Why Does Eczema Itch So Bad?

Why Does Eczema Itch So Bad?

The itch associated with eczema can be excruciating, and at times feel unmanageable. 

Various central and peripheral mediators are involved in the pathophysiology of itching in eczema, and significant cross-talk occurs among the skin's stratum corneum during flare-ups. 

Environmental factors and personal habits can worsen itchiness, such as humidity, temperature, and scratching.

It is helpful to understand the underlying causes of the itch to learn how to effectively manage it and improve the quality of life for those with the condition.

Key Takeaways

  • Eczema is a prevalent skin condition characterized by inflammation, redness, and intense itchiness.
  • The itch of eczema results from various central and peripheral mediators and can be influenced by environmental factors.
  • Effective management of eczema and its itchiness involves understanding its causes and implementing appropriate treatments and lifestyle changes.

Understanding Eczema

Causes of Eczema

Eczema, also known as atopic dermatitis, is a chronic skin condition that affects millions of people around the world. The exact cause of eczema is unknown, but it is thought to be a combination of genetic and environmental factors. 

A compromised skin barrier and immune dysfunction are believed to contribute to the development of the condition (source).

Some common triggers for eczema include:

  • Irritants: Harsh soaps, detergents, and chemicals
  • Allergens: Pollen, pet dander, and dust mites
  • Stress: Emotional stress can exacerbate symptoms
  • Weather: Dry or cold climates can worsen symptoms
  • Food: Allergies to certain foods, such as dairy, soy, and nuts

Symptoms of Eczema

Eczema is characterized by various symptoms that can vary between individuals. The most common symptoms include:

  1. Itchiness: Eczema can cause intense itchiness, leading to a strong urge to scratch the affected area.
  2. Redness: The skin often becomes red and inflamed due to irritation and scratching.
  3. Dryness: Eczema sufferers often have extremely dry skin, which can cause the skin to crack and become painful.

Beyond the above-listed symptoms, eczema can manifest in several different forms:

  • Infantile eczema: Affects babies and toddlers, usually on the face and scalp
  • Childhood eczema: Typically occurs on the inner elbows, behind the knees, and on the neck
  • Adult eczema: Can appear anywhere on the body, but common areas include the hands, feet, and eyelids

Managing eczema involves identifying and avoiding triggers, as well as treating the symptoms with appropriate therapeutics, which may include topical emollients, corticosteroids, and immunosuppressive agents.

The Itch of Eczema

Science Behind the Itch

The itch in eczema is believed to be created by various factors that contribute to this sensation. Unlike in urticaria (hives), histamine is not considered to be a major pruritogen (itch-producing substance) in atopic dermatitis source.

Some factors involved in the itch of eczema include:

  • Inflammation: The skin inflammation in eczema can activate itch-producing nerve endings.
  • Skin barrier dysfunction: Eczema often causes a compromised skin barrier, leading to dryness and increased sensitivity to irritants and allergens.
  • Neurological factors: Research suggests that there may be alterations in the perception of itch source.

Itch-Scratch Cycle

The itch-scratch cycle is a significant aspect of eczema, and it refers to the process of:

  1. Feeling an itch, leading to scratching
  2. Scratching causing skin damage and further inflammation
  3. Increased inflammation intensifying the itch

This cycle can exacerbate the symptoms of eczema and make it difficult to manage the condition. 

Breaking the itch-scratch cycle is crucial in managing eczema and reducing its impacts on a person's quality of life.

Some strategies to break the itch-scratch cycle include:

  • Moisturizing: Keeping the skin moisturized can help reduce dryness and alleviate itchiness source.
  • Topical treatments: Using over-the-counter or prescription anti-itch creams and ointments can help relieve itching.
  • Cold compresses: Applying a cold compress to the itchy area can provide temporary relief.
  • Stress management and relaxation techniques: Since stress can exacerbate eczema symptoms, learning stress management techniques can help reduce the itch.
  • Behavioral therapy: In some cases, cognitive-behavioral therapy or habit reversal therapy can help break the itch-scratch cycle by teaching new ways to cope with itchiness.

Managing itch in eczema requires a comprehensive approach that addresses the underlying causes and helps patients cope with the urge to scratch. 

By understanding the science behind the itch and taking steps to break the itch-scratch cycle, those affected by eczema can experience relief and improve their quality of life.

