Keep Your Hands Busy

Since scratching can make itching worse (see this earlier post and an even earlier one), it is important for eczema patients to try and keep their nails away from their skin. This is hard enough when one is conscious of the itch and the scratch impulse but eczema sufferers often scratch without even realizing it. One way to help limit this type of scratching is to take up another activity with your hands when they would otherwise be idle. For instance, try squeezing a ball while thinking in front of the computer or knitting while watching TV. Activities like this that keep your hands busy can also keep them off your skin, which will ultimately reduce the rash and itching.

More Itch Research and A Few Home Remedies

The Independent recently reported on itch research from Washington University in my hometown of St. Louis. Apparently, it was previously thought that itch was simply a milder form of pain, but the Wash U research shows that itch and pain are conducted on separate nerve pathways. We can all hope that this will lead to drugs that can target and eliminate constant itching. But they suggest such treatments are decades away.

The article also offered some home remedies for relieving itching. Those that seemed potentially useful were rubbing ice on the area or a cold compress (the numbing from the cold can help, I've tried it), rubbing crushed mint leaves on the area (if it doesn't cause irritation, this might be similar to the benefit from menthol in lotions), oat baths, and calamine lotion (I've never seen calamine discussed for eczema, but it is recommended for the itch from poison ivy, so might be worth a shot).

Good Skin Care Routines

• Use lotions and emollients -- lots of them!
• Avoid hot showers. They feel good while you're in them, but then dry your skin out, making the eczema worse.
• But do shower off dirt, sweat, and irritants that can cause flare-ups.
  
• Avoid rubbing you skin with washcloths and avoid excess use of soap.
• Avoid very alkaline soaps. I use Dove Sensitive Skin, which seems to be okay.
• If you can avoid soap, and use a cleanser, such as Cetaphil,
  
• Put lotion on immediately after showering, bathing, or swimming.
• Lukewarm baths may be better on your skin than showers.
• Oatmeal baths help soothe itching for some patients.
• Do not use lotions with artificial dyes or perfumes. Many also contain alcohol, which is drying. I have Lubriderm Sensitive Skin works for me.
• Wear loose, cotton clothing.
• Avoid triggers.
• Run a humidifier in the winter.

Why You Shouldn't Scratch

"The more you scratch, the more itch nerve receptors you'll have in that area. The release of nerve growth factors from damaged nerves makes the skin more sensitive to itch and more itchy for less reason. If scratched enough, itch trigger substances can become embedded in the nerves, causing persistent burning and itching."
- Dr. Adnan Nasir, Eczema-Free For Life

DIY UV therapy?

The New York Times last week cautioned eczema sufferers against trying to do UV therapy yourself at a tanning salon instead of under the care of a doctor since tanning beds carry with them a risk of cancer. Apparently, the UV rays administered by a doctor are UVB and those in most tanning beds are UVA, which are thought to be more dangerous.

Unfortunately, phototherapy from a doctor may not be covered by insurance and/or getting to a hospital or doctor's office as frequently as needed may be inconvienent or just not possible. So many eczema patients turn to tanning beds.

I have tried doctor-administered phototherapy myself during the winter, when it is difficult to get UV rays the old-fashioned way by sitting outside. While it didn't eliminate my symptoms, it may have reduced them slightly. In the end, I decided the co-pays and constant shuttling to the hospital were not worth it. That said, in late spring and early fall and some summer days, when it is possible to soak up some sun but also not get very sweaty (which aggrevates my eczema), I can feel the improvement in the itch and the rash. But I have learned the hard way to be very careful about sun exposure. I got burned on my back a couple months ago and not only was it a bit painful, it triggered a bad flare-up as my skin peeled and new skin came in. Not helpful!

Avoiding Triggers

People with eczema are overly sensitive to anything that triggers itching. Identifying what triggers itching and flare-ups of the rash is important for any eczema patient. Once identified, avoidance is the best policy. The things I have found that trigger my eczema are: wool, grass, dust, pets, hot showers, dry air, and sweat. Certain soaps, lotions, shampoos, and detergents have also triggered itch for me. Right now I use Dove Sensitive Skin soap, Tide Free and Clear detergent, Lubriderm Sensitive Skin lotion, and generic brand Vaseline. I've found these do not bother my skin.

