How to Break the Itch-Scratch Cycle if You Have Severe Eczema

Tanya Trevett, of Boston, knows a thing or two about itching. As someone who’s been living with severe atopic dermatitis, a form of eczema, for more than 15 years, she has tried everything from topical steroids and hydrocortisone to various other creams and lotions, all to no avail.

Some of the treatments temporarily relieved the itch, but once she stopped using them, the itch returned, Trevett says.

She isn’t alone. A study published in 2023 found that among adults with moderate-to-severe atopic dermatitis, 73 percent named itching as their most bothersome symptom, with nearly 50 percent reporting severe “itch intensity” over the week prior to being surveyed.

At least some of this itching is the result of scratching, a phenomenon called the itch-scratch cycle. All forms of eczema itching, but scratching the area damages the skin even further, leading to the release of chemicals called histamines, according to Tania Elliott, MD, a board-certified allergist and spokesperson for the American College of Allergy, Asthma & Immunology (ACAAI).

In turn, these histamines cause more itching and swelling in the skin, she explains.

“The moment you scratch your skin, you cause more trauma to it, which recruits more inflammatory cells to the skin,” Dr. Elliott says. “Even though you’re doing something that [temporarily] quells the itch, it just makes it worse.”

The good news is that the itch-scratch cycle can be interrupted — and even prevented. Here are some tips:

1. Stay moisturized. Applying moisturizer regularly is a basic tenet of any dry skin disorder, but Elliott says it’s also one of the most important. “The best thing to do is try to re-create the protective layer of your skin,” she explains. “Take a bath, soak in that water for 10 minutes, and before you dry off with a towel, rub Vaseline or any preservative-free ointment all over your skin. Vaseline is like plastic wrap, and it can lock in moisture. This won’t work if your skin is dry. By doing this, you’re re-creating that protective skin barrier that plays a role in preventing the itch-scratch cycle to begin with.” Another study published in 2023 found that petrolatum, the main ingredient in Vaseline — a moisturizer recommended for all forms of eczema, including atopic dermatitis — functions as a skin barrier and prevents irritants and allergens from infiltrating it. If Vaseline is too greasy or thick for your skin, start with a lighter lotion or cream and transition to an ointment based on your preference and the time of year. In severe eczema cases, Elliott recommends the additional step of wrapping the skin in plastic wrap after applying moisturizer, which allows it to sit on the skin for several hours to lock in moisture even more.
2. Ice it out. A simple but effective and natural way to prevent itching is to use ice. “The nerve cells that transmit itch also transmit sensation and temperature,” says Elliott. “If you place something cold on the itchy area of skin, it overrides the itch signal, and you get the cold and pain sensation instead. You’re essentially tricking your nerve cells to no longer transmit the sensation of itching to the brain.” A small study found that people with eczema who used a cryotherapy (also called cold therapy) device experienced less itching than those who didn’t try cold therapy. Cryotherapy is thought to have anti-inflammatory and anti-itching effects that ultimately calm the inflamed area, resulting in less of an urge to scratch. Heat may have the opposite effect, though. “Very high temperatures cause a dilation of the blood vessels,” Elliott explains. “More red blood cells to the area causes more redness and contributes to inflammation, which can cause more itching.” Take warm baths and showers, as opposed to piping hot ones, and skip hot tubs and sunbathing.
3. Stick to the plan. It might seem obvious, but sticking to the treatment plan from your doctor is important. “With eczema, you have to be on top of your medications, topical treatments, and environment,” explains Viktoryia Kazlouskaya, MD, PhD, a dermatologist at Dermatology Circle in New York City. “Your whole lifestyle has to be adjusted, and that includes maintaining your routine with your skin care.” When eczema is left untreated, bacteria and viruses can cause infections, leading to further trauma to the skin — and potentially more scratching and itching.
4. Beat stress. Researchers have found that people with atopic dermatitis report having very high levels of stress, compared with people who don’t have eczema. By managing stress, you may be better able to avoid and combat the itch-scratch cycle. “Don’t underestimate the effect stress has on the itch-scratch cycle,” says Elliott. “Anything you can do to relieve stress will help stop the cycle from beginning in the first place.” Research suggests mindfulness meditation — a type of meditation where you are intensely aware of what your body is sensing and feeling — helps reduce the urge to itch by deactivating those areas of the brain that trigger the sensation. “Instead of scratching, you’re retraining your body to give a signal to your brain that, ‘Now I feel the itch. I’m not going to scratch it. I’m going to change my behavior,’” Dr. Kazlouskaya says. “Some people scratch unintentionally, but mindfulness meditation can help stop that urge.” Elliott also suggests incorporating meditation and relaxation apps into your self-care routine. “The FitMind app teaches your mind to be fit like a muscle to combat stress,” she says. “I’ve seen it be really effective in patients with high levels of stress.”
5. Lotion up. Creams and ointments tend to be the best options for over-the-counter atopic dermatitis relief, but avoid any with potentially irritating fragrances and preservatives. “Look for lotions and creams that are labeled ‘dermatologist approved,’” Kazlouskaya says. But, beware of “all-natural” lotions and creams, she adds. “It’s become very popular to choose something that’s labeled all natural, but that could be a very misleading thing for people with eczema. Botanicals and natural elements can cause allergic reactions.”
6. Avoid allergens. To avoid an itch-scratch flare, it’s best to remove any allergens. “Things like dust mites, trees, and laundry detergent can all irritate the skin barrier, weaken it, and cause eczema to begin,” says Elliott. The more allergens you can remove from your environment, the better your skin will be. This includes food allergens, which have been shown to trigger eczema flares days after eating them. To determine if you have a food allergy, seek out a board-certified allergist through the ACAAI for testing. Food sensitivities can also trigger a flare — even though there’s no allergic immune response — through a gastrointestinal reaction and ultimately set off the itch-scratch cycle. Keep a food journal, so you can track what foods may be causing flares.
7. Take advantage of topical creams. Over-the-counter creams such as hydrocortisone could offer you short-term relief and interrupt the itch-scratch cycle. “Topical steroids are the most common eczema medications available today,” says Kazlouskaya. “However, it’s not advisable to use them long term, due to the side effects.” If you stay on top of moisturizing and other preventive measures, you may be able to avoid steroids altogether, she adds. Also, there are nonsteroidal topical creams, such as prescription calcineurin inhibitors and Janus kinase (JAK) inhibitors, that can help alleviate eczema symptoms and stop the itch-scratch cycle. Calcineurin and JAK inhibitors alter the immune system and help reduce inflammation and a number of atopic dermatitis symptoms, such as itchy, dry skin. Unlike steroid treatments, calcineurin and JAK inhibitors can be used in both the short and long term, according to the National Eczema Society.