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Psychogenic Itch Explained

Itch 101, Types of Itch

sad girl

We’ve all had an itch that we’ve needed to scratch, but many people don’t realize that itchy skin can be a symptom of a number of health conditions, some of which are very serious, like psychogenic itch.

Described as an excessive impulse to scratch, gouge, or pick at normal skin, psychogenic itch is related to psychological abnormalities. It is typically diagnosed only after other possible causes are eliminated and the patient has tested negative in screenings for skin disorders or diseases. Itchy spots are often found in easy-to-scratch parts of the body such as face, arms, and legs.

Some studies say depression may be the root cause of psychogenic itch, but this condition is also associated with obsessive-compulsive disorders, mania, and even substance abuse. Additionally, stressful life events such as loss of a job or a loved one and relocation can play a role. Although the prevalence of psychogenic itch is unknown, a study published in Dermatology Therapy notes that approximately 2 percent of patients (predominately women between the ages of 30 and 45) seen at dermatology clinics are diagnosed with psychogenic itch.

Data also shows a significant correlation between mental stress and itch and pain. Although limited data are available on the treatment of psychogenic itch, medications used to treat chronic pain caused by damage to the nervous system, depression, and anxiety have proven to be effective in helping to control the sensation.

Source: G, Yosipovitch. Neuropathic and Psychogenic Itch. Dermatology Therapy. 2008. 2.1:32-41. http://onlinelibrary.wiley.com/doi/10.1111/j.1529-8019.2008.00167.x/epdf

Source: S., Jain. Current Psychiatry. Problematic pruritus: Seeking a cure for psychogenic itch. 2015. http://www.currentpsychiatry.com/articles/pearls/article/problematic-pruritus-seeking-a-cure-for-psychogenic-itch/aa9549f0c20448041cb5a75723273625.html

Photo by Helga Weber

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Skin Tip

Skin Tip #1

“Every day my patients ask me how they can prevent wrinkles and brown spots. My advice is to first and foremost protect yourself from the sun and UV rays.” –Dr. Gigler

Reducing Itch Without Medication

Manage My Itch, Tips for Relief

sipping juice

We have all experienced the urge to scratch, a sensation that is usually very hard to resist. Whether it’s all over your body or confined to a specific body part, itchy skin is an uncomfortable, but common, symptom for a number of health conditions. If you have itchy skin, listen to your body and talk to your doctor about your symptoms. For those instances that do not require medical attention, here are five ways you can reduce itch without medication:

  1. Keep Your Skin Clean – Did you know that harsh soap and cleansers can wreak havoc on your skin, stripping it of essential moisture and natural oil? As the outer layer of your skin loses moisture, your skin becomes sensitive to harsh irritants such as fragrances, house cleaners, harsh weather conditions, etc. If you are experiencing itch, consider using low-pH balanced products, and, for more sensitive skin, try to avoid perfumes and dyes, including laundry and dish detergents.
  1. Stay Hydrated – The easiest way to improve your skin is to increase your daily water intake. Experts recommend drinking at least six to eight 8-ounce glasses of water each day to remain hydrated. Drinking enough water not only reduces itchy skin symptoms but also improves overall health.
  1. Moisturize Your Skin – Using a topical moisturizer can help keep your skin moist, which is crucial to reducing irritation and redness. Look for moisturizers that contain ingredients such as shea butter, dimethicone and ceramides.
  1. Eat Healthy Fats – Low-fat diets can often impact the amount of natural oils needed to keep your skin moisturized from within. Talk to your physician about the types of fats that are good for maintaining healthy skin to ensure you are making the right dietary choices to meet your specific needs.
  1. Reduce Stress – Research shows that stress can aggravate itch. Yoga and exercise, meditation, and/or counseling and therapy are excellent ways to relieve stress and its physical manifestations.

Sources:

American Skin Association. Dry Skin. 2012. http://www.americanskin.org/resource/dryskin.php.

