Eczema (atopic dermatitis) is a chronic condition in which the skin becomes irritated and inflamed. People with eczema may experience many symptoms, with chronic itch typically recognized as one of the most severe.
The itch-scratch cycle, sometimes called the itch-scratch-damage cycle, starts with inflammation of the skin. This inflammation leads to itching so intense that it’s hard not to scratch. Scratching the affected area causes the skin to become more inflamed — in turn causing the skin to become itchy. Then, the cycle begins again. Scratching seems to be the only source of relief.
Chronic itching and the itch-scratch cycle can lead to several problems and complications, including:
Persistent scratching of the skin can also cause the skin to thicken — a process known as lichenification. The affected areas of skin become leathery and may take weeks or months to return to their normal thickness.
Luckily, there are ways to manage itching and put a stop to the cycle, both at home during your skin care routine and with your dermatologist’s help. These self-care approaches can help manage itchy areas of skin and improve your overall quality of life.
Watch dermatologist Dr. Brian Kim explain why scratching makes an itch worse.
Controlling the itch in the first place — thus preventing scratching — is the best way to avoid skin damage, infections, and scarring. Although currently there is no cure for eczema, there are treatments that may help you find some itch relief. Because everyone’s eczema is different, the same remedy may not work for everyone. Some people may need only one treatment, while others may need to use several different approaches, which may include creams, pills, and injections.
To find the right treatments and itch management techniques, talk to your dermatologist. They will work with you to determine the causes of your itching and find the best way to manage it.
Many everyday substances can irritate the skin and cause itching in people with eczema. Soaps, detergents, and fragrances are common causes of the irritation that leads to itching. Soaps with sodium lauryl sulfate (sometimes called SLS) should be avoided, as they can strip the skin of its natural oils.
Figuring out which allergens contribute to your eczema may require trial and error. Allergens that may worsen itching include pollen, pet dander, and dust mite droppings. If you are unsure whether allergens may be contributing to your itching, your doctor may refer you to an allergist for patch testing.
In people with eczema, the skin’s protective barrier is compromised. An insufficient skin barrier leads to transepidermal water loss, or the loss of water through the skin. Eliminating dryness and keeping the skin hydrated is the most important part of stopping the itch-scratch cycle.
Dry skin is itchy skin. Moisturizers (also known as emollients) are meant to help the skin stay well moisturized. Emollients reduce dryness by forming a thin layer on the skin that helps repair the skin barrier, preventing the loss of water. Emollients are usually applied twice a day. Cooling the moisturizer before application may help relieve the irritation that causes the skin to itch.
Many different kinds of emollients are available. Some are available over the counter, while others are only available through a prescription. MyEczemaTeam members have shared their favorite choices for moisturizing. Some of the most popular options include aloe vera, shea butter, and coconut oil.
Read more about the best moisturizers for eczema.
Some materials can irritate the skin. Stiff, coarse fibers like wool can rub against the skin and leave it itchy and raw. Synthetic materials can make the skin hot, leading to feelings of itchiness. Friction caused by loose threads and rough seams can also be a problem.
Opt for softer fibers like cotton to prevent itchiness and irritation in eczema. Wearing loose-fitting clothing and dressing in layers can also prevent friction and overheating, both of which can start the itch-scratch cycle.
Avoiding the sun can help prevent eczema flare-ups for some people. As one MyEczemaTeam member wrote, “After being in the sun for a couple of hours, I get an angry rash on my legs. I just came in from gardening, and my arms and legs are breaking out. The itch is awful.”
What’s more, sunburns, which cause injury to the skin, can lead to what is known as the Koebner phenomenon — new eczema lesions caused by trauma to the skin. In people with eczema, the Koebner phenomenon can result in new dry, itchy patches developing across skin injured by a sunburn.
If you can’t avoid the sun entirely, take care to apply a generous layer of sunscreen to all exposed areas of skin before heading outside. The National Eczema Society recommends applying sunscreen in gentle, downward motions, since rubbing it into the skin may cause itching. Because they contain fewer chemicals, sunblocks with zinc oxide and titanium dioxide may be less irritating to the skin.
Soaking in a warm — not hot — bath is one of the most common ways to help relieve itching. Several members have shared how baths and soaks help them find relief. One said, “I make my own bath melts with four ingredients because less is more. I use coconut oil, jojoba oil, tea tree oil, and juniper.” Another member said, “I take a daily warm bath and apply moisturizer without fragrance.”
Several ingredients can be added to baths to help manage itching with eczema.
