Breaking the itch scratch cycle in atopic eczema…
What is atopic eczema?
Atopic eczema is a common, non-contagious inflammatory skin condition, characterised by dry, red, itchy, skin, which can sometimes weep, crust and become thickened.
The major symptom is an intense itch. The urge to scratch can be overwhelming, but only provides temporary relief, and can lead to more itching and scratching. This is often referred to as the itch scratch cycle.
The ‘itch that rashes’
Atopic eczema has been described as the ‘itch that rashes’. Itch is an unpleasant sensation which activates the desire to scratch. The desire to scratch can be so intense that people can sometimes scratch until the skin becomes painful and bleeds. Occasionally, this can lead to cuts, abrasions and skin infections.
Scratching is a behaviour used to relieve itching, but sometimes it can also be prompted by emotion, or it can become habitual. Some people scratch when they are stressed or anxious. Some people scratch through subconscious repeated behaviour, and can get stuck in the itch scratch cycle. When they feel itchy they scratch – when they scratch chemicals are released that causes more itch.
Itch scratch cycle
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- Related: Top Tips for Avoiding Potential Atopic Eczema Triggers
Habit reversal – a behaviour modification technique
Alongside conventional management and treatments for atopic eczema some simple techniques may help to relieve the itch.
Habit reversal is a behaviour modification technique that can be beneficial in helping to replace an old habit with a new one.
To stop scratching, the person first needs to become aware of the desire to scratch and the action of scratching. However, people living with eczema can get fed up of family saying “stop scratching!”, so it may help by developing a code word to provide encouragement instead. Maybe gently ‘pinch’ or ‘tap’ or count the number of times scratching is observed to create awareness of the action. Some people choose to use a tally counter.
Psychiatrist Dr Christopher Bridgette used this method as a combined treatment for eczema patients. The skin improved in combination with conventional topical treatments. It broke the habit by creating awareness.
Replace the old habit with a new one
- Clench the fists for 30 seconds, so that it is impossible to scratch. If the desire to scratch is still there after 30 seconds, pat the itchy area, or gently pinch or hold the skin until the desire passes.
- Apply more moisturiser instead of scratching. Moisturiser with cooling menthol can be beneficial
- Apply a cool wet compress to the itchy area.
Distraction therapy can help some people. It may be just focusing on breathing – concentrating on breathing in and out slowly until the desire to scratch passes.
If you can break the itch scratch cycle, your skin will improve.
Remember, dry skin itches!
- Establish a good daily skincare routine and try to stick to it.
- Don’t stop moisturising when your skin is clear.
- Always keep fingernails short.
- Try to avoid eczema triggers e.g. Protect your skin from changes in temperature, e.g. during cold weather, wrap up well when moving from centrally-heated environments into cold outdoor conditions
- Avoid soap! Choose emollient wash products when hand washing, bathing or showering.
- Your bath or shower should be lukewarm temperature; 5-7 minutes bathing is long enough. After your bath/shower, pat your skin dry. It is a great time to apply moisturising emollient all over.
- Dry skin itches – take your moisturisers everywhere. Keep a supply at work, in your handbag, at the crèche and school.
- Used prescribed treatments as recommended by your healthcare professional.