Breaking the Itch-Scratch Cycle:  Management of Cutaneous Itch in Dry Skin


What is dry skin?

Dry skin is a common but burdensome clinical problem that occurs when the skin loses water too quickly and becomes dry. While reasons vary, this is often due to the use of cleaning products that remove the oils and fats from our skin. In many people with dry skin, these are often marked by scaling, itching, and cracking of the skin.

Who develops dry skin?

Some people are more prone to dry skin than others but in general, it’s a common condition among older adults, due to aging. As people age, our skin produces less sebum which is needed to keep our skin soft and youthful. Other factors that can result in dry skin include smoking or certain medications including diuretics and statins.

How does dry skin cause itch?

The human skin is a multilayered organ, and functions to protect our body against the external environment, infection, and temperature regulation. The outermost layer, often referred to as stratum corneum is composed of dead skin cells which acts as a barrier to prevent water loss. For some of the reasons mentioned above, the skin’s barrier function is disrupted, leading to increased water loss leading to dry and flaky skin. This may lead to symptoms of discomfort and itching.

The itch-scratch cycle

While different people experience dry skin at different degrees, one common symptom is that the skin often feels tight or stiff, with a burning, stinging or itching sensation which can appear to be rough or scaly. When a person scratches the skin obsessively to relieve the itch, they can damage the skin layer which can cause inflammation. This can further lead to a sensation of itch, which leads to scratching, a condition known as the itch-scratch cycle.

How to Break the Itch-Scratch Cycle?

For many people, there are severe simple, and effective ways to relieve or prevent itch as listed below

  • Stay moisturized. Use a topical moisturizer regularly which helps to soothe the skin, and helps the skin to be cool. This can help reduce the skin irritation that contributes to the constant itch.  Aim to apply them at least twice a day, with one of the applications immediately after the bath
  • Use a mild non scented moisturizing soap. As soap can worsen dry skin by removing the body’s natural lubricants, use a mild soap. Avoid using powders after bath as they can further irritate and dry the skin.
  • Clothes such as linen and wool can cause irritation due to their rough surfaces which induce friction. As such, use cotton materials or fabric softeners that can reduce friction and thus prevent dryness of the skin

Dry skin options available

An ideal dry skin treatment should aim to reduce skin dryness and irritation and thus scratching over time by restoring the barrier of the skin. While there are many products that are available over the counter, the following are some active ingredients that are helpful for dry skin

  • As aforementioned, moisturizers are products that contain glycerol, petroleum, mineral oil, and glyceryl stearate which help reduce itch by reducing skin dryness and restoring the natural barrier.  Depending on the preference of a person, they can be purchased as a cream, ointment, or lotion. For instance, aqueous cream is a commonly used moisturizer and can be used as a  ‘wash-off’ soap substitute to relieve the symptoms of dry skin conditions
  • Products that provide a cooling sensation, such as menthol can also be useful in concentrations below 5% as it is known counterirritant.
  •  Zinc oxide is another common component of topical products, including calamine, and has been shown to be useful for contact dermatitis.

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