If you’ve got an itch, you’ve got to scratch it; but should you? To borrow from the Bard, “To scratch, or not to scratch; that is the question.” Maybe I’m focused on skin lately because my own nose is so red and painful. Recently, my dermatologist prescribed a topical chemotherapy agent to try and combat precancerous sun damage which seems to be concentrated on my nose. As I’ve often said, I write about what’s on my mind, and currently my nose is hard to overlook.
A sage once observed that “White men should stay out of the sun.” Well, we didn’t know as much about the harmful effects of solar radiation fifty years ago. We knew about sun burns, but skin cancer risk and accelerated aging of the skin by the sun (photo-aging) were not hot topics in my youth or medical school training. Interestingly, the major cause of aged skin is due to solar radiation. If you don’t believe me, go into the bathroom and place your hand next to your derriere and compare the appearance of the skin. (This comparison will only work for those of us who aren’t nudists.)
This time of year a common complaint is dry and itchy skin. My wife, Becky, is a wonderful person, but has a unique perspective on itchy skin, a condition doctors call pruritis. She loves a small patch of poison ivy and the luxurious sensation of scratching the area! However, by the time my patients drag in to see me they have usually moved beyond the pleasure of relieving an itch and have moved into the vicious cycle of a condition called neurodermatitis.
You may have noticed that as sunburn heals the pain is replaced by a mild itching sensation. In fact, I’ve told patients this represents a sign of healing. Our brains receive information from our eyes, ears, nose and tongue as well as from specialized receptors in the skin. There are skin receptors which register pressure, hot and cold, vibration and pain. Interestingly, the sensation of itching is a variation of pain and carried along the same nerve fibers to the brain.
Our brains sit inside our skulls and perceive the outside world through our interconnected sensory array. Injury produces pain and tells you to drop the hot pan before you do serious damage to your fingers. The resulting burn causes an inflammatory reaction mediated by cellular-signaling chemicals called cytokines, which modulate the healing process. Outwardly, we observe our red, swollen, and painful fingers that have lost function. The ancient Greeks beautifully described these as rubor, tumor, dolor, and functio laesa, the calling cards of inflammation. The ancients may not have understood cellular biology as we moderns do, but they were keen observers, a prerequisite of science and observational truth.
As the body’s repair crew mends an injured part, the signaling cytokine levels released from injured cells begin to decline. Finally, after the bleeding has been stopped and dead cells have been removed, new parts are fabricated from blueprints stored in our cellular DNA. In a home remodeling project dry wall goes up after the demolition; and after some spackling and a fresh coat of paint, the repair crew shuts down and goes home. In fact, if the body’s repair/fabrication system gets out of control, cancer ensues. We take this wondrous process of injury and restoration of health for granted, most of the time. Sometimes it takes a boo-boo or perhaps insightful story-telling to get our attention.
When you scratch too much you may actually cause injury. Then, as the injury is being repaired and pain signals morph into an itching sensation you may be tempted to scratch and ultimately produce more injury. I call this the injury- inflammation-itch-injury cycle. This process has a somewhat pejorative name (neurodermatitis) implying that neurotic people are the ones who scratch themselves to death. “Elementary, Watson,” it’s all about inflammation.
The treatment of pruritis is based on the cause and an understanding of pathophysiology (diseased bodily function). A potent topical anti-inflammatory corticosteroid is very important in reducing the inflammation and itching-scratching cycle. I advise patients to avoid scratching the inflamed area as much as possible and to use an over the counter anti-itching product called Aveeno cream or bath soaks. “I know it’s tough, but if you leave it alone it will heal.” Picture a skinned area on your hand. If you keep picking at the area, it will not heal.
Americans bathe a lot and we use soap whether we need it or not. Soap removes dirt, but also the oils in the skin. These oils seal the skin’s surface and prevent the loss of moisture. When skin dries out it often becomes cracked like leather and irritated. This often initiates the inflammation-itch cycle. When you consider the drying effects of our home heating systems and that older people produce less skin oil than pimply teenagers, you begin to understand the factors which contribute to the Winter Itch.
My recommendation for skin care is to avoid mindless scrubbing of your skin and to use a bath oil or moisturizer after bathing. Use a sunscreen and common sense. Your body is designed to regulate and heal itself; give it a chance. Sometimes a little ingenuity helps, and at other times understanding and patience is the pathway to wisdom.