Atopic dermatitis, commonly known as eczema, is a chronic inflammatory skin condition characterized by dry, intensely itchy patches. While itching is the most recognized symptom, many people experience a sharp, uncomfortable burning sensation that is often more painful than the itch itself. This distressing heat is not a random symptom but a direct consequence of the underlying biological changes in the skin. Understanding the specific mechanisms that cause this burning can lead to more effective management strategies.
The Biological Cause of the Burning Sensation
The burning sensation in eczema stems from a compromised skin barrier and over-sensitized nerve endings. A healthy skin surface functions like a protective wall, largely composed of lipids such as ceramides. In eczema, genetic or environmental factors cause a deficiency in these lipids, leading to a dysfunctional barrier that allows excessive transepidermal water loss and leaves the skin highly vulnerable to external substances.
This structural breakdown enables irritants to penetrate the skin easily and reach the sensory nerve fibers. These nerves, specifically C-nerve fibers, are stimulated directly by chemicals that would normally be blocked by intact skin. The repeated damage and chronic inflammation cause these C-fibers to become hyper-responsive, a process known as nerve sensitization, which lowers their threshold for activation.
Furthermore, the immune system’s response to the eczema flare releases inflammatory mediators that intensify this painful signaling. Cytokines, such as interleukins, are produced in excess and act directly on the sensory nerves. Neuropeptides are also released, promoting further nerve growth and hypersensitivity in the affected area. This constant chemical and physical stimulation of damaged, exposed nerves is directly interpreted by the brain as a burning or stinging pain.
Common Irritants That Intensify the Burn
The already sensitized nerves react strongly to various everyday exposures that act as chemical and physical irritants. Chemical ingredients in personal care items are frequent culprits. Common foaming agents like sodium lauryl sulfate (SLS), strong preservatives, and denatured alcohol found in many lotions can strip protective oils, causing immediate stinging upon application to compromised skin. Fragrances contain numerous compounds that readily penetrate the weakened barrier and chemically irritate nerve endings.
Physical factors also dramatically intensify the burning. Sweat is particularly irritating because its high salt and mineral content acts as an irritant on open or fissured skin. As sweat evaporates, the concentrated salt crystals draw moisture out and cause a painful sting. Friction from rough fabrics like wool, or from tight clothing, physically stimulates the hyper-responsive pain nerves.
Secondary Infections
A secondary bacterial or fungal infection, often signaled by increased weeping, crusting, or sudden severe pain, can exacerbate the burning sensation, requiring prompt medical evaluation and targeted treatment.
Immediate Strategies for Soothing the Burn
When the burning sensation flares, the most immediate and effective strategy is to introduce cooling to calm the irritated nerves. Applying a clean, cool compress to the affected area for 10 to 15 minutes can temporarily numb the sensory fibers and reduce localized inflammation. Lukewarm baths, sometimes incorporating colloidal oatmeal, are a gentle way to hydrate the skin, but hot water must be avoided entirely as it strips oils and intensifies the burning.
Following any exposure to water, immediately “soak and seal” the skin to lock in moisture and protect the exposed nerves. This involves generously applying a thick emollient or ointment, rather than a lighter cream or lotion, while the skin is still slightly damp. Look for products containing ceramides and colloidal oatmeal. Avoid products that contain menthol, peppermint, or strong essential oils, as these can trigger further irritation and burning on damaged skin.
For an intense, widespread flare-up, wet wrap therapy can provide profound relief by delivering sustained moisture and cooling. This technique involves applying a topical medication and thick moisturizer, then covering the area with a layer of damp cloth, followed by a dry layer. The damp cloth cools the skin, helps emollients penetrate deeply, and provides a physical barrier against scratching. Wet wraps can be left on for a few hours or overnight, significantly calming the painful burning and allowing the skin to begin the healing process.