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Eczema has been called “the itch that rashes”. In reality the features of eczema come about in part from the scratching of the skin as a result of the itching.
This itching is usually very severe in atopic eczema and leads to discomfort, agitation and frequent interruption or loss of sleep.
The dry skin in someone with eczema itches, the itching will lead to scratching of the skin. Scratching not only has a significant effect on the appearance of the involved skin but will also further damage the skin barrier and will provoke the release of pro-inflammatory mediators such as cytokines that make the itching worse.
Scratching may well produce breaks in the skin which, in turn, produce erosions (superficial skin ulcers) and excoriations (scratch marks which break the skin surface). Breaks in the skin or lesions are also itchy and leads to a vicious itch-scratch cycle being set up which increases the risk of secondary infection which is most frequently caused by the bacteria Staphylococcus aureus.
Repeated rubbing of the skin will in time cause the skin to thicken. This will produce thickening of the epidermis Thickening of the epidermis will produce increased skin markings the appearance of which is called lichenification. This is particularly seen in the flexures in front of the elbows and behind the knees. There is a criss-cross pattern to the thickened skin which is very distinctive and easily recognized.
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