WebMD. Why is it important to drink enough water? 2014. http://www.webmd.com/a-to-z-guides/drinking-enough-water-topic-overview.

National Psoriasis Foundation. Stress and psoriatic disease. 2015. https://www.psoriasis.org/life-with-psoriasis/stress.

Photo credit: Tanya

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Skin Tip

Skin Tip #1

“Every day my patients ask me how they can prevent wrinkles and brown spots. My advice is to first and foremost protect yourself from the sun and UV rays.” –Dr. Gigler

Don’t Let Psoriasis Define You

Conditions & Symptoms ,

girl sitting on a bench

 

Imagine having to explain day in and day out that the big, red blotches of scaly skin on your arms and legs are not contagious, they’re called psoriasis. Although approximately 7.5 million people are living with psoriasis in the U.S., psoriasis can be hard to diagnose and is often mistaken for other skin conditions.

By definition, psoriasis is a chronic disease that develops when a person’s skin cells grow too fast, causing new skin cells to form in days rather than months, which results in the itchy, sore, red patches seen on the surface of the skin. As a result, many psoriasis patients find themselves avoiding the outdoors and social situations to reduce how often they need to explain what psoriasis is.

The impact of psoriasis on patients’ quality of life is frequently underestimated. In a recent study published in the Journal of the European Academy of Dermatology and Venereology, most dermatologists (63 percent) reported that psoriasis impacted patients’ daily activities and work, and 80 percent reported it affected their patients socially and emotionally.

Don’t let psoriasis define you or someone you know. Yes, living with psoriasis has some unique challenges; however, there are things you can do to help manage your symptoms. Whether you make changes in behavior (e.g., consuming less caffeine) or consider available treatment options (both over-the-counter and prescription), it is likely that you can achieve some relief for recurring and/or painful itch.

Research suggests that stress can also trigger specific immune factors associated with psoriasis flare-ups. Meditation, exercise and a good night’s sleep are great ways to manage stress levels, but don’t be afraid to also seek outside help. The National Psoriasis Foundation encourages patients to connect with other people living with psoriasis and or find a therapist in their area, if needed. Be sure to talk to your primary care physician or dermatologist about your symptoms and ways to effectively manage your psoriasis. For more information check out the “Manage My Itch”.

Sources:

National Psoriasis Foundation. Statistics.2015. https://www.psoriasis.org/cure_known_statistics.

National Psoriasis Foundation. About Psoriasis. 2015. https://psoriasis.org/about-psoriasis.

P.C.M. van de Kerkhof, et al. Journal of the European Academy of Dermatology and Venereology. Physician perspectives in the management of psoriasis and psoriatic arthritis: results from the population-based Multinational Assessment of Psoriasis and Psoriatic Arthritis survey. 2015.

University of Maryland Medical Center. Psoriasis. 2015. http://umm.edu/health/medical/reports/articles/psoriasis#ixzz3jndildRN 

National Psoriasis Foundation. Stress and psoriatic disease. 2015. https://www.psoriasis.org/life-with-psoriasis/stress.

Photo by Rishi S

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Summer Fun and Our Skin

Summer Fun and Our Skin

Expert Corner

Summer Fun and Our Skin

Summer is just around the corner and many of us are anxious to get on our summer tan. But we need to be cautious about how we care for our skin. Each year more than two million cases of skin cancer are diagnosed in the United States, and the incidence is increasing.

The most common types of skin cancer are basal cell carcinoma, squamous cell carcinoma and melanoma.  Of the skin cancers, melanoma is the most serious, with a high death rate if not caught early. Melanoma accounts for approximately five percent of all skin cancers. All skin cancers are linked to sun exposure. Interestingly, melanoma is linked to high-intensity exposure that leads to sunburn, whereas the other cancers are linked to accumulative exposure. In other words, the more sunburns you get, and the more severe the sunburns, the higher your risk of developing melanoma.

