Still itchy with atopic dermatitis even though your skin looks clear? You could have phantom itch

With phantom itch, You dont see the patches or the plaques, but they'll still be persistently itchy, says Shira Y. Wieder, MD, a board-certified dermatologist at Montefiore Einstein and an assistant professor of dermatology at the Albert Einstein College of Medicine in New York City. There's nothing there that you can see with the eye, but there's clearly something going on under the surface.

Sometimes the itchy sensation even feels like its moving around. Thats due to the overactive nerve cells under the surface of the skin, which keep firing off itch signals even after the inflammation you can see has quieted down, explains Aderonke Obayomi, MD, MPH, a board-certified dermatologist and assistant professor at Mount Sinai in New York City.

Just because your symptoms are invisible, though, doesnt mean they're not treatable.

How Chronic Inflammation Rewires the Brain

Your immune system and nervous system are in constant communication with each other. But with atopic dermatitis, your immune system sends out the wrong messages.

Think of a smoke alarm thats been turned up too high, Obayomi says. It goes off from a little steam, not just an actual fire. In eczema, the itch nerves get rewired to overreact, and the spinal cord and brain amplify those signals, too.

Psychological and Environmental Triggers

You might catch yourself scratching without even noticing you started, maybe while zoning out during a work meeting or while winding down at night, Obayomi says. The more you scratch, the more ingrained the habit becomes. The brain starts pairing certain moments, like getting into bed, with scratching, until it becomes almost automatic, she says.

Treating the Phantom Itch

• Keeping fingernails short
• Covering the itchy area with comfortable clothing, bandages, or cool compresses
• Wearing loose-fitting clothing made from soft, breathable fabrics
• Taking lukewarm rather than hot showers
• Keeping your bedroom cool at night
• Consistently moisturizing with a thick, fragrance-free cream to protect the skin barrier
• Running a humidifier, especially during the winter when indoor heat dries the air

You might also need treatment for the inflammation simmering beneath your skin. The most important move is to treat the eczema itself, because chasing the itch on its own wont get you far, Obayomi says. Medications might include systemic drugs such as oral immunosuppressants, biologics, or JAK inhibitors.

The interconnected nature of inflammatory and neuropathic itchiness has also brought about new treatment options. Sometimes the treatments aimed at tamping down atopic dermatitis can also soothe a phantom itch, even if no other symptoms are present.

Remember that even though you may not see any signs of atopic dermatitis, your itchiness is valid. Phantom itch is real, says Obayomi. It is not in your head, even when your skin looks perfectly clear. That validation matters for everyone, and it matters even more for patients of color, where a flare can be harder to spot and easier to wave off.

Talk to a trusted healthcare provider sooner rather than later. If the itch is running your life, thats a good reason to see a dermatologist who treats a lot of eczema and wont stop at It looks fine, Obayomi says.

The Takeaway