Factors That Worsen Eczema Itch

Environmental Triggers

Various environmental factors can exacerbate eczema itch. Temperature plays a significant role, as both cold winter and hot summer temperatures can worsen the itch and extent of eczema. Cold winter air can lead to dry skin, while hot and humid conditions in the summer may cause increased sweating, which irritates the skin. 

Exposure to pollen, dust mites, and pet dander can aggravate eczema itch. It's important to be aware of these triggers and take necessary precautions, such as using a humidifier in winter, staying cool in summer, and maintaining a clean living environment.

Stress and Eczema Itch

Stress has been identified as a significant factor contributing to the worsening of itch in eczema. Corticotropin-releasing factor (CRF) is a hormone that, when released in response to stress, can aggravate atopic eczema and itch via a neurogenic mechanism involving neuropeptides. 

Managing stress through relaxation techniques, mindfulness, and exercise can help alleviate the severity of eczema itch.

Managing Eczema and Its Itch

Skincare Routine

Establishing a consistent skincare routine is essential for managing eczema and its itch. The routine should include:

  • Gentle cleansing: Use a mild, fragrance-free cleanser to avoid irritation.
  • Moisturizing: Apply a pH-correcting, unscented moisturizer right after bathing to lock in moisture and maintain optimal skin pH.
  • Bathing: Take short, lukewarm showers or baths to prevent further drying of the skin.
  • Advanced care: For severe cases, consider using wet wraps or specialized eczema clothing for additional relief.

Medications and Treatments

In some cases, a healthcare professional may prescribe medications and treatments to alleviate itching and inflammation:

  • Topical corticosteroids: Applied directly to the skin, these medications reduce itching and inflammation.
  • Topical immunomodulators: Non-steroidal medications, such as tacrolimus and pimecrolimus, that help manage itch in atopic dermatitis.
  • Oral antihistamines: These medications can provide temporary relief from itching caused by eczema.

Follow the recommended course of treatment and consult a healthcare professional if symptoms do not improve or worsen.

Lifestyle Adjustments

Making lifestyle adjustments can further support eczema and itch management:

  1. Avoid triggers: Identify and avoid allergens, irritants, and stressors that exacerbate symptoms.
  2. Wear suitable clothing: Opt for loose-fitting, breathable, and natural fabrics to minimize irritation.
  3. Maintain a comfortable environment: Keep the living space at a consistent temperature and humidity level to prevent flare-ups.
  4. Incorporate stress-relief activities: Practices such as yoga, mindfulness, or meditation may help manage stress-related triggers.

Frequently Asked Questions

What actually causes the itching sensation in eczema?

The itching sensation in eczema is mainly caused by the activation of itch receptors in the skin due to skin dryness, inflammation, and the release of various chemical mediators. It is also influenced by cultural and educational factors related to patient experiences and understanding of eczema.

Are there effective methods for immediate itch relief from eczema?

Some effective methods for immediate itch relief from eczema include applying ice packs or cold compresses, using over-the-counter anti-itch creams, and taking antihistamine medications. Consult your healthcare provider before using any new treatment.

Why does scratching eczema lead to a feeling of relief?

Scratching in response to eczema itch generates a temporary sense of relief due to the activation of pain receptors that momentarily override itch signals. This relief is short-lived and can lead to further damage to the skin.

Can eczema become worse from scratching and potentially spread?

Yes, scratching eczema can make the condition worse and potentially spread it. Scratching can lead to the formation of open sores, cause the release of more inflammatory mediators, and increase the risk of infection.

How can scratching impact the healing process of eczema?

Scratching can have a negative impact on the healing process of eczema by interrupting the skin's natural barrier, introducing bacteria, prolonging inflammation, and contributing to the "itch-scratch cycle" that exacerbates the condition.

What are known triggers that may intensify the itch of eczema?

Triggers that can intensify the itch of eczema include exposure to allergens, irritants, increased stress levels, and certain environmental factors such as changes in temperature or humidity. It is important to identify and avoid these triggers to better manage eczema-related itching.


  1. https://academic.oup.com/bjd/article-abstract/155/3/504/6636999
  2. https://www.sciencedirect.com/science/article/pii/S1323893016301599
  3. https://link.springer.com/article/10.1007/s11882-008-0049-z