Itch now or never
Itch is as an unpleasant sensation that evokes the desire or reflex to scratch; it can be localized or generalized. Itching is one common cause of sleepless nights. It is a dreadful sensation for some as it can lead to depression, heart disease, lowered immune system, and a variety of other problems. So if you have chronic pruritus or itching (meaning itching lasting more than six weeks) it’s about time you sought medical help because chronic pruritus or itching is a characteristic feature of many skin diseases and an unusual sign of some diseased internal body organs. Identifying the underlying cause is the first step towards an effective therapy for itching.
When faced with an itchy patient it is useful to classify itch as an aid to diagnosis and treatment. Yosipovitch et al and Twycross et al classified pruritus into five types:
1. Dermatologic or pruritoceptive — generated in the skin usually by an inflammatory or other visible pathological process, e.g. scabies, urticaria, sweating, dry skin, hormonal disorders, food or drug allergy.
2. Neurogenic — originates or is generated in the central nervous system (CNS, brain and spinal cord) in response to circulating pruritogens as in cholestasis (a medical condition in which stoppage or reduction of bile (greenish to yellowish liquid produced by the liver that aids in digestion and absorption of fat) flow occurs. The person’s liver continues to produce bile which invades the bloodstream and accumulates in the skin, resulting in jaundice).
3. Neuropathic — due to anatomical lesions of the central or peripheral nervous systems, e.g. nerve entrapment, brain tumors, multiple sclerosis, peripheral neuropathy (diabetes), and nerve injury.
4. Psychogenic — psychological disorders including tactile hallucinations, delusional parasitosis or neurotic excoriations or scratching, obesessive-compulsive disorders.
5. Mixed type — one or more pathways are involved.
Here’s how to get rid of itching:
• Avoid scratching; scratching can cause more itching.
• Bathe with mild soap if perspiring excessively and if folliculitis (bump with pus) is present. If job involves contact with chemicals, and if dermatitis is already present, bathing does not help at all.
• Cool baths, light clothes, cool temperature at home and work relieve itching.
• Cold tap water or compress, rinsing in cold water or cooling lotions such as pramoxine, menthol, eucalyptus, camphor, as long as one is not allergic to these, can help.
• Emollients, moisturizers for dry skin.
• Antipruritics.
• Oral and topical antihistamines, topical anesthetics (the latter two may sensitize exposed skin and increase risk of allergic contact dermatitis), steroids for mild itching (but not for prolonged periods of time due to risk of skin thinning (atrophy), opiod receptor antagonists, tricyclic antidepressants, selective serotonin reuptake inhibitors may help in severe cases, wet dressings like Burrow’s Solution (drying agents).
• Topical anesthetic plus capsaicin.
• Antimicrobials.
• Phototherapy.
• Avoid: alcohol, caffeine, spices that dilate skin vessels and thus heat the skin; hot humid environment.
• Wear light, loose clothes and underwear made of materials that absorb sweat (cotton). Wool, rough natural materials like flax, and synthetic clothes may irritate the skin
• Use protective clothes when working in the garden, walking through woods or on the beach; choose the right detergent for washing clothes.
• Protect yourself against wind and sun by wearing the appropriate clothes and using protective creams.
• Limit cosmetics.
• Fingernails, especially in children, should be kept short to minimize abrasions from scratching. If the urge to scratch is irresistible, rub the skin with the palm rather than scratch.
• Botulinum toxin for neuropathic itch
• Pimozide, a neuroleptic medication, is being used for psychogenic itch, but it’s not without side effects so it should be taken with prescription.
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