
- Always wear protective gloves when using any type of chemical or detergent. You may want to wear cotton gloves inside rubber or PVC gloves.
- Avoid chlorinated pools. If you have to swim in a chlorinated pool, moisturise your skin well when you get out.
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What Is The Mechanism Of Itch
Itch in atopic dermatitis generally originates in the skin. Medical names for itch starting in the skin can be pruritus, dermatological itch, or pruritoceptive itch. This type of itch begins when free nerve fibers are stimulated by nerve endings called C fibers in the top layer of the skin . The nerve endings can be stimulated by different factors, including external irritants, dry skin, eczema flares, or chemical mediators in the skin .
In response to itch in the skin, nerve pathways are activated and messages travel to the brain. People often respond to itch with a behavior , which is often scratching. However, itch in atopic dermatitis is not as straightforward as this it is actually thought to be very complex. This is because there are two other types of itchneurogenic itch and psychogenic itchthat are also thought to play a part.
Neurogenic itch is generated in the central nervous system in response to circulating itch factors. Psychogenic itch is completely different as it relates to itch being stimulated by psychological factors. In eczema these include unconscious or conscious urges to scratch, habit, or a response to stress.
Q 1: Where Can More Information Be Obtained
Nip Allergies in the Bub
Patient support organisations : www.allergy.org.au/patients/patient-support-organisations
ASCIA is the peak professional body of clinical immunology/allergy specialists in Australia and New Zealand
ASCIA resources are based on published literature and expert review, however, they are not intended to replace medical advice. The content of ASCIA resources is not influenced by any commercial organisations.
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Q : How Can Itch Be Controlled
The following actions may reduce itch, to help control the scratch and itch cycle of eczema:
- Keep skin well moisturised every day.
- Use cold compresses and wet dressings/wraps, as directed.
- Consider using non-sedating antihistamines, especially if there are hives . Sedating antihistamines are generally not recommended and should not be used in young children without specialist supervision.
General Tips For Coping With Eczema
Other tips to manage your eczema include:
- Keep your fingernails short longer nails are more likely to injure your skin when you scratch.
- If the water in your area is hard or alkaline, consider installing a water-softening device.
- Swim in the sea in warm weather whenever you can seawater is known to reduce the symptoms of eczema.
- Use sun exposure for limited periods for example, when swimming at the beach. This can help relieve eczema symptoms. But be aware that ultraviolet radiation is a risk factor for skin cancer and premature ageing of the skin. Also, if sun exposure causes overheating, this can also aggravate eczema.
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