Eczema: When Itch Takes Over Everyday Life

Itch sounds like such a small word.

Most of us know what it is to have an itch: an irritation, a quick scratch and then we carry on with our day. But the itch associated with eczema can be something entirely different. It can be intense, persistent and consuming; a burning need to scratch that can dominate waking hours and continue even during sleep.

Someone may spend an entire day consciously resisting the urge to scratch, carefully protecting their skin, only to wake the following morning to find they have scratched unknowingly during the night. Skin that had begun to heal may once again be excoriated, sore or bleeding; sometimes the evidence is there on the bedsheets. The disappointment and frustration can be enormous, despite something having happened entirely outside their conscious control.

Scratching may bring momentary relief, but it can perpetuate a difficult itch–scratch cycle, further damaging already inflamed skin and increasing the risk of infection. And when itching repeatedly disrupts sleep, the consequences inevitably begin to extend beyond the skin.

During my years working in dermatology, I saw how eczema could reach into almost every aspect of someone’s life. Sleep, concentration, clothing, relationships, confidence, work and social activities could all be affected. For some people, managing their skin became an exhausting part of everyday life.

In dermatology we used measures such as the Eczema Area and Severity Index (EASI) alongside the Dermatology Life Quality Index (DLQI). They told us different things. EASI helped assess the extent and severity of the eczema we could see; the DLQI helped us understand what living with that skin condition was doing to the person’s life.

Both mattered.

Two people whose eczema appeared similar clinically could experience it very differently. Conversely, an area of eczema that might appear relatively limited could have a disproportionate impact because of where it was, how intensely it itched, how it affected sleep, work or relationships, or simply how that individual felt about living with it.

Treating eczema therefore means looking beyond what we can see on the skin.

When eczema reaches beyond the skin

The impact of eczema is not confined to the symptoms we can see. During my years working in dermatology, people often shared with me how eczema had found its way into ordinary, everyday activities that most of us rarely have to think about.

Work could become particularly difficult. Heat and sweating could intensify pruritus, making some working environments extremely uncomfortable. Uniforms or protective clothing could aggravate symptoms further. For someone already struggling with persistent itch and disrupted sleep, simply getting through a working day could become exhausting. For some, repeated flare-ups contributed to periods of sickness absence or made continuing in their usual role increasingly difficult.

Hand eczema could be particularly disabling. Painful fissures and inflamed skin could make fully opening the hands difficult, while everyday activities such as washing, preparing food or peeling vegetables could cause considerable discomfort. Wearing protective gloves might help with one problem while creating another: they can make practical tasks more cumbersome and, for someone already conscious of their skin, make the condition more noticeable to others.

Then there are other people’s reactions. Eczema is not contagious, yet visible skin disease can still cause uncertainty or misunderstanding. Someone working at a counter may notice another person hesitate when taking something from their hand. A person with eczema affecting their face or hands cannot easily conceal it and may become increasingly self-conscious about being seen. For some, withdrawing from situations can begin to feel easier than repeatedly managing other people’s reactions.

Even getting dressed can require thought. Clothing needs to feel comfortable against sore or irritated skin and avoid making someone excessively hot. Regular use of emollients and ointments can leave marks on clothes and bedding, creating additional washing, expense and frustration.

And these seemingly practical issues can become deeply personal. Imagine beginning a new relationship while worrying about the appearance of your skin, scratching during the night, or ointments and blood staining the bedding. None of these things appears on a simple description of eczema symptoms, but they can matter enormously to the person living with the condition.

This is why quality of life matters when eczema is assessed. Clinical measures can tell us about the extent and severity of disease, but they cannot, by themselves, tell us what that disease is costing somebody in sleep, work, relationships, confidence, independence or participation in everyday life.

Treatment: from limited options to a changing landscape

Eczema treatment is not one-size-fits-all. What is appropriate will depend on factors including the type and severity of eczema, the areas of skin affected, the person’s age, previous treatments and the impact the condition is having on everyday life.

Emollients (moisturisers) are a fundamental part of eczema management. They help moisturise and protect the skin barrier and are generally used regularly, even when the skin appears relatively settled. They are available in different forms, including creams and greasier ointments, and finding a preparation that someone is comfortable using is important.

Topical corticosteroids (steroid creams or ointments) are used to reduce inflammation during eczema flares. They are available in different strengths, and the treatment prescribed will depend on factors including the severity of the eczema and the area of the body affected.

One of the important lessons we regularly reinforced in dermatology was how to use these treatments correctly and when to stop them. It can be incredibly tempting to stop treatment as soon as the skin looks and feels better. However, stopping treatment too early can allow the eczema to flare again, sometimes undoing weeks of hard-won improvement.

I saw how disheartening this could be. Someone could have worked diligently with their treatment, finally reached a point where their skin felt controlled, stopped because they understandably believed the treatment was no longer needed and then found themselves dealing with another significant flare.

