One-to-One: Why is atopic dermatitis so itchy — and is it okay to scratch?

Hey, Dr. Heather, what makes atopic dermatitis so extremely itchy?

HEATHER WOOLERY-LLOYD: This is a great question. Atopic dermatitis, or AD, is a noncontagious inflammatory skin

disease. And as I'm sure you're aware, it can be extremely itchy. If you talk to your healthcare provider about AD,

the word "pruritus" may come up. So what does that mean? Just know that's a medical term for itching. So what causes AD to be so itchy?

Research suggests it comes from inflammation. The mechanisms are pretty complicated. And it's still an active area of research.

But the idea is this. Your skin barrier isn't working the way it should. An allergen makes its way into your skin,

which kicks off inflammation. And in response, nerve cells in your skin talk to your brain and tell your brain that something is wrong.

That's the pruritus or itching. The brain gets these signals. And its response is to tell you to scratch because scratching

feels good in the moment. OK, that makes sense. But if the brain says scratching feels good,

is it really that bad to scratch? The short answer is yes. Scratching irritates the skin further and just

makes the itching worse. This is partly why the cycle of feeling itchy and then scratching is so hard to break.

Some people even scratch their skin until it bleeds, which can lead to risk of infection and scarring, which also leads to--

you guessed it-- more itching. Itchy skin can also happen at night. And it's not uncommon for nighttime pruritis to disturb your sleep and further reduce quality of life.

If you have AD, chances are you've scratched and you're not alone. Studies have shown that chronic pruritis, which

is pruritis lasting more than six weeks, can be just as life-altering and incapacitating as chronic pain.

Pruritis caused by AD can have a big impact on your quality of life and your mental health, so it's important to try and manage it as much as possible.

Speaking to a healthcare professional about your AD is critical. There are lifestyle changes you can make that may help to reduce itching,

as well as treatment options that may be able to help manage your symptoms. Talk to your healthcare provider, and together, you can develop a plan to manage your AD.