What causes itchy skin in eczema?
That dry, itchy, and flaky skin known as eczema or atopic dermatitis (when there is an allergen involved) may affect up to 20% of children. These children are miserable when their skin flares. Their misery is all too often shared by other family members. Parents can become frustrated in their search for cause/causes. The flaring of the condition is multi-factorial – there are many reasons why these children will scratch their skin. It is usually never just one thing that causes the itch/scratch cycle nor is it only due to allergy. So what other things cause itchiness of the skin?
 
An infant with a flare of eczema.
As our Atopic Dermatitis Signature Center at Riley was evolving, five dermatologists and two allergists (Drs. Leickly and Vitalpur) completed a survey that asked what we thought caused an exacerbation of eczema/atopic dermatitis. Dr. Vitalpur and I focused on a limited number of foods and did not mention any contribution by inhalant allergens in children. In contrast, the dermatologists did not mention foods but thought that pets and other inhalant allergens were possible triggers. Clearly, depending on your specialty, different exposures may be responsible for a flare. This begs the question, ‘How does the rest of the world see this?â€
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A recent article in the British Journal of Dermatology 2009 by Langan, Silcocks, and Williams reviewed and studied what causes flares of eczema in children. This was a group of dermatologists at the Centre of Evidence-based Dermatology, Nottingham, U.K…
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In their review they state that in some cases the cause for the flare is obvious, but most of the time it is not and this leads to unnecessary avoidance including restrictive diets and missed fun (recreational activities). They point out that there are few good scientific studies to support the role of potential triggers in provoking this condition. The literature to date was briefly reviewed.
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They quote a study from Germany published in 2005 that suggested environmental/seasonal or inhalant factors play a role. The conclusions of the 2005 study were based on a post hoc (after the fact) approach and the study was limited by the fact that it did not include all seasons. If this is the support for inhalant triggers of eczema then it is somewhat shaky ground. The group from the Centre of Evidence-based Dermatology has done some preliminary work on the impact of heat, dampness, and stress on eczema flares in children. It was pointed out by the authors that there is a need to sort out the confusion that exists. What causes the skin to flare and do these ‘flare factors’ work independently or in combination? Which are the more common triggers?
The purpose of the paper was to assess the role of a variety of environmental factors on eczema severity. Four questions were asked
- In hot weather, does the combination of heat, sweat, and grass pollen increase eczema severity?
- In cold weather, does the combination of cold, indoor allergen exposure and decreased humidity lead to increased severity?
- Do detergents (soaps, shampoos) increase severity?
- Does any combination of three or more items at any time cause flares?
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There were 60 children in the study. The average age was 6 years (range <2 years to >12 years). Fifty percent had asthma and 60% had allergic rhinitis (hay fever).
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According to the patients/families dust, wool, nylon, and sweating were the individual triggers. Those things that worked in combination were direct skin exposure with nylon clothing, increased exposure to dust, exposure to unfamiliar pets, sweating, and shampoo exposure. These items also tended to worsen eczema in winter months.
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The items that did not have an association with severity in this population included; minimum humidity levels, birch tree pollen levels, temperature changes, grass pollen, seasons, and swimming.
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My take on this is to add a few things to my Allergist’s Approach to Atopic Dermatitis. For those children who continue to flare, especially in winter months, avoidance of nylon clothing, dust, someone else’s pet, shampoo, and sweat (keep them cool) should all be added to the program.
Fred Leickly
September 13, 2009
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fleickly · 
8 Comments
Posted in: Atopic Dermatitis
8 Responses
I’d like to note that in my experiences with my six-year-old daughter, Elspeth, the only thing worth noting as an “external” source of excema is scented laundry detergents or fabric softener, etc. We were given some hand-me-downs which caused a lot of itch until washed inside-out several times. Unscented “All” seems to be okay.
Most of the time, it’s her diet that causes exzema. I avoid the things for which she’s tested positive, but there are a host of other items, like most enrichments, additives, food thickeners, stabilizers, etc. which cause it, too. My point is that the simpler the food, the less chance of itching.
I always appreciate insights from parents regarding their specific situations. You bring up a number of helpful items that I am sure others will benefit from. So much of the avoidance therapy for eczema is individualized.
Thank you for the helpful hints- simple foods and unscented products. and especially no fabric softeners even on other family member’s clothing. These eczema children love hugs and the fabric softener on another’s clothing can be a trigger.
FEL
i suffer from Eczema and what i do is just take as much vitamins A, C and E supplements plus some topical corticosteroid to remedy the itch.
I am glad you have found something that works for you. There is a considerable interest in Vitamin D in atopic eczema.
Thanks for the comment.
FEL
Eczema is really so itchy and i cant help but scratch it. Corticosteroid is a heaven sent because it can relieve the itchiness and redness. ~
It is a never ending itch/scratch cycle. The topical steroid helps. Also consider skin hydration- dry skin itches too. We have been suggesting petroleum jelly at night, something like Eucerin during the day and Cerave (?sp) inbetween times. Keep the skin hydrated- moist and help keep the moisture in with a barrier ointment.
It the allergy literature- it is an itch that rashes.
Thanks for the comments.
FEL
i really hated eczema because it does not look good and it is sometimes very itchy,:`
Great points- many others would filp it around- it is always itchy and looks terrible.
Thanks for the comments.
FEL
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