Eczema is characterized by itchy, red, and inflamed skin that can cause significant discomforts. This chronic inflammatory skin condition is not contagious. But does it spread to other parts of your body when you scratch it?
Eczema Itch-Scratch Cycle
Sometimes this skin condition is also often referred to as “the itch that rashes,” emphasizing how the affected area becomes itchy and prompts the urge to scratch.
But when you scratch it, this drives the release of inflammatory substances in the skin. As a result, the affected area may become larger in size or even spread to nearby areas. The more you scratch, the more intense your itch becomes! That’s what we call as a vicious cycle.
The itch-scratch cycle is a significant factor to deal with eczema. Many times the flare-up starts with the sensation of itchiness, typically triggered by certain allergens, dry skin, or other environmental factors.
At first scratching may provide a temporary relief. But then it causes micro-tears in the skin, ruining the skin barrier. As you scratch more, there is greater risk for skin damage to occur. This allows bad things (such as allergens or irritants) to penetrate deeper, leading to skin inflammation [1].
The Role of the Skin Barrier
We know well that your skin acts as a protective barrier to keep harmful substances away. The outermost layer of the skin (also known as the stratum corneum) contains cells held together by lipids. These lipids are responsible to maintain your skin hydration and protect your skin from environmental irritants.
In people with eczema, this barrier doesn’t work as well as it should due to genetic factors, environmental triggers, or immune system malfunctions. Unfortunately the exact cause of eczema is not known yet!
A protein called filaggrin is one of key components for your skin barrier. In people with eczema, mutations associated with filaggrin might have an effect to a defective skin barrier. This results in the loss of natural moisturizing factors –making the skin more prone to dryness, irritation, and inflammation [2].
When the skin is dry, it becomes itchy. And scratching can further damage the already compromised barrier, which might eventually lead to the spread of eczema lesions.
Inflammatory Mediators and Eczema
Scratching might also have to do with the release of inflammatory mediators (chemicals in the body that play a role in the immune response). In eczema, they may contribute to worsen the condition. One such mediator is a neuropeptide called substance P. It is involved in the transmission of pain and itch signals in the nervous system.
When substance P and other inflammatory mediators are released in response to scratching, this can cause increased blood flow to the area. Then you’re likely to have redness, swelling, and more intense itching in the affected area.
And if you keep scratching — this not only worsens the existing eczema lesions but may also cause new ones to form in nearby areas [3].
The Psychological Impact of Itching
The bad news, the itch associated with eczema is not just a physical sensation since it also has psychological components as well.
Itching may have to do with psychological factors such as stress, anxiety, and even the mere thought of itching. This psychogenic itch is common in people with eczema and it can be just as intense as itch caused by physical factors.
Stress is a well-known trigger for eczema flare-ups. When you are stressed a lot, your body releases stress hormones such as cortisol. It can weaken the immune system and exacerbate inflammation. As a result you can feel that your skin become more sensitive and prone to itching.
Unfortunately the psychological burden of dealing with a chronic condition like eczema can also lead to a cycle of stress and itching. All these things can make it difficult to manage the symptoms effectively.
Localized Spread and Infection
So while eczema is not contagious and does not spread to other people through scratching, it can spread to different parts of your body, particularly true during flare-ups. This localized spread is often due to the fact that scratching damages the skin barrier, making it easier for the rash to expand.
For example if you scratch an eczema lesion on your arm, the rash can spread to the surrounding skin. The more you scratch — the more likely for eczema to affect larger area.
In addition to spreading the rash, scratching can pose your skin to infection. Staphylococcus aureus (a type of bacteria commonly found on the skin) can easily enter through the micro-tears caused by scratching.
And infection can make the problem get worse. This can make the affected skin to become itchier and more inflamed with pus-filled blisters [4].
Since scratching plays a lot in worsening eczema, it is crucial to take steps to prevent and manage the itch-scratch cycle. Here are a few strategies to manage eczema symptoms and prevent eczema lesion from spreading:
- Keep your fingernails trimmed short to help minimize damage to the skin if you do scratch. Wearing gloves at night is also a helpful way to prevent unconscious scratching while you sleep since eczema usually tends to itch more at night.
- Keep your skin well-hydrated, regularly apply emollients and moisturizers to help restore the skin barrier and reduce itching!
- Apply a cold compress to itchy areas to get immediate relief. This numbs the skin and reduces inflammation.
- Wet wrap therapy! It applies a damp layer of fabric over a treated area of skin, followed by a dry layer on top. This method helps to lock in moisture, reduce inflammation, and soothe itching.
- Identify and avoid triggers that worsen your eczema! Common triggers include harsh soaps, detergents, certain fabrics like wool, and allergens such as pollen and pet dander.
- Since stress is a known trigger for eczema, practicing stress management techniques is worth a try for people with eczema. Try stress-controller therapies such as deep breathing, meditation, progressive muscle relaxation, and mindfulness.
If the problem doesn’t respond to these lifestyle measures, ask your doctor for medication. Topical corticosteroids are commonly prescribed to reduce inflammation and control eczema flare-ups. In addition to corticosteroids, other topical treatments like calcineurin inhibitors and barrier repair creams might work effectively to soothe your eczema symptoms.
