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).

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

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.

Atopic Triad

Eczema is part of what is often called the atopic triad of eczema, allergies (rhinitis), and asthma. Patients often suffer from more than one of these or they may run in families. They are all characterized to some extent by the immune system reacting to things that it shouldn't - or doesn't in non-atopic people.

At a time of a serious flare of my eczema I underwent comprehensive allergy testing. My dermatologist wanted to make sure that contact allergies were not making my eczema worse. I found out that I had a number of allergies that gave me hives or triggered my eczema. A big one was nickel. What I had thought was eczema around my neck was actually an allergy to several necklaces I had that were made of nickel. I now have a nickel testing kit to avoid exposure. I also discovered a serious allergy to dust mites and have dust mite-proofed my home. This has had no noticeable effect on my eczema, however.

I have also always suffered from rhinitis and as I paid attention, I have noticed that some things I am allergic to also trigger my eczema. Cats, for instance, and grass. After being around cats or sitting in the grass I am very likely to have a bad flare-up. Other allergies cause a runny nose but no change in my eczema. I think it just takes a lot of time paying attention to what you are exposed to and how your body reacts. Once you notice patterns that lead to flare-ups, you can start to avoid those triggers.

Eczema on your eyes?

A couple years ago, I had trouble with eye irritation. My eyes would itch. When it was very severe, they would feel like there was something in my eye that would not come out. It could get so bad that I would have to lie down with a cold washcloth on my eyes for long stretches at a time. After weeks of suffering with these symptoms, I went to see an eye doctor. He was certain it was not an infection and gave me antihistamine drops. We tried two types of antihistamine drops that did little good. Then he prescribed me Alocril - that solved the problem. They are bright yellow drops. A couple in each eye twice and day and symptoms went away.

I learned later from Nasir's book that eczema can inflame the conjunctiva. The conjunctiva is tissue covering the eyeball. When inflamed, it feels like there is something in your eye. This could be what I was experiencing. If it happens to you, ask for Alocril.

What is eczema?

Eczema, also called atopic dermatitis, refers to skin conditions characterized by dry skin, rash, and persistent itch. It can affect people of all ages. Eczema has been called the itch that rashes, because the persistent itch leads to scratching, which causes the rash. Eczema is a terrible cycle of itch and scratch that is difficult to break.

Why so dry?
In patients with eczema, the skin loses its moisture rapidly, causing chronic dry skin. Lipids hold skin cells together. As discussed in Your Guide to Eczema by Sarah Wakelin, in some patients with eczema, not enough lipids are produced, leading skin cells to dry out and be lost more easily. This makes the barrier layer of the skin thinner and thus even more likely to dry out and crack. The cracks can let irritants into the skin, exacerbating the eczema.

Further, eczema patients do not produce enough of the oils made by the sebaceous glands. This also leads to very dry skin.

Why so rashy?
The dermis is the deeper layer of the skin. In the dermis are many blood vessels. White blood cells that fight infection come to the skin through these vessels. In patients with eczema, the natural barrier function of the skin has broken down. This allows irritants to enter the skin, which trigger more white blood cells being sent to the skin. These white blood cells trigger inflammation, releasing antibodies and cytokines to fight off bacteria or infections, even when they don't need to be fighting. Steroids are anti-inflammatory drugs to help limit this response.

Why so itchy?
When the white blood cells get to work in the cell, they can trigger nerve endings in the skin, causing the sensation of itch.