Reversing the Habit of Scratching


A common point of frustration is: HOW CAN I STOP SCRATCHING?!?

Scratching is what causes eczema to be chronic. Acute eczema has a variety of triggers, and when it is subject to continuous scratching, it becomes chronic. Even normal skin, when subjected to continuous scratching, develops eczema. The process is called Lichenification -> Continuous scratching disrupts the epidermis, causing it to “fight back” in response. Skin cells thicken and harden in the area to protect itself.

For those going through TSW, the itch is unbearable and way more intense than eczema, and scratching is even harder to stop. Years of going through TSW could lead to developing a habit of scratching. I’ve observed that the longer someone has had their skin condition, the more difficult it is to stop scratching, and more instances of them habitually touching or rubbing their skin.

The good news is, scratching can be managed and stopped. This of course comes with effort and determination. I’ve compiled some really good directions on reversing the scratching behaviour from a book called The Eczema Solution by Sue-Armstrong Brown. Here is the protocol:

1) Tools and aid that help with itching

  • Ice packs/cold compress

    • I recommend numbing the itch and calming any redness with ice packs or cold compresses. Put a thin towel or a t-shirt over the ice pack to prevent condensation from getting onto the skin and irritating it. Whenever you feel itchy, grab it out of the freezer and gently press it on the area. You’ll find the itch reducing very soon!

    • I love using crystal rollers for the face and neck. Rose/jade rollers can be left in the fridge or freezer and easily rolled onto the skin without causing irritation from water condensation

  • Blunt tools

    • A soft brittle brush can help scratch the itch without breaking the skin

  • False nails

    • I highly recommend getting nail extensions, particularly acrylic nails. The acrylic extensions are a lot thicker and blunter than your natural nails and makes it impossible for you to scratch your skin open or pick at scabs. This has changed my life - you won’t know how wonderful this is until you try it. I know of many ladies who are afraid of going to the nail parlor due to how their skin looks but fret not, I have not had one nasty comment from anyone who did my nails. To be honest they just are there to do their job!

    • Some prefer gel nails on top of their natural nails. I do this when my nails need a break. Gel polish creates a layer over your natural nails and thickens them. However I would say they are not as effective as acrylic nails because they are still less blunt and thick than acrylics, and sometimes the gel polish peels off easily!

  • Medication

    • We have found that Fexofenadine has been the most effective antihistamine for TSW itch. In some cases, Ibuprofen helps take the inflammation away.

2) Count and log your scratching behaviour

We are often told off for scratching, which causes unpleasant and even triggering emotions to be brought up whenever the topic of Not Scratching is broached. However, when Not Scratching is directed by yourself, with you taking responsibility without the direction of others, it becomes an empowering process. If you’d like to stop scratching, are excited and determined, feel free to consider the steps below!

The first step is to count and log your scratching behaviour.
A) Use a clicker and click each time you scratch, touch, rub your skin. Do not make excuses or skip any counts, be firm with yourself! Do not worry about the times you scratch at night, for it would be impossible to sleep and count at the same time. You may be shocked by the number of times counted, it may go into the hundreds or even a thousand! But note this number neutrally, it does not have to have a negative connotation.

B) Log your number of scratches into a log book, indicating the number of times you scratched, when you scratched most during the day, and the areas you scratch the most.

3) Self-monitoring your symptoms

A) Log your symptoms into a log book, measuring the severity of itch, pain, open wounds, flaking, tightness, log old and new affected areas, log your mood and changes in environment, exercise, and note any new products you may be trying in your daily life, down to laundry and floor detergent, soaps, special places you visited etc.

B) Study this log book every week and notice any patterns of when you scratch the most, and areas you scratched the most, and whether most of your scratching is due to habit or real itch.

4) Habit reversal

With every habit, there are 3 components: Antecedent, Behaviour and Consequence. Change your Undesirable ABCs into Desirable ABCs. For example, Undesirable ABCs are: Impulse (itch) -> Scratching -> Damage and pain. Change them into Desirable ABCs such as Impulse (itch) -> Non-damage alternative -> Healing. Like my good friend Michelle says, there is always space between the stimulus (itch) and the reaction (scratching). Catch yourself between this space and replace them with non-damaging behaviour!

How do we change Undesirable Behaviour of scratching to Desirable Behaviour of the Non-Damage Alternative?

There are 2 steps to scratching:
1. Going to the area to scratch
2. Scratching

Replace them with:
1. Clenching your fists with your arms relaxed by the sides of your body
2. Stroking an area of skin that is unaffected

Feel free to replace 1. and 2. with any other behaviour. However, avoid replacing scratching with pressing into your skin, pinching your skin etc. These behaviours are equally damaging to very weak TSW skin, and can cause infections when bacteria in your nails are transferred to your skin.

If you failed a couple of times, do not be discouraged, and keep going. Keep practising the replacement of these behaviours until it becomes natural to you.

5) Predicting your scratching and avoid them by taking care of yourself

Study your log book often and thoroughly and notice the times when you scratch the most. There are usually times of the day when we feel the most itchy, or break out into scratching the most. For me, I scratch the most after a day out and am returning home. The fatigue, tiredness, causes my body to heat up and heat irritates the skin and can cause inflammation.

Avoid those scratch fests by taking care of yourself. If I find myself about to feel tired, I will cancel any plans and head home. When I was working full time, I noticed myself getting restless and itchy at about 12pm and 5pm. I would bring a change of clothes and a face towel, with which I would give my skin a cleanse. The change of clothes also makes me feel less restless and irritable, I feel fresh with no dead skin flakes in my clothing. This helps me avoid a scratch fest while at work.

Know your own schedule and your habits and develop habits to take care of yourself. This may seem like a lot of effort, however you will soon get used to these routines and feel a lot more comfortable in the long run, and eventually this contributes to your healing.

Many TSW sufferers may be too fatigued or frustrated to put in the extra effort to care for themselves. It is normal to feel like it is unfair that you have to make sacrifices because of this condition, and that you just want to lead a normal life. Acceptance of your condition is the first step to taking responsibility for your healing, taking action and developing good and healthy routines for yourself.

Put yourself first, and you will get to enjoy your life later! Make healing a goal and a priority, but not a criteria for your happiness.

Love, Jing

P.S. Note that I have revised some points in the book regarding scratching/habit reversal. Also, the author of The Eczema Solution recommends using topical steroids and emollients in addition to the habit reversal, which I personally cannot advocate due to my experience with TSA/TSW.