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From the Clinic #10: Stress, itching and scratching
In clinic most people with atopic eczema list stress as one of their trigger factors, and the way this happens, for example through drying the skin, and by provoking inflammation, is increasingly understood. The pressures that lead to the stress reaction are all common life experiences, but include the experience of eczema itself.
The central relevance of the itch-scratch cycle in atopic eczema is also widely recognised: itching leads to scratching, which damages the skin and leads to more itching. The Combined Approach tackles this, and promotes peace breaking out on what is otherwise a dermatological battle-ground of chronic unhappiness.
And the vicious cycle of itching and scratching is driven on both sides by stress. Above on the left stress provokes itch directly: this is generally termed psychogenic pruritus, and it can be difficult to treat in the absence of other trigger factors.
On the right stress and scratching also interact. Stress commonly induces scratching and rubbing without itch, at least initially - itching can follow the scratching. When scratching damages the skin, with increase in inflammation and sometimes bleeding, most of our patients report feeling stressed as a result, completing three overlapping vicious circles.
Fortunately for many using The Combined Approach to atopic eczema tackling the central circle of itching and scratching does the trick. After two weeks treatment the improvement in both skin condition and general Quality of Life is usually striking, with improved sleep being especially important.
However, for a few at this stage progress may not be so satisfactory. Life pressures may be such that a complicating stress-reaction needs to be understood and successfully tackled.
Once this is achieved, the programme can be resumed, and our goal of living without eczema achieved.