Why is it that eczema flare-ups often occur at night, leaving you with intense itching and burning? It just doesn't make sense. You are following a regular skin care routine. Yet, you still find yourself struggling with unrelenting discomfort.
Night after night, this pattern repeats, with varying levels of intensity. The last thing you want is for your delicate skin to endure more harm from constant scratching. You are desperately seeking some sort of relief from the itchiness and suffering.
Why is it that it gets worse at night? In this blog, let's look at 4 main reasons why your eczema can act up at night. Then I'll discuss some tips to take note of, plus my 2 favourite cleansing bars to help manage the itchiness.
4 reasons why your eczema acts up at night:
1. Body Temperature and Sleep
At night your skin temperature rises, which can contribute to inflammation and itchiness. This occurs as the core temperature and brain temperature both drop in order to induce sleep.
By dilating blood vessels on the skin, the body cools itself down. This increases blood flow to the outer layers and causes the skin, hands, and feet to become warmer. This overheating of the skin can continue all night if the bedclothes are too heavy. Certain foods and drinks, such as coffee, alcohol, and hot spices, can worsen the overheating. These are vasodilators, causing the blood vessels to dilate further.
To combat this overheating, it is best to avoid hot showers or hot baths right before bed. Wear lighter bedclothes. Different people have different core temperatures at night. Finding a comfortable solution, such as using separate duvets, can help.
2. Cytokines and Inflammation
The immune system and body clock are interrelated. What helps us fall asleep can sometimes worsen eczema symptoms by causing increased skin inflammation. Cytokines are proteins that act as signals between immune cells and other cells in the body. Some cytokines, such as interferon gamma (IFNγ), are thought to be promoters of sleep. They also activate inflammatory signals. These cytokines are naturally more abundant at night. This is when the immune system is working to rejuvenate and protect our cells. Not all cytokines are inflammatory. Some act as anti-inflammatory's. However, these aren't necessarily active at night as they may affect sleep.
Cortisol or the stress hormone, also has a role in regulating inflammation. Cortisol is highest during the day, which is where it exerts it's anti-inflammatory effects. However, cortisol levels drop during the night, which helps with sleep, however may play a role with regard to eczema symptoms at night.
I also find with many clients in the clinic that stress is a primary trigger for their skin issues.
Cortisol has a role in an acute stress response, however these days many are in a pattern of chronic stress which can dysregulate cortisol patterns and the immune system. Chronic stress can actually contribute to inflammation in the body and is often seen as a primary or secondary trigger for many people with eczema and other skin conditions
3. The Itch-Scratch Cycle of Eczema
Eczema is often referred to as the "itch that rashes" because it's the scratching the itch that causes the redness and rash. Unfortunately, avoiding scratching while sleeping is difficult and only worsens the itching. Any skin damage caused by eczema or scratching triggers an immune response and the release of inflammatory cytokines. This increases inflammation and the itch, leading to more scratching and creating a vicious cycle.
People with eczema may also have sensory hypersensitivity, causing their brain to mistake touch sensations for itching.
4. Irritants & Dry Skin
Eczema and atopic dermatitis are often linked to dust mite allergies. Dust mites, which thrive in bedding and feed on dead skin cells and microbes. Their faeces can trigger an allergic reaction in those with eczema, causing inflammation, itching, and redness. This occurs when the skin's barrier is damaged and exposes the immune cells to dust mite particles, which are then mistakenly identified as a threat.
It can be challenging to avoid dust mites completely. Taking measures to minimise exposure; Avoid using wool blankets, feather pillows, and duvets, and opt for allergy-friendly alternatives. Wash bed linen weekly at 60 degrees, and regularly vacuum, ideally using a HEPA filter, and dust rooms using a damp microfiber cloth.
Consider dust mite bedding protection products too. These help minimise exposure to dust mites if there is a known or suspected reaction. Bedding – Asthma New Zealand
Remember that allergies and eczema can develop at any age.
It is well known that dry skin can cause itching and sensitivity, and that sweating during the night can lead to further loss of moisture. Additionally, the natural oil that helps keep our skin moisturised, sebum, is at its lowest production rate at 4am, when the skin is most receptive to absorbing moisture. To combat this, it is recommended to apply a nourishing moisturiser before bedtime.
Keeping the body cool during the night can also help prevent excessive sweating and further moisture loss.
The itchiness particularly at night can be so frustrating. Especially at night when it can interfere with your sleep. Here are some tips to help you manage your eczema symptoms and get a good night's rest:
Some tips to manage eczema at night:
Moisturising your skin is crucial to preventing eczema flare-ups. Use an unscented moisturiser and apply it to your skin after every shower or bath. A nice moisturiser to use is Shea Butter. If you’re NZ based, you can find this here: Shea Butter
Many people choose refined Shea butter over unrefined as they don’t like the smell. For more information on Shea butter, take a look here What is Shea Butter?
Or book a consultation with one of our holistic skin specialists to have a custom topical cream made specifically for your skin presentation.
Avoid triggers: Certain triggers can worsen eczema symptoms, such as hot showers, harsh soaps, stress, certain foods and an array of other factors. Identify what triggers your eczema and try to avoid them.
Use a humidifier: Dry air can exacerbate eczema symptoms, so consider using a humidifier in your bedroom to keep the air moist. Although, humidifiers can increase the risk of mould, so factor this into your decision when purchasing.
Wear breathable fabrics: Synthetic fabrics can irritate eczema-prone skin, so choose clothing made of breathable materials like cotton.
Avoid scratching: Scratching can damage your skin and make eczema worse, so try to resist the urge to scratch and use a cold compress instead.
Have you tried Oatmeal for itchy eczema skin?
Oatmeal isn't just an excellent option for a morning breakfast, it's also a great remedy for alleviating various skin irritations and itching. The natural hydrating properties of oats provide relief to the skin, and its milky emollients may effectively soothe even the most persistent itchiness.
Oat contains avenanthramide which have been shown to have an anti-inflammatory, antiproliferative, and anti-itching properties. Which explains traditionally, why oats have been used in baths, poultices and creams to soothe inflamed or itchy skin.
2 of my favourite cleansing bars for Eczema:
Avoiding normal soaps and body washes when you have eczema is a topic all on its own however, I wanted to mention 2 of my favourite cleansing bars for helping with itchy eczema skin.
- SoapOman Naked Oatmeal Cleansing Bar. SoapOman - Naked Oatmeal Cleansing Bar – SoapOman.com
- Soratinex Moisturiser Bar available on my website. Soratinex moisturiser bar
In conclusion, eczema can be a challenge to deal with, especially at night. By understanding the drivers to what makes your eczema worse at night as well as implementing some of the tips mentioned, it may lead to a calmer, more restful sleep. If you are looking for more support with your skin then reach out and we can discuss ways that you can address your eczema at a holistic level.
Can we help you? Book a time that suits you at one of our Clinics in Drury or Mount Eden, or online via Zoom.