Eczema sufferers can also interpret sensations as itch that others would not. Hair brushing across your face, for instance, may make someone with eczema itch when it is unlikely to make someone without eczema itch. Mild pain can also be interpreted as itch by eczema patients.

Itch Survey

A study published in the British Journal of Dermatology this year (160: 642-644) reports on a "characteristics of itch" survey. The survey was available on the National Eczema Association for Science and Education website. 304 eczema-suffers answered.

They asked patients how many times a day they itch. 91% said at least once a day, 68% said at least 5 times a day, and 38.3% said more than 10 times a day.

Not surprisingly, respondents reported experiencing itch more frequently at night, in the evening, and in the winter.

Over half of respondents reported feeling pain and heat with itch.

A quarter of respondents reported itching with sweat.

New York Times Interview with Dr. Gil Yosipovitch

The New York Times has an interview with Dr. Gil Yosipovitch, a dermatologist at Wake Forest University who studies itch.

He is very understanding of the chronic itch associated with eczema, which is comforting for anyone who suffers from pruritus (techincal word for intense itching). Interestingly, he notes that the number one cause of itching is eczema. But he says that only 10% of eczema patients have severe itch. This may explain why I've seen several dermatologists who are very dismissive of the persistant itch and how disruptive to you life it can be. It is nice to see someone who understands how terrible it is!

He discusses how scratching can make the itch worse, leading to terrible itch-scratch cycle:
"So, now we can understand that brain-wise, it could feel like scratching helps for a couple of hours. But in chronic eczema the more you scratch, the more you damage the upper layers of the skin barrier, the protective layer. And the more you damage it, the nerve fibers are — I would call them wacky, they are not functioning as they are supposed to. They become overactivated, so that scratching actually intensifies the perception of itch, causing more itch. So that can explain why we have that itch-scratch cycle."

On treatments, he notes that the use of steriods can be essential for eczema patients and that anti-histimines at night can have a sedating effect to help patients sleep. He mentions new reasearch they may lead to anti-itch medications but they appear many years off still -- sadly for those of us suffering now.

Staph Infections

Eczema patients have been found to suffer from staph (staphylococcal bacteria) infections on the skin more than others.

Eczema patients do not make enough antibacterial proteins called magainins. These proteins kill bacteria in the skin but those of us with eczema are in short supply. Staph infections will usually manifest themselves as pustules. One type of staph infection that I had several years ago was folliculitis. This is a staph infection in which red pimple-looking bumps appear around the hair follicles. I had them all up and down my legs. I know, gross.

Treatment: If you have a staph infection go to your doctor immediately for antibiotics. Oral antibiotics cleared up my folliculitis in a couple days (for more of folliculitis from the Mayo clinic, click here). Oral antibiotics, though, are only given for severe infections since they can also build up resistence. The doctor also told me to wash with an antibacterial soap in the shower. Usually, eczema patients are told to avoid harsh soaps since they can be very drying, but when staph is getting out of control, it is best to use them. For less severe outbreaks, topical antibiotics can be used. One that my doctor has given me is a cream called Mupirocin. When I get a postule that appears to be infected, I just put some of this on right away.

Prevention: Since eczema patients have more staph on them than others, when an eczema patient gets a cut or scrape, it is best to wash with soapy water quickly to prevent the spread of staph. And keep cleaning it regularly. Also, use emollients often because staph likes dry skin better than well-moisturized skin.

More on Your Skin

Nasir's book Eczema-Free For Life provides some insight on how the skin of eczema patients is different from those who do not suffer from the itch that rashes.

Your skin is made up of three layers: epidermis (this is what itches and flares), the dermis (where blood vessels, glands, and hair follicles are), and the subcutis (fat layer with blood vessels).

New cells in the epidermis push older ones out and off. This is an ongoing cycle. When the older cells are pushed to the top of the skin, they form a layer called the cornified envelope. As Nasir notes, in eczema patients, this layer does not have as many lipids as in non-eczema people. This lack of lipids leads the the epidermis to dry out and crack. Irritants can enter the skin through the cracks, causing flare-ups. Essentially, the barrier function of the skin has broken down.

This is why emollients like Vaseline are great for those with eczema. The Vaseline provides needed moisture and also acts as a barrier over the cracks to prevent irritants from entering the skin.