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Wednesday, July 6, 2011

The Unrelenting Itch

scratching an itch

Few things are as irritating as a temporary itch. A mosquito bite, an allergic reaction to makeup, even exposure to poison ivy (although many would describe that as agony) — the urge to scratch may be overwhelming, but it is mitigated by the knowledge that it will go away. But a surprising number of people suffer from unrelenting itching that makes their lives miserable.

A new study in the Archives of Dermatology shows that unremitting, chronic itching (pruritus), defined as itching that lasts more than six weeks, can cause the same physical and emotional distress as constant pain. This will come as no surprise to people with chronic eczema or those with sensitive skin who are allergic to just about everything. These are the patients who scratch themselves bloody in an attempt to relieve the itch, or who are on a constant medical merry-go-round, trying new pills and creams.

The truth is that itching can be a serious medical symptom. Sometimes generalized itching can indicate diabetes, iron deficiency anemia, celiac disease, kidney disease, thyroid disease, and cancers like leukemia and lymphoma. If the itching persists despite the use of anti-histamines, and especially if it accompanied by other symptoms like weight loss and fever, ask for a complete medical work-up.

Most of the time, though, the causes of itching are less serious and can be treated by a dermatologist. Here are just a few conditions I see in patients every week:

  • Extremely dry skin is probably the most common cause and may require prescription moisturizing creams and a change in daily habits, like a quick shower instead of a long, soak in the tub.
  • Eczema, which can be treated with creams, prescription medications, and in the case of allergic people, avoiding whatever it is that makes them react.
  • Food allergies, which many people don’t realize are responsible for the generalized itching that makes them so uncomfortable. A doctor can help pinpoint the cause with specific blood tests that seem to be more reliable than skin patch tests for food allergies.
  • Scabies, tiny mites that burrow in skin and cause intense itching. Scabies is a highly contagious condition which can spread anywhere where groups of people live in close quarters, from prisons to expensive summer camps. Treatment requires a prescription cream and meticulous washing and drying of clothing, bed linens and towels.
  • Fungal infections, such as the yeast infections that women frequently develop between or under their breasts, or tinea infections, such as athlete’s foot or jock itch. These can be treated with creams, but sometimes require a course of anti-fungal pills as well.
  • Bedbugs. I’m sorry to say that I’m seeing bedbug bites more often, reflecting the bedbug infestation spreading across the nation.
  • Shingles, caused by the chicken pox virus that can lie dormant in the body for years and then reactivate and inflame nerve endings, leading to intense pain or itching.
  • Allergic reactions to makeup and skin care products. The average adult uses around seven skin care products a day. Think about it: the body wash or soap in the shower, the body moisturizing lotion, sunscreen, makeup – they all have the potential to cause itching in sensitive individuals. Fragrances are the most likely culprit, but often individuals are allergic to other ingredients as well.
  • Reactions to medications. If itching starts a short time after beginning a new medication, call your doctor and report it. Don’t try to wait it out, because the reaction may become more serious.

Bottom line: If itching persists for more than a few weeks, see your doctor.

Photo: Hemera

Posted by: Debra Jaliman, MD at 8:10 am

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