Why atopic dermatitis itch intensifies at night and how to manage it

If you live with atopic dermatitis (AD), does it feel like the itch gets worse at night?  Many report to ESC that the itch can make it challenging to not only fall asleep but stay asleep at night. This lack of sleep can make us exhausted, stressed, and can negatively impact our mental health. Even worse, the stress and fatigue tend to trigger even more flares, making us feel trapped in an endless cycle. So why does itch feel worse at night, and what can we do to stop it?

ESC had the opportunity to ask Ottawa-based dermatologist Dr. Mark Kirchhof, MD, PhD, FRCPC, FAAD about itch during a recent webinar. He told us: “There are both neurological and physiological components at play when it comes to the sensation of itch. During the day, the belief is that we’re more distracted which makes us not notice the itch as much (for example, the movement of our clothes offers a continuous distraction to our nerves). But when we go to bed, we are calm and not moving as much, so our nerves are free to send itch signals which leads to more scratching. And unfortunately, the more you scratch, the itchier you tend to become. Thankfully there are ways to help manage the itch.”

Here are some tips to help reduce itch at night:

• Moisturize before bed: Try taking a calming, warm (never hot!) bath, followed by moisturization to lock in hydration as well as sooth the skin.
• Avoid harsh fabrics: Whether it’s the clothes you sleep in or the bedsheets you use, avoid using fabrics that can irritate your skin – cotton tends to be gentler on the skin.
• Keep the temperature of your bedroom cool: Sweating and feeling hot can bring or intensify itch, so keeping a cooler room can help.
• Keep nails short: Keeping your fingernails short and smooth can help you avoid damaging the skin from scratching.

If you are having difficulties falling asleep or staying asleep due to itch, speak to your health care provider about ways to reduce itch and manage symptoms, and consult our recent resource on coping with the itch of eczema to learn more.

Eczema Society of Canada (ESC) thanks Dr. Mark Kirchhof, MD, PhD, FRCPC, FAAD, for sharing his expertise during ESC’s March 2022 Life with Eczema virtual event series and on this content.  Funding for the Life with Eczema Winter 2022 event series was generously provided by Pfizer Canada and Sanofi Genzyme, a division of sanofi-aventis Canada Inc.

Disclaimer: Information provided in this resource does not constitute medical advice and is not intended to be used as a diagnostic tool. The information is up-to-date at time of publication. All medications, interventions, and treatment plans have risks and benefits, and it is important that individuals discuss their or their child’s specific health care needs with a qualified health care professional.

March 2022