Breaking the cycle
The Asian Parent: Doctor, what is the “Itch-scratch-itch cycle”?
Dr Lynn Chiam: The itch-scratch-itch cycle is a vicious repetition of scratching which causes more itch, which in turn leads to more scratching. This diagram will be able to illustrate the condition better:
TAP: How does it play a part in increasing flare-ups or inflammation issues in children with eczema problems?
Dr Chiam: With the itch-scratch-itch cycle, the skin gets more damaged and even drier and with constant scratching, the redness and swelling of the affected areas gets worse. Scratching also creates breaks in the skin, through which bacteria and virus can enter. Thus children with eczema tend to get skin infections easily. With an infection, the flare of the eczema is even harder to control.
TAP: Are there any ways to break that cycle?
Dr Chiam: Breaking the itch-scratch cycle requires effort on the part of the patient and caregivers. Skin that is well moisturised itches less. It is important to apply regularly, generous amounts of moisturiser to all parts of the skin. Furthermore, for washing, use a gentle soap and ensure not to over wash the skin as that may exacerbate the dryness and make the itch worse. For areas which are red and inflamed, see a doctor who would prescribe the most appropriate medication for your condition.
If you see your child scratching, constantly remind them not to do so. In order to distract them, some doctors encourage the use of distraction like “play therapy”. Children who are distracted by something that they enjoy tend to scratch less. Habit reversal programmes have also been shown to be useful in children. Physical therapy like cold packs on the itchy areas can reduce the itch. To prevent further weakening of the skin by scratching, cut fingernails short and cover the affected areas ( long pyjamas) , especially when sleeping.
Itch-scratch-itch cycle and its effect on the skin barrier
TAP: Would the cycle damage the child’s skin? If so, what are the remedies or prevention?
Dr Chiam: Yes, the itch-scratch cycle may potentially damage the skin’s barrier function. Wet wraps therapy is an excellent way of increasing the absorption of creams into the skin. This involves wearing a damp layer of cloth over skin on which moisturiser and/or steroid has been applied. This leads to better and faster absorption of the creams, which improves the hydration of the skin, resulting in rapid reduction of itch and associated scratching.
TAP: Are there any tips for parents/ caregivers on how to reduce the presence of allergens in the child’s surroundings at home or at school — to reduce the risk of a flare up of itch-scratch symptoms?
Dr Chiam: Many of the children with eczema are sensitive to house dust mite. This is the most common allergen among children in Singapore. Wash and change your bed sheets and pillow cases every fortnight. Wash them in hot water and sun them under strong sunlight. Sun your mattress regularly and if possible, change them after 1-2 years. Do not have too many carpets and soft toys in the bedroom to decrease the number of house dust mite.
TAP: If damaged skin barrier increases allergen exposure, how can we effectively repair it?
Dr Chiam: Think of your skin as a brick wall composed of “bricks” and “cement”. A good skin is like a good brick wall which does not allow environmental allergens to enter easily. The skin of people with eczema is like a “crumbling” brick wall, with loose, small bricks and insufficient “cement”. By improving and repairing the “bricks “and “cement” of your skin, you can improve your skin barrier function and ensure that there are fewer openings for allergens and infection causing microorganisms to enter.
You can repair the skin barrier function by:
- Moisturising your skin regularly
- Avoiding scratching
- Using a gentle skin cleanser
- Avoiding over-washing
- Treating skin infections early
How good skincare can reduce scratching and itching
TAP: What makes an ideal cleanser for children with eczema?
Dr Chiam: An ideal cleanser is able to wash away dirt without over drying the skin. It must be hypoallergenic and gentle to the skin. It should also be acceptable in colour and texture to the child.
TAP: What makes an ideal moisturiser for children with eczema?
Dr Chiam: An ideal moisturiser for children should be able to do the following:
- Hydrate the stratum corneum ( top most layer of the skin) and prevent water loss through the skin
- Repair the skin’s natural moisture retention mechanism. Moisturisers, which mimic the lipid structure of skin, will help to repair the skin barrier to give long lasting hydration
- Be hypoallergenic, non-sensitising, fragrance free
- Be absorbed easily and rapidly
- Make the skin smooth and supple
- Be acceptable in colour and texture to children
TAP: What makes an ideal cleanser for children with eczema?
Dr Chiam: An ideal cleanser is able to wash away dirt without over drying the skin. It must be hypoallergenic and gentle to the skin. It should also be acceptable in colour and texture to the child.
Dr Lynn Chiam graduated from the National University of Singapore and subsequently received a Membership of the Royal College of Physicians (Internal Medicine) United Kingdom. She completed her specialist training in dermatology at the National Skin Centre, Singapore. She is an accredited dermatologist and is a Fellow of the Academy of Medicine (Dermatology), Singapore. Dr Lynn Chiam was a Consultant Dermatologist in the Singapore National Skin Centre before leaving for private practice. She also served as a Visiting Consultant at the Department of Paediatrics, National University Hospital. Dr Lynn Chiam is currently practicing at The Children & Adults Skin Hair and Laser Clinic and is also a visiting consultant to Kandang Kerbau Women’s and Children’s Hospital (KKWCH).
This series has been brought to you by Physiogel® and theAsianparent.
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Physiogel ‘The Essentials of Skin Care’ Series
The right skin care for eczema-suffering kids
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