Why does dry eczema-prone skin cause a cycle of stress itching? Top skin/mind specialist Consultant Dermatologist Dr Anthony Bewley explains why we get that uncontrollable urge to scratch and he offers his top skin-calming tips for National Eczema Week
If there’s one thing guaranteed to raise your stress levels if you have dry, itchy skin, it’s some helpful soul telling you to “stop scratching”. If only it were that easy.
In fact, of all the symptoms of dry skin, itching is what bothers sufferers the most, according to new research by dry and eczema-prone skincare specialists Diprobase. It’s not just the physical aspects of itching that are irksome - the soreness and discomfort - but the emotional effects too: 19 per cent of the 2,000 UK adults who responded to the survey reported that itchiness affected their sleep. What’s more, 17 per cent said it got in the way of everyday life. Shockingly one in ten said they had avoided a social event because of their skin.[i]
So, it’s no surprise dry skin sufferers are more likely to experience stress, with more than two in five (44 per cent) reporting that they feel stressed daily, compared with just 29 per cent of non-sufferers.[i]
Ironically this stress can make the itch/scratch cycle worse, which is why in medical circles the focus is increasingly on a holistic approach. As a specialist in psychodermatology – which looks at the skin/mind connection – it’s something that Consultant Dermatologist Dr Anthony Bewley of Bart’s Hospital, London, knows all about. “The skin and the brain are closely linked through the nerves in the skin,” he explains. “Patients are often told that it is ‘only your skin’ and ‘just a skin disease’ and can feel very disempowered by those kinds of statements.”
He sees patients daily with skin conditions such as eczema, psoriasis and acne that have a large psychological component; people who “feel that their self-esteem is massively reduced, or people who get anxiety or depression about their skin,” he says.
If someone starts to scratch in front of you, then you often start to feel itchy yourself
Treating the skin and the mind together is key. “People are increasingly demanding to have holistic patient-centric skin and general health management and that is why psychodermatology is so important.”
“The treatment for the skin disease can be creams, tablets, phototherapy (ultra-violet light treatment) or even injections. Treatment for the psychological distress can be relaxation techniques, mindfulness, seeking support from counsellors or even medication for anxiety and depression.”
It is important to remember that you’re in charge here too and that exercise and a good, balanced diet with lots of fresh fruit and vegetables will help support your goal of becoming itch-free.
So, if you’re ready for a deep dive into the skin science of itching and the pyschodermatologist-approved solutions, read on for Dr Bewley’s advice.
Get the Gloss: Why do dry skin and eczema cause itching?
Dr Bewley: "There are many reasons why we itch. This can understandably lead to scratching, rubbing and picking as ways to relieve the itch. One of the reasons why the skin can be itchy is dry skin.
"Dry skin can lead to itching as the barrier function is poorer than in ‘normal’ skin. When the barrier function of the skin is compromised (by over-washing with detergents and soaps etc) irritants can trigger the skin's immune system to generate the itch. But the skin's nervous system is automatically more sensitive when the skin is dry and the skin's barrier function is not as good as it could be. So it's really important to maintain good barrier function of the skin by using non-foaming, non-detergent-based soap substitutes. It's also really important to use a good moisturiser (an emollient) to preserve the barrier function of the skin - especially after washing and showering - and to help prevent dry itchy skin."
Get the Gloss: What gives you that urge to scratch?
Dr Bewley: "The exact mechanism which generates itch sensations in the brain is not fully understood and is the subject of ongoing research. What we do know is that the skin is connected to the brain directly through nerves from the skin and that the nerves probably most responsible for the sensation of itch are the 'c' nerve fibres, which are relatively slow-firing, but very sensitive. We also know that the skin's immune system is very intimately connected to the skin's nerve endings. So, inflammation leads to stimulation of the skin's nerves which makes the skin itchy, red and swollen.
"Psychological stress can impact the skin's immune system, through the skin's nerves, as the nerves generate the inflammation (inflammation can present itself as eczema, psoriasis or other skin conditions - to some extent depending on patients’ genetics). We also know that itching is psychologically contagious. If someone starts to scratch in front of you, then you often start to feel itchy yourself. This mirroring behaviour is just that, a behaviour, but it is very powerful. So, sometimes, itch can be purely psychological, and sometimes scratching can be a habit. We know that the phrase ‘having a good scratch’ means that scratching (and relieving the itch) can be pleasurable experience – just look at the delighted faces of animals when they scratch. But the habit of scratching can be unhelpful, and persistent itch can be tortuous."
