ask the expert

Dr. Raechele Cochran Gathers, an ABMS board certified dermatologist, spoke with Healthline about eczema itch triggers and how to cope with itching.

People sometimes refer to eczema as “the itch that rashes.” It’s also known as atopic dermatitis (AD).

Triggers for eczema flares and itching can include the following:

  • irritants like detergents, soaps, or fragrances
  • allergens like dust mites, pet dander, or certain foods
  • temperature extremes
  • sweating
  • stress
  • illness
  • certain clothing fibers, like wool

Evidence suggests the skin’s microbiome plays a significant role in the development of eczema and the itch that goes along with it. The skin is the largest organ, and it’s colonized by more than 100 microbial phylotypes and 1,000 bacterial species.

Healthy skin has a balanced microbiome and consists of diverse microorganisms. These beneficial microorganisms help prevent skin from being colonized by harmful pathogens, balance the immune system, and maintain a healthy skin barrier.

People with eczema have reduced diversity in their skin microbiome and an overgrowth of certain bacteria, such as Staphylococcus aureus (S. aureus). One research review suggested that S. aureus may intensify itch in people with eczema.

The causes and triggers of eczema are complex. Evidence suggests that avoiding foods that cause an allergic reaction rarely prevents flare-ups.

While it’s true that food allergies are common in children who have atopic dermatitis, eliminating the offending foods rarely stops eczema symptoms.

That being said, it’s possible for food to cause AD flare-ups. Many experts recommend allergy testing for foods when a child has moderate to severe AD that skin care, trigger management, and medication can’t control and an immediate allergic reaction after eating a specific food.

Over 50% of people with eczema report having at least one stressful life event in the month before a flare.

Stress can significantly impact itch and result in a vicious cycle in which stress worsens itch and vice versa.

Stress can aggravate itchiness by activating the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system. This triggers the production of specific proteins associated with itch. Itch causes people to scratch, which damages the skin barrier and worsens eczema symptoms.

You may be able to manage stress and limit this itch-stress cycle using the following strategies:

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Try soothing itchy skin at night by doing one or more of the following before bed:

  • taking an oatmeal bath
  • moisturizing skin with additive and fragrance-free creams or ointments
  • applying products with cooling agents like menthol or calamine

Placing your moisturizer in the fridge before applying it to your skin can also deliver a soothing and cooling effect.

Wearing cotton gloves or cutting fingernails short can help protect the skin from night-time scratching, and over-the-counter (OTC) corticosteroids can also help with mild itch.

While antihistamines like Benadryl can stop itching from skin allergies, they don’t work for eczema. However, some healthcare professionals may recommend antihistamines to help you fall asleep when dealing with a flare.

For intense nighttime itching, a healthcare professional may recommend or prescribe:

  • topical prescription creams or ointments
  • immunosuppressant medications
  • phototherapy
  • a topical anesthetic like pramoxine
  • low doses of antidepressant medications like mirtazapine

Here are a few tips for adjusting your skin care routine to manage the itch that comes with eczema:

  • Use lukewarm water: When bathing or showering, try to use lukewarm (not hot) water and limit wash time to about 5 to 10 minutes.
  • Avoid irritating ingredients: Choose fragrance-free lotions, soaps, and detergents, and avoid known triggers whenever possible.
  • Opt for soothing, hydrating ingredients: Your moisturizer should ideally contain ceramides, and you should apply it frequently throughout the day.
  • Take advantage of cooling effects: For itchy flares, a product with menthol or calamine can be helpful, and placing your moisturizer in the refrigerator can help cool the skin. Applying a cold, wet cloth compress to itchy skin for 5 to 10 minutes or until the itch subsides can also help provide relief.
  • Be gentle on your skin: Pinch and pat itchy skin rather than scratching, and wear soft, breathable, natural clothing to prevent irritation. Also, avoid sitting on grass, rough carpet, and upholstery with bare legs.

Sweating and extreme temperatures can worsen eczema and itch. Maintaining a relatively cool and neutral humidity environment can help with itching.

Additionally, a humidifier may help during the winter, especially if you live in a dry environment and are prone to dry skin.

Dr. Raechele Cochran Gathers is an ABMS board certified dermatologist and a fellow of the American Academy of Dermatology. She is passionate about health literacy, and she is the founder of MDhairmixtress.com, a health and wellness website focusing on skin, hair, and wellness.