What is Eczema and why does it itch?
Eczema or atopic dermatitis (AD) is a chronic and growing problem, which can often be dismissed as a trivial skin disease. It is characterized by rashes, skin redness, and itchy skin. People with milder eczema may only have a few patches of dry skin and minimal itching. However, for a significant number of sufferers, the eczema kitch can be painful, hard to treat and have a disabling impact on their lives. In moderate to severe cases, a person may have widespread inflamed skin all over their body and the constant, unbearable need to scratch. This can be particularly difficult for children to manage.
The exact cause of eczema is unknown, however experts have found that certain environmental triggers and genetics have a role to play. External triggers and overactive immune systems, cause inflammation, which leads to the itchy, red, cracked and sore skin, we find with eczema.
In this blog post, we discuss why eczema prone skin has that unbearable itch, what happens when scratching occurs, and what can be done to help.
Why is it hard to stop scratching with eczema?
The main challenge of eczema is unbearable scratching which often gets worse at night. Night-time scratching has a great impact on families as it sleep disturbances affects both the child and their parents. It is estimated that 60-80% of children with eczema have disturbed sleep patterns. This has a major knock-on effect in terms of energy levels, mood, and behaviour. Regardless of age, everyone who has eczema from mild, moderate, to more severe cases, will experience that dreaded itch and urge to scratch. There are different reasons why eczema causes this unbearable itching:
· Damage to the skin barrier – The skin barrier of someone with eczema is not as intact as in someone without the condition. In fact, researchers have found structural and genetic differences in eczematous skin.
Eczematous skin cells can’t retain water. As a result, the skin dries out, and gaps open up between cells, creating weaknesses in the skin barrier. Skin moisture loss is highest at night, which contributes to itching becoming worse at nighttime. In eczema prone skin, the usual lines of skin defence are broken. Irritants can easily enter the skin, causing further inflammation and itching. Over time, skin can become much more sensitive, making itching and scratching worse.
· Flare-ups - When a person has an eczema flare-up, the skin becomes sore, red, and has inflammation, which causes itching. This happens because an external or internal trigger, send the immune system response into overdrive, which causes the inflammation.
· Sweating – Perspiration can aggravate eczema and worsen itching. The exact reasons why sweating worsens itchiness are still unclear. Researchers have found that people with eczema are overly sensitive to their own sweat. Their bodies release histamine in response, which can make itching worse. As sweat is made up of water and salt, it is thought that the salt remaining on the skin after water in sweat evaporates, directly triggers the nerves that transmit itch.
As well as the physical factors, there are also environmental triggers or irritants that can cause an allergic response. These may include:
· soaps/perfumes
· cleaning products/detergents
· synthetic clothing
· dust
· pollen
· extremes of temperature
· humidity
· contact allergy to latex, dyes, chemicals, or metals
· food allergies
· stress responses
What happens when a person scratches?
When people are experiencing a flare-up of eczema they can be caught in an “itch-scratch cycle.” They scratch to relieve an itch, which in turn causes more itching, inflammation, skin damage, and even skin infections. This leads to more scratching and skin damage, and so the cycle continues, prolonging and worsening the eczema flare.
Scratching leads to painful, red skin, which can break and bleed. As the skin barrier is already structurally different, further damage from scratching increases the risk of infection. Broken skin also makes it easier for external triggers and irritants, to enter the skin barrier and prolong an eczema flare.
Scratching also causes lichenificiation. This is a process that causes the skin to become thick, leathery, and may cause changes to skin colour. Scratching can also lead to scarring in the skin and in darker skin, there a risk of the skin areas having permanent discoloration.
Treatment and prevention
The best way to stop skin damage with the eczema itch is to stop scratching, however this can be extremely difficult to control, particularly with young children. To reduce the likelihood of a flare up and itching, careful management of eczema is essential. In general, it is helpful to:
· Moisturise regularly
· Keep nails trimmed
· Stay hydrated and eat well
· Avoid environmental triggers
· Wear clothing made from natural, breathable fabric during the day
· Wear protective clothing made from natural, breathable fabrics when sleeping to minimize damage from nightime scratching
A dermatologist can also provide prescribed treatment to help manage and alleviate the symptoms of eczema. The National Institute of Clinical Excellence (NICE) sets out the UK guidelines for standard treatments to alleviate eczema symptoms. These include steroids, moisturising creams, wet-wrapping, antibiotics and in severe cases, immunotherapy and phototherapy.
With advice from your dermatologist, garments like the Skinakin Onesie can also be used alongside regular prescribed medication. These are useful as they can be worn at night to reduce the damage caused by nocturnal scratching, aid emollient absorption, and protect the skin from environmental triggers.
Choosing natural fabrics such as organic cotton, also ensures that skin can breathe. Another benefit of organic cotton is that there are no nasty chemicals used in the manufacturing process. Be sure to check if your organic cotton carries a ceritification mark like GOTS or similar.
As the skin barrier is weakened with eczematous skin, the Skinakin Onesie all in one option offers another line of defence, for a child with uncontrollable scratching. The full body protection option means that there are no entry points for scratching, and gloves and socks cannot be removed. This creates a barrier for the most determined itchy child. Overall this should help improve sleep disturbance and reduce the damage caused by scratching.
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Fighting the Eczema Itch and reducing skin damage | Skinakin 2022
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