But eczema has another very serious symptom: pain. Inflammation, injury to the skin from scratching, fissures (cracks and wounds), and intolerance to irritants related to eczema can cause pain that ranges in intensity from aggravating to agonizing. Research published in July 2020 in the Swedish journal Acta Dermato-Venereologica found that about 43 percent of the 305 adult and adolescent patients with eczema in the study experienced pain. An investigation published in November 2019 in The Journal of Allergy and Clinical Immunology revealed that among 365 participants with atopic dermatitis, 61 percent dealt with pain issues at least once a week and 5 percent had pain daily. “I think that the first thing that comes to mind when we talk about eczema is the itch,” says Bruce Brod, MD, a clinical professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania. “But pain is also a relatively common symptom of atopic dermatitis that is often underrecognized. I have found that anywhere from half to two-thirds of patients with atopic dermatitis will experience pain.”
Where and Why Eczema Hurts
Jonathan Silverberg, MD, with the department of dermatology at George Washington University School of Medicine and Health Sciences, told the National Eczema Association that cracks and wounds on the palms, soles of feet, toes, chest, and around the mouth may trigger excruciating soreness. Atopic dermatitis on the buttocks, fingers, legs, neck, and forearms can also be particularly painful. In the Journal of Allergy and Clinical Immunology study cited above, Dr. Silverberg and colleagues found that patients with mild eczema were more likely to have pain related to scratching, while those with moderate or severe eczema felt more constant discomfort and aching due to inflammation. The scientists noted that for most eczema patients with pain, the issue was linked to open parts of the skin caused by scratching (27 percent) and with fissures in the skin (27 percent). About a quarter said they were hurting from inflamed skin. Just 10 percent reported a burning sensation caused by topical medications like steroid creams. Karan Lal, DO, committee chair for the Society for Pediatric Dermatology, says that when inflamed skin opens up, exposed nerves increase the risk of pain as well as infection. “I think a lot of people who get pain have more active eczema that is inadequately controlled and have chronic disease in the common eczema sites,” says Dr. Lal.
One Young Patient’s Battle
Lal described the experience of one of his pediatric patients who was highly active in sports and had horrible eczema behind his knees that resulted in extreme pain. The 10-year-old’s pants rubbed against the affected areas of his legs, staining his jeans with blood and making the pain even worse. Lal treated the boy with ointments and a topical steroid medication, and he instructed the parents to make sure their son’s legs were wrapped and lubricated at all times. Lal also prescribed Tylenol for pain relief. “It was really aggressive management — he had to do these wraps on weekends when he could stay at home and rest and not move around a lot,” said Lal. “It took about nine days or so to clear him up, but it helped a lot.”
Keeping Eczema Pain at Bay
For most people with atopic dermatitis, standard therapies to relieve eczema will help reduce pain. “It’s really just treating the underlying eczema with the same medicines you would use if it were just itchy,” says Matthew Lewis, MD, a clinical associate professor of dermatology who practices at Stanford Hospital and Clinics. The Mayo Clinic provides an extensive list of medications and therapies with proven track records:
Creams and ointments. Corticosteroid (steroid) cream or ointment can reduce itchiness and heal the skin. Some people benefit from creams containing drugs called calcineurin inhibitors, such as tacrolimus (Protopic) and pimecrolimus (Elidel), which help tamp down the overactive immune systems that cause eczema inflammation.Antibiotics to fight infection. Topical antibiotics (applied to the skin), such as fusidic acid, and tablet antibiotics, such as flucloxacillin, can help eliminate infections. Antiseptic soaps and bath additives (such as a bleach bath) can kill bacteria.Anti-inflammatory drugs. Pain relievers such as nonsteroidal anti-inflammatory drugs can help. More severe cases may require an oral corticosteroid such as prednisone.Injectable biologic. Dupilumab (Dupixent) is a monoclonal antibody prescribed to atopic dermatitis patients who do not respond well to other treatments.Wet dressings. A combination of topical corticosteroids covered with wet bandages can mitigate inflammation and pain in the affected areas.Light therapy. Also called phototherapy, this treatment uses different wavelengths of ultraviolet light to reduce inflammation and itchiness.Mental health counseling and behavior modification. Patients can learn ways to manage thoughts and behaviors that may be leading to excessive itching and increased pain.
Eczema Can Cause Emotional Pain
Mental health counseling can be important for eczema patients who are in pain, since severe cases can lead to embarrassment, social isolation, anxiety, and depression, among other concerns. “Pain can impact mental health, lead to sleep disturbances, and reduce the overall quality of life,” says Dr. Brod. “It can interfere with a patient’s ability to work and socialize, and that can lead to depression and anxiety.” Dermatologists may counsel patients directly or refer them to a therapist for more extensive help. “Although it’s typically not life-threatening, pain from eczema has the real ability to ruin somebody’s life,” says Brod. “There’s also optimism in the fact that there are treatments that can control this and return patients to a much better quality of life. If you’re experiencing severe pain, it’s best to visit a board-certified dermatologist, who is the best person to be able to treat this.”
