Scratching causes further damage to the skin barrier, stimulating skin inflammation, allowing for entry of irritants and pruritogens, and leading to an aberrant type 2 immune response, with increased immunoglobulin E (IgE) production, eosinophilia, mast cell activation, and overexpression of Th2 cytokines (interleukin [IL]-4, IL-5, IL-13) [38]. This evidence concerns the gene IL4 and Increased total eosinophil count.