Itching & Scratching
Eczema can be unbearably itchy, especially when it flares up. The itch then triggers scratching. But in the long-term scratching easily becomes an unconscious habit, like anything that’s done often enough. Scratching can then be triggered by a variety of situations, circumstances and activities, without any initial itch.
The habit of picking, rubbing and scratching damages and thickens the skin. The skin also becomes unstable – prone to flare-ups – and vulnerable to infections. Left alone for long enough, damaged skin will heal naturally, as long as it is not infected. Scratching not only hinders natural healing, it prevents topical treatment for eczema from being effective, and it starts up itching by damaging the skin further.
It is possible to deal with “habit scratching”, and this is now recognised as very important in managing long-term atopic eczema. There are three key steps in managing long-term atopic eczema:
- Make sure you are using your emollient frequently enough. Prevent your skin drying, rather than treat dry skin. Little and often should be the rule – always have it with you – and apply it gently.
- Use topical corticosteroids as prescribed, and don’t stop too soon: after the period of “obvious healing” there is a period of “hidden healing”: with long-term atopic eczema hidden healing takes about one more week (with a flare-up, hidden healing takes one or two days).
- Do something about the habit of scratching. First make yourself aware of what you are doing by counting the episodes of scratching and rubbing each day. A hand tally counter is ideal for this purpose, but pencil and paper can do! Get others to help!
In place of scratching, try to introduce alternative, safe behaviours that make rubbing and scratching less likely e.g. on an impulse to scratch, close each hand into a light fist and hold the position for 30 seconds, then relax! If there is an itch at the end of the 30 seconds, press the itching area with a finger tip, or lightly pinch the skin until the itch goes. For the times when most scratching occurs, think up ways of getting through the situations quickly, and have ways of keeping your hands busy in the meantime.
This approach needs to be maintained for at least four weeks to clear long-standing atopic eczema. But don’t forget the hidden healing.
It is important that the approach does not involve thinking or being told “Stop scratching” – that never works. What is required is doing something instead – that works!
Tips
- If the urge to scratch is too strong, pat the itchy area with the flat of your hand, pinch it with your fingertips or apply something cold (e.g. ice cubes or frozen peas, wrapped in a towel or cloth)
- Try keeping emollient creams in the fridge. Children often find warm emollients more soothing, however. Ointments may become too hard and difficult to apply if kept in the fridge
- You can help to keep skin cool by wearing loose cotton clothing, avoiding hot baths and overheated rooms
- Rather than shouting ‘Stop scratching’ at someone, it is much more effective to do something that distracts their attention from the urge to scratch
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