Oatmeal baths are an at-home treatment some people use to soothe their itchy skin. Colloidal oatmeal, in particular, is regulated by the U.S. Food and Drug Administration (FDA) as a skin protectant. This oatmeal derivative can help soothe itchy skin caused by eczema. Its antioxidants can help lessen inflammation and itching. They also help cleanse the skin while maintaining its natural pH balance and protecting the skin barrier.
One member said that oatmeal baths helped them with eczema-related itching: “Terrible itching this morning. It drives me crazy. I decided to take an oatmeal bath and leave the lotion off for a while … the itching has calmed down quite a bit.”
A bleach bath contains a small amount of extremely diluted household bleach. Bleach baths can help reduce bacteria on the skin, which may ease eczema symptoms like itchiness and irritation.
Tub time should be limited to five to 10 minutes — soaking for any longer may cause discomfort. Bleach can dry and irritate the skin, so before you try a bleach bath, it’s crucial to speak with a dermatologist.
Because of the harsh ingredients in standard soaps, soap is one of the most common irritants for people with eczema. Gentle cleansers should be used rather than soaps, and you should avoid scrubbing. When choosing cleansers and other bath products, look for dye-free, fragrance-free items. Avoid waterless, antibacterial cleansers, as these options usually contain alcohol and other solvents that are especially tough on the skin.
Many brands now advertise for sensitive or eczema-prone skin. Also, syndet (synthetic detergent) cleansing bars have been recommended for people with eczema. These soaps have a neutral or slightly acidic pH, which makes them less irritating to the skin.
Some doctor-recommended medications may help stop the itch-scratch cycle. Some, such as topical corticosteroids, are available over the counter. Higher concentrations may be available with a prescription. As always, speak with your doctor before trying any new medication for your eczema.
Steroidal or nonsteroidal topical anti-inflammatory medication may help reduce skin inflammation and ease itching. A systemic antihistamine, like an oral antihistamine, may help block itch caused by the production of histamines. Antihistamines could also double as a sleep aid and help you get sleep while dealing with intense itch.
One MyEczemaTeam member shared their experience with ketoconazole, an antifungal cream prescribed for eczema on the scalp: “My dermatologist stated that I had a yeast infection on my scalp and prescribed 2 percent ketoconazole cream. It’s my second day using it, and I actually can say I am only itching slightly.”
A popular natural remedy, apple cider vinegar can provide itch relief for some people. If your doctor gives you the all-clear, you can use apple cider vinegar topically in a bath, hair mask, or skin wrap. One MyEczemaTeam member shared, “Today, I mixed apple cider vinegar and water and applied it with a cotton ball. Much less itching, and the redness is going away!”
Wet wrap therapy has been known to work wonders for some people’s intense pain or severe itching. This approach may help calm and rehydrate the skin. It may also help topical medications work more effectively.
Talk with a health care provider about how to apply the wet wraps, as their application depends on the location of the itch and whether you will be applying a topical medication.
Dry air, which has low humidity, draws out moisture from the skin and can aggravate eczema symptoms such as itching. Humidity is especially low in the winter, when temperatures and atmospheric moisture fall. People often crank up the heat indoors as the weather gets cold, so the air becomes even drier.
Humidifiers put moisture into the air. It’s not been proven that humidifiers help people with eczema, but some of our members have found them helpful for their symptoms. Placing a bowl of water in the rooms you frequent can help increase humidity if using a humidifier isn’t possible.
Certain hormones are released during stressful situations. These hormones may affect a person’s mental health — they may also trigger the itch-scratch cycle. It’s been suggested that emotional upset and stress are common eczema triggers. They may even keep some of the most effective eczema medications from working.
Some research-based psychological techniques attempt to help reduce symptoms like itching and control the need to scratch. These techniques include keeping a symptom diary to help determine emotional triggers and when these triggers usually happen. People are also taught how to alter their behaviors, including persistent picking and scratching.
If you find yourself in the midst of the itch-scratch cycle, talk to your dermatologist. Be sure to check with your doctor before trying any new treatment or home remedy, as mixing different substances could potentially be dangerous or impact the efficacy of your treatment. A doctor can help you find safe remedies and avoid any possible interactions.
Your health care provider may also refer you to an allergist for allergy tests, which may be needed before you try certain remedies. Discuss all symptoms, including any emotional issues or stressors, so your doctor has all of the information needed before recommending or prescribing treatments. Remember that the first intervention you try may not work. It may take some time, but you and your doctor can work together to find the approaches that give you the most relief from itching.
MyEczemaTeam is the social network for people with eczema and their loved ones. More than 43,000 members come together to ask questions, give advice, and share their experiences with others who understand life with eczema.
What treatments have you tried for the itch-scratch cycle? Share your experiences and thoughts in the comments below or by posting on MyEczemaTeam.