Dear Dr. Garner,

What started out as a small area that itched on my back has now taken over my entire skin. I scratch so hard that it bleeds but there is no sign of any rash.

My doctor gave me a moisturizer but it is not helping. This is beginning to affect me mentally. I am irritable, I can hardly sleep and the more I scratch, the more it itches.

Is there anything you can think of that could help?

Scratching in Sheepshead Bay

 

Dear Scratching,

When the skin becomes itchy, it can feel most uncomfortable. Itchy skin can cause you to scratch severely and can even lead to bleeding. The medical term is “pruritus” (proo-ri-tus). It can be caused by many different medical conditions. When there is itching without a rash, a doctor will most likely prescribe a moisturizer, similar to what you doctor did.

When this does not improve the situation, further work-up is required. The key is to become a detective and figure out what is causing the problem. Some possible causes other than dry skin include skin rashes, such as eczema, psoriasis or an infectious rash like scabies or chicken pox. In certain types of rashes, the appearance and location help identify the cause.

Itching can also occur from disease within the body such as liver or kidney problems. These also include cancer, leukemia and lymphoma.

Nervous disorders often cause severe itching and scratching. These usually occur in conjunction with other mental issues and often respond to tranquilizers and antidepressants.

Of course, allergic reactions to everything from poison ivy to food to makeup can cause severe itching. It is important to review the medications you are taking as drugs can cause allergic reactions in the form of itching and rashes.

It is advisable that you see a dermatologist to figure out why the itching is so severe and why it affects your entire body. Do you have other symptoms such as fatigue, weight loss, change in bowel or urine habits and any evidence of fever? It is important to note when your symptoms began and what makes them worse.

In addition to moisturizer, there are things you can try while waiting for an appointment. Steroid cream can be obtained over-the-counter and often help to reduce inflammation and control itching. Certain medications, like Protopic, can be used instead of steroids, especially if the itchy area is small. There are antihistamines you can take to reduce the itching and perhaps help you sleep as well. Benadryl is a type of antihistamine that can provide relief. There are also over-the-counter antihistamines that do not make you sleepy. Antidepressants have been shown to reduce various types of skin itching. Light therapy, in which the skin is exposed to different strengths of ultraviolet light, has been shown to be helpful as well.

There are lifestyle changes and home remedies too. A high-quality moisturizing cream can often reduce the itching. Unfortunately, in your case this has not worked. There are anti-itch creams and lotions that contain hydrocortisone and some that contain topical anesthetics which will help reduce the itching. These can be obtained over-the-counter and I suggest you ask your pharmacist for help.

The key part is to avoid scratching as this worsens the itch. This is easier said than done but you can trim your nails and wear gloves at night, which will help to reduce the irritation created from scratching. Cool and wet compresses often help to decrease the scratching and prevent scarring. Take a lukewarm bath and use oatmeal products to soothe the skin and stop itching. Use mild neutral-type soap without dyes and perfumes and a mild detergent for washing your clothes.

Finally, it is important to reduce tension as it can worsen the itching. It could be helpful to visit a psychologist or psychiatrist to find ways to decrease stress.

The process for investigating itching can be a long one, however a systematic plan is necessary.

Keep me updated on your progress.[hr] Dr. Garner is a Fidelis Care provider who is affiliated with New York Methodist Hospital, Park Slope. He also hosts “Ask the Doctor” on The NET, Tuesdays at 8 p.m. on Channel 97 Time Warner and Channel 30 Cablevision.