Why is eczema so itchy?

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Why is eczema so itchy?

Skin barrier  |  Itch-scratch cycle  |  Scratching  |  Night itch  |  Management

Written by the QV science community with contributions from Dr. Niyati Sharma MBBS, FACD, MPH.

Updated on June 30, 2023

Eczema, also known as atopic dermatitis, is a chronic, inflammatory skin condition characterised by a dysfunctional skin barrier1. 

Skin barrier

How does eczema affect the skin barrier? 

The skin is made up of three main layers: the hypodermis (deepest layer), the dermis (middle layer) and the epidermis (upper layer)2. Eczema primarily affects the top layer of the skin, the epidermis, also known as the stratum corneum3. When the skin barrier becomes weakened due to eczema, moisture escapes and the entry of external irritants or allergens can lead to itchy, dry skin3,4.

Itch-scratch cycle

What is the itch-scratch cycle?

Have you noticed that as your skin becomes drier you find yourself scratching more? Itchy skin, a key symptom of eczema prompts scratching leading to further damage to the skin barrier1,3. This itching and scratching sequence, known as the ‘itch-scratch cycle’, can further damage the skin and increase inflammation, thus creating a vicious cycle5,6.

Diagram of the Itch-scratch cycle

For eczema sufferers, external and internal factors trigger their immune system, leading to inflamed skin. This is what causes the 'itch' component of eczema. If an external factor such as soap or dust is known to be the cause, it is best to avoid these to reduce the likelihood of an eczema flare up.

Dr. Niyati Sharma

Scratching

Why do we scratch?

Why does scratching an itch feel so good? It is thought that scratching triggers mild pain causing signals to the brain that distract from the itch, thus relieving the itch at the time5.

Serotonin is thought to be released, often giving a sense of pleasure in the moment, but can actually make the itch, itchier5.

Night itch

Why is my itch worse at night?

While eczema symptoms can happen at any part of the day, itch often worsens at night7. The reason for this is not quite known, but it is thought that the rise in skin temperature and reduced anti-inflammatory hormone levels at night may play a role5,7.

Management

How can I stop the itch?

Eczema is a condition that can be hard to live with, but it can be managed with the right approaches. If you are ever in doubt, speak to your health professional about management strategies that could work for you. Here are some ways that might help with your eczema symptoms:

1. Consider treatment for flare ups – Anti-inflammatory treatments, such as topical corticosteroids are recommended when treating eczema flare ups1

2. Everyday management – To work effectively, the skin barrier needs to be hydrated all the time, so daily use of moisturisers should form the foundation of any eczema management plan1,8

3. Lifestyle changes – Identifying and avoiding triggers for eczema can help with your management routine. These aren’t the same for everyone, but often include fragrance, soap, detergent, rough fabrics such as wool, heat, stress, animal dander, dust, and food allergens like egg1,8

The information included is for educational purposes only and is not intended as a substitute for medical advice. Eczema requires diagnosis by a medical practitioner. See your medical practitioner for further information. 

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References

1. Nemeth V, Evans J. Eczema. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Available from: http://doi.wiley.com/10.1002/14651858.CD012119.pub2

2. Yousef H, Alhajj M, Sharma S. Anatomy, Skin (Integument), Epidermis. [Updated 2022 Nov 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Available from: www.ncbi.nlm.nih.gov/books/NBK470464/

3. Harding CR. The stratum corneum: structure and function in health and disease. Dermatol Ther. 2004; 17(s1):6–15. 

4. Matsui T, Amagai M. Dissecting the formation, structure and barrier function of the stratum corneum. Int Immunol. 2015; 27(6):269–80.

5. Rinaldi G. The Itch-Scratch Cycle: A Review of the Mechanisms. Dermatol Pract Concept. 2019; 9(2):90–7.

6. Wahlgren CF. Pathophysiology of itching in urticara and atopic dermatitis. Allergy 1992; 47(2 Pt 1):65-75.

7. Wahlgren CF. Itch and atopic dermatitis: an overview. J Dermatol. 1999; 26:770-779.

8. Schneider L, Tilles S, Lio P, Boguniewicz M, Beck L, LeBovidge J, et al. Atopic dermatitis: A practice parameter update 2012. J Allergy Clin Immunol. 2013; 131(2):295-9.e1–27.

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