As a skin condition, atopic dermatitis prompts a vehement itch that not only takes on a life of its own, but takes over yours.
Everyone’s familiar with itchiness, and the guilty pleasure of scratching it away.
But what if the itching is so relentless that it’s basically a disorder you struggle with on a daily basis?
For the over 200 million people in the world diagnosed with atopic dermatitis, this is their reality. And it’s more than just a discomfort – it can be so distressing that it impacts their quality of life and psychological wellbeing.
But how can something as trivial as an itch become so overwhelming? We speak with dermatological experts to understand the complexities of this condition, and what we can do to cope.
Atopic Dermatitis: Intense, Insistent Itchiness
Atopic dermatitis, also known as eczema, is a chronic skin condition that produces dry, itchy skin. It often appears as reddish or brownish patches, scaly or thickened skin, and small bumps that crust over or even ooze fluid.
Atopic dermatitis has a strong hereditary component, and flare-ups can occur as an allergic response, or due to environmental triggers. But what causes the itchiness itself?
The main answer: inflammation.
“When the skin is inflamed, the skin cells (keratinocytes) and immune cells on the skin produce various chemicals. These chemicals bind to receptors on nerve endings in the skin, which then transmit signals to the brain that give rise to the sensation of itch,” illustrates Dr Koh Hong Yi, the Senior Consultant Dermatologist at TSN Dermatology Skin Specialist Clinic.
This inflammation could be the result of a weakened skin barrier, thus damaging the skin via the entry of irritants and moisture loss.
Sensitisation is also another factor at play.
“In atopic dermatitis, patients have an overactive immune system, leading to the release of chemicals called cytokines, which are directly responsible for the sensation of itch, much like one would experience in an allergy,” explains Dr Kok Wai Leong, a Skin Specialist at Dermatology Collective Clinic & Surgery.
“Studies have also shown that nerves in the skin affected by atopic dermatitis is more sensitive than normal skin. Therefore, even minor triggers like heat and scratching will stimulate these nerve fibres, leading to itch.”
Scratching Makes It Worse
When our skin starts to itch, our first instinct tends to be to give in to the urge to aggressively scratch the irritated spot with our fingernails. However, this can come with some massive consequences, especially for those with atopic dermatitis.
For one, scratching can break the skin, and even result in bleeding.
“Breaks in the skin may lead to infections as open wounds are a portal for the entry of bacteria, viruses or fungi,” elaborates Dr Kok. “In addition, the mechanical effect of scratching leads to the activation of chemicals leading to inflammation and swelling.”
This damage to the skin can interfere with the healing process, potentially leading to scarring and hyperpigmentation.
And if you scratch over the same area again and again, your skin will respond by getting thicker, rougher and drier.
Why is the Itch in Atopic Dermatitis Different?
Atopic dermatitis is far more complex than most other skin conditions or allergy-related itches, making it especially difficult to manage. Much of this complexity comes from the unique type of itch it causes.
Itch can be classified as histamine-induced and non-histamine induced.
“The itch in atopic dermatitis is predominantly non-histamine induced, which explains why antihistamines are often not very effective in the treatment of eczema.” explained Dr Kok.
He adds: “Chronic itch is caused by a complex interaction of skin barrier defects, immune system dysregulation, and nerve hypersensitivity. Therefore, a comprehensive treatment plan to address all these factors are required to effectively deal with the itch.”
However, the repercussions of this itch don’t stop at physiological reactions and the need for added medical support. It can be so overpowering that it inundates your mind, hampering day-to-day living.
“The most common effect to a person is sleep disturbance. Itch is often worse at night, and many are unable to sleep well, leading to daytime tiredness, an inability to concentrate, or memory issues,” highlights Dr Kok.
“Moreover, many experience anxiety, low mood and emotional stress, because they feel worried or frustrated. It is also well reported that those with chronic itch feel embarrassed or self-conscious about their skin, leading them to avoid social situations or activities.”
“The impact of atopic dermatitis also extends to the family members of young children suffering from eczema,” adds Dr Koh. “Parents report being stressed by their children’s symptoms, losing sleep when their children are unable to sleep, and experiencing a sense of helplessness in managing their children’s eczema flares.”
Do you have eczema or know someone who does? Medical Channel Asia is conducting a short 5-min survey to understand how eczema and itch affect daily life in Singapore. Leave your contact details and stand a chance to receive a wellness pack as a token of our appreciation!
Coping With Chronic Itch
The frustrations of atopic dermatitis can be profound, but there do exist ways to ease its effects on our lives – and treatment options have improved dramatically.
“We have seen significant advancements in eczema therapies in the past 5 to 10 years, and many patients who previously were deemed to have refractory disease are now getting good results from these treatments,” Dr Koh reassures.
So if you feel atopic dermatitis is deteriorating your quality of life, pay a visit to your friendly dermatologist. They will help you understand the type and severity of the itch, what might contribute to it, and create a plan for alleviating it.
“Patients with mild eczema can often be adequately treated with topical creams that may or may not contain steroids. Patients with more severe eczema may benefit from advanced therapies such as phototherapy (use of ultraviolet light for medical treatment), oral or injectable medicines,” says Dr Koh.
Other practical tips for dealing with the itch on a daily basis include:
1. Creating a Comprehensive Skincare Routine
Use gentle soaps and fragrance-free moisturisers. It is best to apply these moisturisers right after a shower on damp skin, to lock in hydration.
2. Identifying and Avoiding Triggers
“Wear soft fabrics and avoid wool or rough fabrics,” suggests Dr Kok. “Reduce environmental exposures to factors that may aggravate your skin like sweat, harsh chemicals and dust.”
In addition, you might benefit by keeping to cooler environments, and setting the water at a lower temperature when you shower.
3. Using Behavioural Modification Techniques
Whenever the temptation to scratch arises, squeeze a stress ball instead. You can also press or pat the itchy area.
To prevent the stress of your reaction from aggravating the itch further, practice distraction methods like deep breathing or mindfulness-based meditation.
4. Seeking Emotional Support
Don’t be afraid to openly discuss your struggles with those you trust. The emotional support they provide can be more helpful than you think.
Remember that you’re not alone on this journey, and that there are numerous resources and treatments available to you. An effective treatment plan, consistent care, and emotional support can make it manageable – allowing you to reclaim your nights, your skin, and your life.
Visit our Dermatology Chapter – Atopic Dermatitis for more information and resources on living with eczema and chronic itch.
External References
- Jeskey, J., Kurien, C., Blunk, H., Sehmi, K., Areti, S., Nguyen, D., & Hostoffer, R. (2024). Atopic Dermatitis: A Review of Diagnosis and Treatment. The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG, 29(6), 587–603. Retrieved from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11627575/
