Q: When my atopic dermatitis flares, it’s hard to keep from scratching – it only makes it worse. How can I stop this cycle?

Stanley Fineman, MD: Atopic dermatitis is a chronic skin condition caused by inflammation in the skin, resulting in a lot of itching. It’s called the itch-scratch cycle: when patients scratch, it causes more inflammation. The itch causes the scratch, and the scratch causes more inflammation with more rash.

Atopic dermatitis usually starts in infancy and it can progress from adolescence to adulthood. It causes a lot of problems for patients and reduces quality of life. Some treatment strategies that allergists recommend include:

  • Use moisturizers. Topical moisturizers soothe the skin, especially if they are cooled off. By cooling the moisturizer before you put it on the skin, it can help reduce skin irritation that contributes to the constant itch.
  • Use a systemic antihistamine – like an oral antihistamine – that can help block the itch sensation when it’s caused by histamine release.
  • Use a topical anti-inflammatory medication – steroidal or nonsteroidal – to reduce the inflammation in the skin and ease itching.

Apart from medications, avoid wearing tight-fitting or wooly clothing or sweaters that can rub against the skin. This can cause more irritation to the skin and leading to more itching, contributing to the itch-scratch cycle.

Stanley Fineman, MD, FACAAI, is a board-certified allergist and immunologist with Atlanta Allergy and Asthma. He is Past President of the American College of Allergy, Asthma and Immunology.

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