Help for itchy, scratchy skin: a common skin condition

Nili N. Alai, MD
Article by
Orange County Dermatologist

HELP FOR ITCHY SCRATCHY SKIN: a common skin condition.

Itchy skin (Pruritus) is a very common skin condition that can produce tremendous physical discomfort and psychological distress. One of the most common dermatologic causes of pruritus is dry skin. Symptoms may be present year round, but overall tend to be worse in the winter and more dry months. The condition can affect any age, although is more prevalent in the older population. At least 50-70% of patients aged 70 or older suffer from severe pruritus at some time in their lives. Pruritus is frequently also seen in younger individuals with a personal or family history of related disorders, including eczema, atopic dermatitis, allergies (hay fever) and asthma.

Many patients with pruritus have not thought about dry skin as a main cause. There is a gradual tendency toward drier skin as we age and a decreased overall production of needed natural skin oils and lubricants. Often regular skin moisturizer lotions are not very helpful because they lack enough petrolatum. It is very important to use the right kinds of mild soaps and rich moisturizers. The key time to use a good moisturizer like Aquaphor, Vaseline, Crisco vegetable shortening, or SBR Lipocream is right after drying off after a shower or bath. Then the skin has been hydrated and is ready to seal in the moisture.

Often, there may be no visible sign of pruritus on the skin. Many patients have dry skin all over their body. It may develop into a chronic, itching, superficial inflammation or redness of the skin. Severe itching often leads to repeat scratching of lesions - hence the “itch-scratch-rash-itch cycle.” The skin lesions can further develop into a red rash with multiple small rough bumps and/or little blisters. The skin may later become intensely red, blister, ooze and form scabs.

A not uncommon complication of the disease is secondary bacterial infection, which may often require antibiotic treatment. Because of the persistence of this itch-scratch cycle, the skin may become very thickened in these areas from rubbing. Fortunately, most patients can recover from pruritus within several days of beginning their sensitive skin program (see 10 step list below). If the itching has not improved within one to two weeks of self- treatment using the ten step program, a dermatologist visit may be indicated. Stronger prescription anti-itch medications may be helpful and options for newer therapies which involve non-steroid type of topical medications like Elidel cream and Protopic ointment. These therapies have the advantage of avoiding some of the common bad side effects with stronger steroid creams like skin thinning and long term skin changes.

The majority of patients with pruritus are generally very healthy and don’t have any other associated medical problems. However, there are other medical causes of pruritus which may need further evaluation by your dermatologist or primary physician. Other causes include liver disease, malignancy, diabetes, thyroid disease, chronic kidney disease, neurologic disorders, certain medications, blood disorders, etc. Much of these other causes can be evaluated through complete lab tests and physical exam.

General recommendations for patients with sensitive skin:

Do’s:
• Bathe with lukewarm water
• Lubricate skin frequently with rich moisturizers like Aquaphor or Crisco vegetable shortening
• Use a soapless cleanser like Eucerin Gentle Cleanser
• Maintain a comfortable room temperature
• Keep fingernails short and clean
• Wear light, smooth, nonbinding cotton clothing

Don’t:
• Wear rough, scratchy clothes or woolens
• Bathe too often with hot water and soap
• Use harsh skin cleansing products or soaps
• Use fragrances lotions or body washes

Special TEN STEP recipe for sensitive skin

1. Stop All soap to skin
2. Use only Eucerin Gentle cleanser or Cetaphil soapless cleanser to wash skin
3. Shower or bathe daily or every other day
4. Apply Aquaphor ointment to entire body within 5-10 minutes after drying off after showers or bathing
5. Re-apply Aquaphor ointment to dry skin 2-3 times a day
6. Use ALL Free and Clear detergent
7. No bleaches or fabric softeners
8. May consider double rinsing clothes
9. Take Benadryl every 6-8 hours as needed for severe itching
10. Apply Hydrocortisone cream or ointment ( Cortaid or Cortizone 10) to rash or itchy areas two to three times a day