Atopic dermatitis/ neurodermatitis: Treatment of neurodermatitis in children
02.09.2025
Wir freuen uns sehr, dass wir am 02.09.2025 Frau Dr. Tatjana Braun und...
Is scratching really that bad? - A look at causes, consequences and therapies
Scratching is a natural behavior that is deeply rooted in our evolution. Originally, it served as a protective mechanism to remove potentially dangerous irritants such as parasites or foreign bodies from the skin. Even today, many people initially feel a sense of relief when scratching - itching subsides, tension is released and it is not uncommon for pleasure or euphoria to set in.
But this short-term feeling of well-being comes at a price. Negative emotions often arise shortly after scratching, such as feelings of guilt, anger or frustration - especially in people with chronic skin conditions such as atopic dermatitis or prurigo, where scratching can set back the healing process. Many patients report an inner pressure not to give in to the urge to scratch - which paradoxically makes the itching even worse.
From a neuroscientific point of view, the sensation of itching and scratching are closely linked in the brain. The itch signal is transmitted via skin nerves to the spinal cord and then from there to the brain, where it is first perceived. At the same time, areas of the brain that are important for planning and initiating movements are activated. This initiates the scratching response. After scratching, areas in the brain are activated that ensure that less fear and more reward is felt. If itching becomes chronic, i.e. lasts longer than 6 weeks, the relationship between itching and scratching becomes dysfunctional. Chronic itching leads to an overactivation of motor areas of the brain and scratching leads to an overactivation of reward areas of the brain. Scratching can therefore be "addictive".
From a learning theory perspective, scratching can also be "trained". Immediately after scratching, the itching becomes less and a feeling of reward follows. This is known as "positive reinforcement". In addition, something negative, the itching, becomes less for a short time, which is referred to as "negative reinforcement". Both mechanisms contribute to the behavior occurring more frequently and a so-called "automated scratching behavior" can develop. Some patients therefore report that they continue to scratch even after successful treatment for itching - not because the skin itches, but because scratching has become a habit.
Furthermore, scratching causes damage to the skin and cutaneous nerves. The skin's protective barrier and nerves are damaged. The sensitivity of the nerves increases. This can result in a stimulus that triggers itching in everyone being felt more strongly by patients with chronic itching (hyperkinesis). In addition, stimuli that do not actually trigger itching (e.g. a gentle touch) can trigger severe itching attacks in patients with chronic itching, which is known as alloknesis.
Scratching also leads to an increase in inflammatory reactions in the skin. Due to the damaged skin barrier, harmful substances, allergens and germs can easily penetrate the skin, which can increase the inflammation; contact allergies can also develop. It is therefore important not to use creams on inflamed skin that contain fragrances, preservatives and colorants, for example.
Scratching can lead to the formation of bloody scratch lesions, which can heal crusty and turn into scars. Scratching can contribute to the further aggravation of skin diseases (e.g. eczema in atopic dermatitis or inflammatory nodules and lumps in chronic prurigo). Scratching is also a psychological burden, as not only does the skin hurt after scratching, but there is also self-reproach and reproach from those around you. People are often admonished not to scratch, which further increases the pressure to scratch for those affected. The scratching itself and the visible scratch lesions are also associated with shame and stigmatization for many patients; they worry that others will think they are suffering from a contagious disease. As a result, many patients withdraw, develop sleep disorders, anxiety and depression.
Important: Scratching is not "forbidden", but a completely normal reaction to itching. The key is to effectively treat the underlying itch. Modern dermatology offers a variety of proven and new options for this.
Therapy strategies include, among others:
Conclusion: Scratching is an expression of real suffering - not a weakness of will. It is an understandable reaction to a strong inner signal. The most important message of the presentation is therefore: don't blame yourself. And tell your fellow human beings that sayings such as "Stop scratching" or "You shouldn't scratch" are taboo. The aim should not be to forbid scratching, but to treat the itching effectively. If this is successful, scratching will also become less frequent - and can become a thing of the past in the long term.
