Anyone who has ever experienced atopic dermatitis (AD), the most common type of eczema, is acutely, intimately aware of "the itch," even if they have a mild-to-moderate case. It’s a particular brand of discomfort that can be persistent — relentless even— and if you do inevitably succumb to it and scratch, instead of finding any sort of relief, it can exacerbate the problem, leaving you…still itchy. So you scratch, and the dreaded itch-scratch cycle begins all over again.
“Itching is by far the most common symptom I hear about from my patients living with AD,” says Dr. Sonia Batra, Los Angeles-based board-certified dermatologist and founder of Batra Dermatology. “When your skin is inflamed, dried out, and flaky, it can be quite itchy and naturally, people scratch.”
As it turns out, when you scratch, even more inflammatory chemicals are released, thus fueling more itch. And over time, Dr. Batra says persistent scratching can cause more damage to the skin, like long-term changes in color, thickness, and appearance. But to break the cycle, it’s helpful to understand what AD is and why the itch happens in the first place.
Broadly speaking, AD is a chronic immune-mediated skin condition that “often presents as itchy, flaky patches and commonly occurs in folds of the skin, such as the sides of the neck, inner folds of the elbows, and behind the knees,” says Dr. Batra, explaining that in skin of color, AD often looks dark brown, purple, or ashen gray, while it looks red and inflamed on lighter skin.
A healthy skin barrier protects against the outside — bacteria, viruses, irritants — but a compromised one from AD has cracks or fissures, which allows those external triggers to infiltrate the skin, according to Dr. Batra. That will lead to an uptick in proteins called cytokines, which affect other skin-protecting proteins and send the immune system into overdrive, causing inflammation and thus, dry and itchy skin, otherwise known as flare-ups.
And to break that itch-scratch cycle, it’ll take forging a relationship with your derm, a whole lot of patience, and more. Keep reading to find Dr. Batra’s top nine ways to help mitigate your itch.
Establish a relationship with your derm
First of all, it's essential to be proactive about your AD management, and that means making regular appointments with your derm even when you aren’t experiencing a flare-up. In other words, don't book an emergency appointment as it's happening — the goal is to get ahead of it from happening in the first place. “I always tell my patients this to ensure we tailor their management plan to stay ahead of the curve and avoid flare-ups,” says Dr. Batra. “You don’t want to just put out fires when they occur. Finding a trusted dermatologist is a crucial part of managing your AD, even if it’s mild or moderate.”
Resist the itch
For so many with AD, the itch is one of the most burdensome symptoms. To restore and maintain the seal of the skin, you’ll need to avoid scratching so as not to further compromise the skin’s barrier (easier said than done, we know). To help minimize damage as much as possible, Dr. Batra says to cut your nails short and file them smooth.
Remember to also speak with your derm about how the itch is impacting your day-to-day life so they can help you create a management plan that addresses your symptoms.
Know your triggers
Quite literally anything can trigger flare-ups. It could be a food allergy, stress, a fragrance, household cleaners — so a way to take control (and feel less overwhelmed by it all) is to document every flare-up and figure out what may have caused it. “I encourage my patients to write down everything they did and came in contact with or consumed for one to two days prior to a flare,” Dr. Batra says. “Being able to investigate, play detective, and figure out on a particularly bad day what might have led to a flare can help inform conversations with your dermatologist, who can work with you to create a personalized management plan.”
Shorten your showers
Eliminate any habits that strip and dehydrate the barrier, like taking long, hot showers or baths. “We have this misconception that water is going to help hydrate the skin, but that is not the case,” Dr. Batra explains. “While you might feel good at the time, the hot water is breaking down the skin barrier. This is also true for long soaks.”
Seal in moisture
Take stock of your body care products and toss the ones with known irritants, like those with fragrances and dyes, which can cause inflammation. Steer clear of cleansers that foam or lather, because they tend to be drying. And if you're experiencing a flare-up in a more sensitive area, like on your face, it's crucial to find a product that's safe, effective, and feels good on your skin. Be sure to also talk to your derm for recommendations.
Winter is especially unkind to anyone with AD (dryness creates dryness), so Dr. Batra advises moisturizing at least once daily to lock in hydration and protect the skin (though it’s a good habit to keep year-round). “Follow every shower with a scent-free, dye-free moisturizer,” Dr. Batra says. “This will help restore a seal to the skin.”
Dr. Batra points to stress as a major trigger for many people. “When we’re stressed, the body releases a hormone called cortisol, which can throw the immune system off balance and contribute to AD flares,” she says. Take deep breaths, step away from whatever’s stressing you out (or better yet, eliminate that stressor completely), or distract yourself from the situation. Thinking about the itch, for example, will only worsen it, so put on a movie, go for a walk, do anything to take your mind off it.
Remember that you're not alone
In the throes of a flare-up, it can feel frustrating, not to mention incredibly isolating, especially if no one in your circle has or understands AD. That's why Dr. Batra is a big believer in the importance of finding a support group — a community that can provide comfort in knowing that others share the same experiences.
Take advantage of resources
Managing your AD is easier when you understand the science behind the condition, so read up and consult credible, reliable science-backed resources that are at your disposal. Dr. Batra highly recommends Start From Scratch, a website sponsored by Incyte, and More Than Skin Deep as starting points, both of which dive into what AD is and how it can impact your quality of life, while spotlighting stories from those living with the condition.
And finally, be patient
The reality is, your itch won’t go away overnight. And when it does, chances are it’ll come back — so exercising patience and kindness to yourself is essential. “My biggest piece of advice is just to be open and flexible since this condition is chronic. It is going to show up in different ways as you change, as your skin changes, and as your body changes,” Dr. Batra says. “But learning more about the science behind AD, being your own advocate, and establishing a trusting and open relationship with your dermatologist can help aid you in finding the best management options for you."
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