People who are at higher risk for developing melanoma are those who:

1)      Are fair-skinned  – often red-heads or blonds with freckles

2)      Have green or blue eyes

3)      Have a family history or personal history of melanoma

4)      Have more than 50 large moles

5)      Have a personal history of other cancers

Signs of melanoma include new spots on the skin or a change in size, shape or color of an existing mole. The ABCD rule is another way to recognize abnormal growths that may be melanoma skin cancer:

  • A is for Asymmetry: A mole that has an irregular shape or two different looking halves.
  • B is for Border: Irregular, blurred, rough or notched edges may be signs of melanoma.
  • C is for Color: Most moles are an even color – brown, black, tan or skin color – but variations in the shade or distribution of color throughout the mole can signal melanoma.
  • D is for Diameter: Moles larger than ¼ inch across (6 mm, the size of a pencil eraser) may be suspect, although some melanoma cancers may be smaller than this.

Other melanoma cancer symptoms may include:

  • Sores that do not heal
  • Pigment, redness or swelling that spreads outside the border of a spot to the surrounding skin
  • Itchiness, tenderness or pain
  • Changes in texture or scales, oozing or bleeding from an existing mole

As the old adage goes, “An ounce of prevention is worth a pound of cure.” When it comes to the prevention of skin cancer, especially melanoma, this couldn’t be truer.  The American Academy of Dermatology website site does a great job of providing guidelines for sunscreen use and other preventative measures that will help you protect your skin most effectively.

 

Safe in the Sun

Safe in the Sun #21

“Wear a beach cover-up when headed for an all-day outing in the sun. I actually love the sun shirts that have SPF woven into the fabric.” – Dr. Vishakha Gigler

Expert Opinion

Expert Opinion #42

“The basic difference between a cream and a lotion is that cream is thicker. This allows for better emollition and hydration.” – Dr. Vishakha Gigler

Avoid Tanning Beds, Period

Expert Corner

Avoid Tanning Beds, Period

Over the past 30 years we have seen a significant rise in the number of skin cancers, including basal cell carcinoma, squamous cell carcinoma, and melanoma. These cancers have a direct correlation to sun exposure, which ironically is one of the most preventable risk factors for skin cancer.

Sun exposure is also one of the most important causes of aging and sagging skin. Every day my patients ask me how they can prevent wrinkles and brown spots. My advice is to first and foremost protect yourself from the sun and UV rays.

So how do you safely protect your skin and your children’s skin from the sun? Here are a few basic rules I instruct my patients to follow:

  1. Avoid sun exposure. Sun avoidance is more effective than sun protection. By this, I do not mean stay inside all day, but I do expect patients to wear a hat and sit under an umbrella when outside. Wear a beach cover-up when headed for an all-day outing in the sun. I actually love the sun shirts that have SPF woven into the fabric. You can wear them in the water and out on the beach. And yes, there are some really cute ones.

Also, try to avoid exposing your skin to midday sun (11 am – 2 pm), when the sun’s rays are the strongest.

  1. Use sunscreen. Using sunscreen will help prevent UV rays from penetrating your skin and damaging the skin cells. See my tips below on how to choose the best sunscreen.
  2. Get Vitamin D safely through a healthy diet or through supplements. The sun should not be your main source of vitamin D.
  3. Avoid tanning beds. That is really all that I have to say about tanning beds—avoid them, period.

One of the biggest problems I find in my practice is that patients are just overwhelmed with the amount of choices, information/misinformation, and controversies over sunscreens. So here are some basic questions and answers about sunscreens.

  1. What sunscreens do you recommend?

There are many great sunscreens. You should chose one that has an SPF of 30 or higher, but mainly make sure it is labeled as broad-spectrum coverage. Broad-spectrum protects you from both UVA and UVB rays. In order to get broad-spectrum, I prefer sunscreens with one of the following ingredients:

  • Zinc Oxide
  • Titanium Dioxide
  • Avobenzone
  • Mexoryl

As long as it has one of these ingredients and has an SPF of 30 or higher, then pick a sunscreen you like. You are much more likely to use it if you like it. It makes no difference if it is a gel, cream, or stick.

