Chronic itch is a common and troubling condition. Patients with eczema rarely find relief in antihistamines. Cortisone is often the go-to OTC or prescription remedy, but long-term use of a topical corticosteroid—even a mild one—is not recommended. While no single strategy will help patients cope with itch, a combination of tactics can help to reduce pruritus and offer patients relief.
The key to both relief and prevention is to protect the moisture barrier of the skin, which is composed of water and lipids. Explain to patients that this is their natural protection against the elements and is essential in helping to prevent moisture loss. Healthy skin has anti-microbial peptides to fend off irritation and potential infection.
Advise patients that harsh cleansers and even detergent ingredients in skin care products and cosmetics can weaken and damage the skin barrier. To put it in basic terms for patients: When skin loses moisture, the cells shrink. This can leave cracks, which literally create points of entry for irritants and activates the skin's inflammatory response. This response can result in chronic itching.
Our skin barrier's protective microflora are most efficient when the outer pH (ratio of acid to alkaline) of the skin is slightly acidic—5.4 is ideal. When this is disrupted our natural buffering capacity quickly returns our pH to its ideal level.
Studies show that after the age of 50, the average pH of the skin barrier is more acidic, 6.0 or higher, and loses its buffering capacity. This leaves skin even more vulnerable to environmental sensitivities and dryness and worsens itching.
Armed with this knowledge, patients are prepared to adopt simple measures to help protect their skin and reduce itch.
FIVE EASY STRATEGIES
Cool It! Short, lukewarm baths and tepid showers (no longer than five minutes) are more comforting to itchprone skin. Hot water and strong or abrasive cleansers can trigger flare-ups by depleting the skin barrier of its protective lipids. Afterward, gently pat skin dry with a soft towel—no brisk rubbing!
Lock in moisture. Applying an emollient-rich body cream or lotion while skin is still damp (within three minutes after stepping out of the tub or shower) helps to keep the skin barrier intact. This makes skin cells more efficient in holding on to essential moisture. An intact barrier also prevents the entry of potential irritants. Emollient ingredients to look for include glycerin, hyaluronic acid, Shea butter, cocoa butter and extra-virgin coconut oil.
Soothe—and prevent—the itch. For itch-prone skin in need of intensive care, choose a product that not only increases moisture but also repairs the skin barrier and strengthens the skin's natural defense system. This helps to guard against any pathogenic agents that can potentially trigger secondary bacterial infections. Consider making specific product recommendations. For example, among the options available, one I often recommend is Avène XeraCalm A.D Lipid-Replenishing Cleansing Oil, Cream and Balm (Eau Thermale Avène). All have thermal spring water and a new active, I-modulia,® that helps to ease itching and inflammation and also helps to strengthen skin's natural immunity.
Stop scratching! Patients should understand that they are only irritating more nerve endings than the irritant that caused the itch. If no soothing creams or lotions are handy, cover the itchy area with an ice pack or a cold, damp washcloth for a few minutes; reapply as needed.
Be on the lookout for potential irritants in cosmetics and skin care products. Ingredients such as perfumes and preservatives in some products are often culprits that can set off itching and bouts of eczema.
Clean up your act! Dust mites and airborne particles can trigger an itchy rash in sensitive individuals. Weekly vacuuming using an anti-allergy filter-equipped vacuum as well as damp-mopping floors can help to keep dust in check. Patients might also consider investing in an air purifier, but make sure they change the filter frequently.
Living with the right indoor plants can also help to purify the air. Clean-air plants to help you breathe easier and stress less are Dracaena, Pothos and Peace Lily. (Keep these in mind when decorating your practices, too.)
Launder with gentle detergents. Dust and airborne particles can also lurk in bedding. Be sure to launder weekly in hot water with a gentle, fragrance-free detergent with a neutral pH to minimize allergies.
Nourish skin from the inside out. In response to irritants, the immune system in sensitive individuals kicks in and sets off the reaction that causes itching. To help keep the immune system running smoothly, patients should drink plenty of water—with a squeeze of lemon or lime whenever possible—and eat an alkalinizing diet.
A colorful Mediterranean diet both high in fiber and rich in Omega fatty acids includes foods such as halibut, salmon, olive oil, flaxseeds, dark green leafy vegetables (such as kale, collard greens, etc.), and winter squash. Alkalinizing grains include oats, wild rice, and quinoa. Examples of alkalinizing fruits are apples, pears, blackberries, cantaloupe, and grapes.
As for supplements, add Probiotics to the regimen as well as Vitamin D3, which helps to regulate the skin's antimicrobial and repair systems.
Manage stress. Just like irritants, negative emotions can set off the body's defense mechanism that triggers or aggravates itching. Regular exercise, yoga, meditation— even 15 minutes of quiet private time daily—can go a long way to reduce stress levels.
PARTNER WITH PATIENTS
Patients don't always present to a dermatologist for itch, even though we know that pruritus can be triggered by seasonal allergies, fungal infections, contact dermatitis, eczema, and very dry skin. In some cases itching can be a sign of systemic disease, such as liver or kidney problems. With the correct diagnosis, a dermatologist can prescribe a regimen to address the overall etiology, which will often lead to improvement of itch and other symptoms. However, for short-term relief of itch symptoms and to improve comfort and prevent future flare-ups of itching and itchy rashes, these straightforward tips can be quite useful.
Jeannette Graf, MD is assistant clinical professor of dermatology at Mount Sinai Medical Center in New York City.