Transcript
Announcer:
This is DermConsult on ReachMD. On this episode, Dr. Mariam Iqneibi will discuss how the itch-scratch cycle can impact children with atopic dermatitis. She’s a pediatric dermatologist at Cincinnati Children's Hospital and an Assistant Professor of Dermatology at the University of Cincinnati College of Medicine. Let’s hear from her now.
Dr. Iqneibi:
Once a child starts scratching, how it affects the skin is that we know that the scratch is a relief response. It provides you with a brief relief. And how it does that is basically when you scratch the skin, you are activating the sensory fibers and the pain fibers. Now, that is different from the fibers that carry itch sensation, which is mainly going to be our unmyelinated C fibers. So when you're scratching, you're activating those other nerve fibers that cause pain and activate sensory nerves. So that temporarily inhibits the itch fibers, so you get a sense of relief temporarily. And that is what causes, "Oh, I have relief. I'm no longer feeling itchy for this brief moment that I'm scratching," and it's a never-ending cycle.
The problem is that when you're scratching, you're obviously doing physical damage to the skin. You're scratching the skin surface. You are opening wounds up in the skin. You're causing erosion and excoriation. You're increasing the risk of infections, which can also activate the immune system and trigger the immune system. And in response, the skin also starts releasing more inflammatory markers, and with time, if this process is chronic, the skin sort of develops its own shield by thickening.
So you'll notice that in some patients who have severe, long-standing eczema, in the areas where they typically get itch or scratch, their skin becomes thicker, more what we call “lichenified.” So it's a very hard cycle to break. I try to be very understanding towards the patients and just educate parents that it's not as easy as, "Don't pick at your skin or don't scratch your skin." We have to really address giving things that lock in the moisture, reduce the inflammation, and also help to not release itch mediators or things that could further perpetuate itch.
What I know with my patients, in terms of what really affects them, is the itching affects them more than the appearance. The itching really drives them crazy. So I try to give them techniques and life skills to do instead when they're itchy. Like, "I understand that you're itchy, and it's really hard to stop, and I completely understand. When you're feeling itchy, try applying a cold moisturizer. When you're feeling itchy, try using these creams instead." There are even things out in the market right now that produce a sort of cold sensation on the skin, so activating other sensory nerve fibers instead of those itch nerve fibers.
You have to be more understanding. These kids don't understand, "My parents or the doctor's telling me to stop itching because it's harming my skin." For them, it's just, "They're not understanding the pain that I'm in and how much I'm suffering, and I can't stop itching." And it's especially hard for babies as well, because babies don't develop a fully functioning itch-scratch cycle on their skin, so they don't know how to properly scratch. So what they'll do instead is that they'll wiggle in the bed, and they'll sort of rub their head against their parents' clothing, or they'll rub their head against the bedding. They won't be sleeping well. So in addition to making it difficult for a child to understand why they need to avoid itch, it's also difficult in pediatric dermatology to sometimes educate parents. And even sometimes it's hard for providers to detect this baby's itching. Rubbing their legs against each other or rubbing their face against their parents' clothing is a sign that they're itchy.
Announcer:
That was Dr. Mariam Iqneibi discussing the itch-scratch cycle in children with atopic dermatitis. To access this and other episodes in this series, visit DermConsult on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!