This is why topical corticosteroids should be used according to the instructions provided by the healthcare professional prescribing them. Treatment should not be altered simply because the skin looks better without understanding when and how the prescribed course should end.

Concerns about topical corticosteroids are also common. During my dermatology practice, I met many people who were reluctant to use them, or avoided them altogether, because they were worried about potential side effects. These concerns should be listened to and discussed rather than dismissed. Used appropriately, topical corticosteroids remain an important and effective treatment for eczema. Understanding why a treatment has been prescribed, how much to use, where to apply it and for how long can help people make informed decisions about their care.

It is also important to distinguish an eczema flare from a topical steroid withdrawal reaction. Withdrawal reactions can occur in some circumstances after topical corticosteroids are stopped and may include symptoms such as intense redness, burning or stinging, itching, peeling or oozing. Anyone concerned about symptoms during or after steroid treatment should seek professional advice rather than simply restarting, stopping or changing treatment themselves.

Topical calcineurin inhibitors, such as tacrolimus and pimecrolimus, are non-steroid treatments that can also reduce inflammation. They may be considered for particular people or areas of the body when clinically appropriate.

Other approaches can be introduced when eczema is more difficult to control. Wet wrapping or bandaging may be used in some circumstances to support treatment and protect the skin. This is something I particularly remember teaching families during my dermatology nursing years.

Phototherapy uses carefully controlled ultraviolet light to treat the skin and can be helpful for some people whose eczema has not responded sufficiently to topical treatment. It usually requires repeated hospital appointments over a course of treatment. Improvement can be significant, although eczema may return after treatment finishes and the benefits and risks of UV exposure need to be carefully considered.

For people with more severe eczema that cannot be adequately controlled in these ways, systemic treatments may be considered. Unlike a cream or ointment applied directly to the affected skin, systemic medicines work throughout the body. Traditionally, these have included medicines that suppress or modify the immune response and require appropriate clinical monitoring.

More recently, the treatment landscape has expanded considerably through targeted systemic therapies.

Biologic medicines work by targeting specific parts of the immune system involved in inflammation, rather than suppressing immune activity more broadly. One of the most significant changes I witnessed during my years in specialist dermatology was the introduction of dupilumab for atopic dermatitis. For eligible people with moderate-to-severe disease who had not achieved adequate control with previous treatment, this represented an important new option.

Further biologic treatments have since become available, alongside targeted oral medicines, including a group known as JAK inhibitors. These act on specific signalling pathways involved in inflammation. The appropriate treatment will depend on the individual, their medical circumstances, previous treatment and the relevant eligibility criteria.

Treatment choice is not only about what might work clinically. People also need to understand what treatment involves and decide what is acceptable to them. Some medicines are injected, while others may require regular blood tests or other monitoring. Needle phobia, for example, can be a very real consideration. Discussing concerns openly allows the person and their healthcare team to consider the available options together and make an informed decision.

The result is a treatment landscape that now offers considerably more possibilities than it once did.

Having worked in dermatology when treatment options for severe eczema were much more limited, I find these developments enormously encouraging. I remember the introduction of dupilumab and what it represented for people who had already worked their way through the treatments available to them. To see that further options have continued to emerge since then feels long overdue.

Access to these treatments is not necessarily straightforward. Eligibility criteria apply and, for some people, reaching the point at which a targeted treatment can be considered may involve trying other appropriate treatments first. For someone already exhausted by years of poorly controlled eczema, that process can understandably feel frustrating.

Yet the important message is that the treatment pathway no longer ends where it once did.

Eczema remains a chronic condition for which there is currently no cure, and no treatment will work for everybody. But there are now more possibilities for controlling the condition and reducing its impact on everyday life. Research continues too, bringing the prospect of further treatment options in the future.

When was your eczema last reviewed?

For someone who has lived with eczema for many years, it can be easy to assume that the treatments they have already tried represents everything available to them. But eczema management has changed considerably, particularly for people living with moderate-to-severe disease.

If eczema remains poorly controlled, regularly disrupts sleep or everyday activities, affects someone’s ability to work, or has a significant impact on how they feel and live, it may be worth discussing this with their GP or dermatology team.

Review is also important because not every persistent itchy, inflamed or scaly skin condition is necessarily eczema. Accurate diagnosis matters. Different skin conditions may require different management, and treatment that is appropriate for one condition may not be appropriate for another.

When discussing eczema with a healthcare professional, it is important to talk about how the condition affects life, not simply what the skin looks like. Sleep, work, relationships, confidence, daily activities and the burden of managing treatment are all part of the picture.

Progress in eczema treatment is enormously encouraging. But successful treatment is about more than improving what we can see on the skin. It is about helping someone sleep, work, participate, feel comfortable and live with less intrusion from their condition.

Both the skin and the person living within it need to be heard.

Further information:

National Institute for Health and Care Excellence (NICE). Atopic eczema: guidance and treatment recommendations.

NICE guidance on atopic eczema: https://www.nice.org.uk/guidance/cg57?utm