I Can’t Stop Scratching

The Doctor Is In is an occasional series where JHU Press authors discuss the latest developments and news in health and medicine.

Guest post by  Gil Yosipovitch, M.D.

Itch, either acute or chronic, shares many similarities with pain. Both conditions are bothersome and they follow the same neural pathway, traveling through the nervous system. When you encounter something that is painful, such as accidentally touching a hot stove, your response is to withdraw your hand. Conversely, an itchy stimulus leads directly to a scratching reflex. Unfortunately, scratching often encourages more itching.

Chronic itch is defined as lasting for more than six weeks. It affects millions of people worldwide. A key difference between acute and chronic itch usually originates from within the body and can be a sign of complex medical problems such as dermatologic and systemic diseases. Treatments that are effective for acute itch many not relieve chronic itch, because they are not directed toward the underlying cause. If relief is attained for someone suffering from chronic itch, it will be temporary and return promptly when the therapy is discontinued.

Living with Itch: A Patient’s Guide, available in both print and interactive formats, was designed to provide people with the information they need to better understand and manage their conditions. In addition to covering the basics of itch and providing an overview of the mechanisms responsible for itch transmission, we focus on specific itchy conditions and unique types of itch. Living with Itch also discusses various forms of treatment, and because there is more to chronic itch than an uncontrollable need to scratch, looks at the emotional and psychological aspects.

When I was asked to write a blog for JHUP, we decided a Q&A might be the best way to go. Here are some questions I am often asked, dealing with topics that range from the common mosquito bite to the new Temple Itch Center.

Q.       My husband and I react to mosquito bites differently. He ignores them and I scratch until it bleeds. Why is this?

A.       There are inter-individual differences in response to mosquito bites. Some people are extremely sensitive to them, and others experience no effect. Your case may involve immune cells and different genetics.

Q.       Can you offer some suggestions for controlling itch without medication?

A.       Sure. Here are some of the more successful options:

    • Hydrate the skin with moisturizers that contain oatmeal or ceramides as ingredients
    • Use mild cleansers with low pH
    • Run oatmeal baths
    • Wear itch-reducing garments
    • Apply cool, wet cloths to the itchy area
    • If you experience dry skin in winter, use humidifiers

If none of these methods work for you, there are some over-the-counter medications that might help.

Q.           What over-the-counter medications would you recommend?

A.           Here are some over-the-counter medications that work quite well on acute itch:

    • Pramoxine lotions and creams
    • Menthol lotion or cream
    • Capsaicin cream 0.075% with repeated applications (do NOT use on face or genitals)
    • Topical cream that contains strontium 4%

Q.           When should I see a doctor about an itch, whether or not I can control it?

A.           You should see your doctor

    • If it is new onset of itch with no apparent cause
    • If it does not improve with OTC products
    • If it worsens and/or affects your sleep and daily living
    • If it is accompanied by rash
    • If you have underlying internal diseases

Q.           You mentioned emotional and psychological side effects of itching. What are they?

A.           Anxiety, depression, stress, and/or obsessive compulsive disorders often accompany chronic itch. As I mentioned before, there are many similarities between itch and pain. There are also many similarities between chronic itch and constant pain. When either itch or pain interfere with your day-to-day life, emotional and psychological side effects can take hold.

Q.           Are there support groups for Itch sufferers?

A.           Currently, there are only support groups for specific itch-causing diseases such as atopic eczema, psoriasis, and lymphoma. Hopefully, in the future, a support group will be formed for those who suffer from chronic itch.

Q.           Dr. Yosipovitch, you just opened the Temple Itch Center. Can you tell us a little about that?

A.         The Temple Itch Center opened its doors this year on September 1 at Temple University School of Medicine. It was established to address the multidimensional aspect of itch similar to pain. The Center will include dermatologists, a nurse educator, a clinical trials researcher, a psychologist, and a specialist in holistic medicine. Its two goals are (1) to raise awareness of the magnitude of the problem and its management, and provide adequate training for residents on the diagnosis and treatment of chronic itch, and (2) to become an institutional hub for patient-focused care and patient education, as well as multidisciplinary research collaborations and interactions among health professionals.

yosipovitch

Gil Yosipovitch, M.D., is a professor and chair of the Department  of Dermatology and director of the Temple Itch Center at Temple University School of Medicine. He is known as the “Godfather of Itch,” and is the founder of the International Forum for the Study of Itch.  He is the author of Living with Itch: A Patient’s Guide.

3 Comments

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3 responses to “I Can’t Stop Scratching

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  2. Jane Runkle

    How can you get an apptment at the itch center?

    • robinnoonan

      A patient can get an appointment at Temple’s Itch Center by calling one of the following numbers below:
      215-875-2200 – Office Direct
      215-707-3376 (Derm) – Main

      The Department of Dermatology’s Clinical Practice location is in Center City Philadelphia, PA:

      Temple Health – Center City
      255 SS. 17th Street
      7th Floor
      Philadelphia, PA 19103

      Temple Univ. Health System has a concierge service that assists with accommodations for out of town patients