Successfully controlling itch is one of the most important goals of eczema management.
The Itch Scratch Cycle
Severe itching is no stranger to those with eczema, even for those with relatively mild disease. The combination of dry skin and greater sensitivity to irritants and allergens makes eczema patients prone to itch, especially during flare-ups. Itching can be a severe problem for those with eczema, triggering a problematic feedback loop called the itch-scratch cycle.
Itching triggers the urge to scratch, which temporarily relieves the sensation, and is even pleasurable. This reflex is a defense mechanism to remove irritants or insects from the skin; this reaction can backfire when done in excess by damaging the skin. In eczema, scratching damages the already dry and vulnerable skin. Although scratching will temporarily relieve the itch, it damages the skin, causing further inflammation and itching, causing a loop that quickly causes eczema to worsen. This well-known feedback loop is called the itch-scratch cycle.
The itch-scratch cycle needs to be stopped at its source—the itch. Resisting the urge to scratch often fails as the urge is quite strong, and in some cases irresistible. Scratching during sleep, or reflexive scratching that is not conscious, are both common, and beyond control.
Topical steroids are the most prescribed topical medication in dermatology, and for a good reason. It is effective at reducing itch and inflammation of the skin and is very fast-acting. Eczema patients should apply their prescribed medication quickly after they notice inflammation or itching from eczema. The proper response to an itch is to control it quickly before scratching damages the skin further.
Those with eczema should be using moisturizers daily. Moisturizers are more preventative and help to strengthen your skin and prevent excess moisture loss. Once the process of inflammation has set in, its effectiveness is often limited. For minor flare-ups, they can help soothe the skin.
Antihistamines can temporarily dampen itch by stopping histamine which is integral for the inflammatory process, from working properly. As they are fast-acting, they can help prevent you from scratching away until other treatments for eczema begin to work, and remove the source of the itch. They are readily available over the counter. It is important to note, however, that many antihistamines will also cause drowsiness.
Many people use other treatments like icing the itch, washing it with cold water, or rubbing the itchy area with menthol. While these alternatives may be better than vigorous scratching, these are all irritating to the skin and are at best, temporary solutions. If you have eczema, you should prepare yourself for potential flare-ups, and have medication available to stop the itch-scratch cycle as fast as possible.