Get the Gloss: Why does it affect our wellbeing?
Dr Bewley: "Itch is something which is very, very debilitating. It can lead to sleeplessness, irritation, anxiety and even depression."
Get the Gloss: Does scratching make itchy skin worse?
Dr Bewley: "Yes. We know that scratching the skin can stimulate the nerves in the skin and the skin's immune system, which can then lead to more itching and a perpetual itch/scratch/itch cycle. This cycle can become a habit and stop skin from healing. The first few times you scratch, it is most often a conscious reaction. However, after repeating this behaviour over time, the response can become unconscious."
Get the Gloss: What’s the link between stress and itching?
Dr Bewley: "We know as dermatologists that any stress can make skin disease worse. Stress can be psychological, such as relationship or work issues, or moving to a new house, or bereavement; or it can be physically related - sleeplessness, tiredness, overworking. We know that stress causes skin disease, but also living with a skin disease can be very stressful. Stress causes the nerves in the skin to more active and to stimulate the skin's immune system, which then leads to the perpetuating itch/ scratch/ itch cycle, skin inflammation (redness, swelling, dryness) and even more stress!"
Get the Gloss: Is there ever a safe way to scratch?
Dr Bewley: "If you are itchy, the temptation is always there to scratch – don’t ignore itchiness but take positive action instead like applying a cream that will provide relief quickly. You can also replace the 'habit' of scratching with an alternative, for example, you could turn your ‘claws into paws’ by clenching your fists whenever you get the urge to scratch your skin."
Get the Gloss: Why can’t we just ‘stop scratching?’
Dr Bewley: "It’s really important is never to tell people to “stop scratching”. With children, it’s usually better to try to distract them from scratching. For older children and adults, Habit Reversal Therapy can be really helpful if scratching has become a habit. It’s a behavioural therapy rather than an alternative to dermatological treatment and works well when combined with the regular use of emollients and creams to hydrate the dry skin and using prescribed anti-inflammatory ointments (such as a steroid ointment and other creams) to reduce the itchiness. Habit Reversal involves two steps – monitoring of how often and when you scratch or pick and secondly identifying and tackling your emotional scratch triggers. Your GP can refer you for Habit Reversal Therapy. Find out more at ( www.atopicskindisease.com )."
Get the Gloss: Does exercise make itching better or worse?
Dr Bewley: "Moderate exercise will really help with psychological wellbeing and also improves the function of the skin. Exercise will also help with the immune system within the skin and so moderate exercise is always a great way of helping with both skin and psychological distress."
Get the Gloss: What holistic strategies do you recommend to reduce stress and stress-related itching?
1. Do not suffer in silence. Always seek the help of healthcare professionals.
2. Do not be afraid to ask for what treatments are available including what treatments are available for psychological distress.
3. Take time to look after yourself. Give yourself time for chilling out, relaxing or using mindfulness.
4. Take moderate exercise.
5. Make sure you allow yourself plenty of time to “come down” from a stressful day and get a good night’s sleep.
6. Eat well with lots of fresh fruit and vegetables.
7. Avoid not-so-helpful coping strategies such as alcohol.
8. Talk about it to somebody else – that can be a family member or a trained counsellor.
9. Make sure that you maintain good skin barrier function.
a. Avoid bubble bath and detergents
b. Use a soap substitute in the bath or the shower
c. Use a good emollient (moisturiser) on to the skin regularly (thinly, swiftly and always sweeping the emollient in the direction that body hair grows, to avoid blocking hair follicles).
Diprobase Daily Moisturising Cream (£10, 150ml) is a light moisturiser enriched with prebiotics. The product helps dry and sensitive skin feel healthy and protected. It helps reduce dry skin flare-ups for up to three months* and is suitable for babies.
Diprobase Itch Relief Cream (£6.99, 20ml) is clinically proven to aid itch relief, caused by dry skin and eczema within 30 minutes. Its steroid-free and fragrance-free formula Diprobase Itch Relief Cream (£6.99, 20ml)is clinically proven to aid itch relief, caused by dry skin and eczema within 30 minutes. Its steroid-free and fragrance-free formula combines a soothing action with regeneration of the skin barrier. combines a soothing action with regeneration of the skin barrier.
*96% of babies completing the clinical study did not develop new flare-ups of extreme skin dryness over three months
[i]Diprobase consumer survey carried out by Opinium Research, 2019. Sample size: 2,000 UK adults, of which 1,097 people were dry skin and/or eczema sufferers