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(10) Skin Disorders


How to Treat Your Skin Problems : Itchy Skin Conditions


What about an itch that persists?

“Scratching is one of the sweetest gratifications of nature, and as ready at hand as any,” Montaigne wrote. “But repentance follows too annoyingly close at its heels.”:

“There was a young belle of old Natchez

Whose garments were always in patchez.

When comment arose

On the state of her clothes,

She replied, “When.” When Ah itchez, Ah scratchez.”

Ogden Nash

Every time I have a patient with an itch, I do a “Mind Google” search and think of my patient’s differential diagnosis. The real Google has over 12,200,000 links to itch.

Not all itches are benign. Itch is a common condition that may be associated with a plethora of various medical conditions, and therefore, examination of the skin may be misleading.

Without proper diagnosis and treatment of the underlying disorder, itch may become severe enough to affect your sleeping habits and overall quality of life. Underlying metabolic conditions that produce itch might include renal failure, HIV, diabetes mellitus, thyroid disease, iron-deficiency anemia, neuropathy, hepatic disease, malignancy, and drugs. If you have a persistent itch, work with your health practitioner to find out what can help you. If you do not have an obvious explanation for the itch, you should undergo a physical examination to look for evidence of a systemic disease.

Itch starts with an external stimuli-dust, touch, a mosquito landing on your arm-and is a built-in defense mechanism that alerts your body to the potential of being harmed. Dermal skin receptors will send an immediate signal through fibers in the skin to your spinal cord and then up to the cerebral cortex in your brain that tells you to scratch. You may feel some relief when this itch response is temporarily interrupted, but a persistent itch may result in chronic itch-scratch. Scratching can cause excoriations, which then may progress to secondary eczema or may become infected.

The itch-scratch cycle is the dermatologic equivalent of chronic pain syndrome and should be treated as such. Just as with chronic pain, there is a reduced threshold phenomenon that occurs in patients with chronic itch. Chronicity not only lowers the threshold for the sensation of itch, but it also increases the intensity of itch. Also, as with chronic pain, short bursts of spontaneous itch may occur, even when the skin is clear.

The term itch has evolved into many connotations in our society. Researchers have found that songs get stuck in our heads because they create a “brain itch” or “cognitive itch,” analogous to histamines that make our brain itch, and can only be scratched by repeating the tune over and over.

 The itch-scratch cycle is the dermatologic equivalent of chronic pain syndrome and should be treated as such.



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