  1. What about spray sunscreens?

I prefer lotion sunscreens to sprays. I do not believe that sprays provide adequate coverage. If you do use a spray sunscreen, please make sure to use enough to cover your body.

  1. Does the sunscreen in my makeup count?

It is nice to have SPF in your makeup, but it is usually not enough. It is best to apply a sunscreen or moisturizer with sunscreen first. Then apply your makeup.

  1. When and how often do I need to apply sunscreen?

Apply sunscreen at least every morning on sun-exposed areas (face, the part in your hair, neck, chest, hands, and any other exposed body parts).  Keep your sunscreen in the bathroom so that you remember to apply it every day.

Sunscreen should be applied 15 minutes BEFORE sun exposure. Reapply sunscreen every two hours when you are in the sun and every hour when you are in the water (or sweating).

  1. How much sunscreen am I supposed to use?

Usually one ounce (enough to fill one shot glass) is considered the amount needed to cover the exposed areas of the body. Try it. It is usually much more than you think.

  1. Should I be worried about all of the chemicals in sunscreens?

I do not feel there’s enough data to tell us whether or not any of the chemicals in sunscreens can cause harm, but we do know that UV rays can cause skin cancer. While there are no official warnings with regards to sunscreen ingredients and cancer, the U.S. Department of Health and Human Services and the International Agency of Research on Cancer have declared UV rays as a known carcinogen.

Having said that, I want you to use a sunscreen that you are comfortable with. There are plenty of “organic,” “pure,” or “natural” sunscreens that are available.

Last but not least, please check your skin at least once per month. See your doctor if you notice anything that is new, changing, growing, or bleeding.

 

Safe in the Sun

Safe in the Sun #21

“Wear a beach cover-up when headed for an all-day outing in the sun. I actually love the sun shirts that have SPF woven into the fabric.” – Dr. Vishakha Gigler

Expert Opinion

Expert Opinion #42

“The basic difference between a cream and a lotion is that cream is thicker. This allows for better emollition and hydration.” – Dr. Vishakha Gigler

Keratosis Pilaris

Expert Corner

Keratosis Pilaris

Not a day goes by that a patient does not ask me about an extremely common condition called keratosis pilaris (KP). Although KP can be irritating, this condition is harmless.

Keratosis pilaris is hereditary, and affects about 50% or more of teenagers and about 40% of adults. It is more common in females and people with dry skin or eczema.  Flare-ups most often worsen in the winter when the air is dry and the skin looses its moisture.

KP often looks like “goose bumps” or “chicken skin.” Patients will have small, rough bumps generally found on the backs of the arms, thighs, buttocks, and face. The skin around the bumps may be reddish pink and itchy.

There are many treatments for KP, but I always like to remind patients that KP does not need to be treated if it is not bothersome. Treatments can be time consuming and can take up to two months before you see results. Also, once the treatments are stopped, KP will reappear.

  • Once or twice a day moisturize the skin with a thick, non-fragrant moisturizing cream. It is important to apply the moisturizer after you shower or bathe to help the skin lock in the moisture.
  • Alternatively, you can try an exfoliating lotion or cream. These contain urea, lactic acid, or glycolic acid.  Use the exfoliating lotion once or twice per day.  These creams are available over the counter, and without a prescription.
  • If the over-the-counter creams and moisturizers do not work, ask your doctor about retinoid creams, which are available by prescription only.
  • Peels and microdermabrasion are a nice way to improve the appearance of KP, especially before an important event.  I usually recommend that the treatments be done two to four weeks apart, with the last treatment ending two weeks prior to the event.

About half of my patients will generally outgrow their KP, but some may see it persists through adulthood. For more information about KP visit www.mayoclinic.com/KP

Safe in the Sun

Safe in the Sun #21

“Wear a beach cover-up when headed for an all-day outing in the sun. I actually love the sun shirts that have SPF woven into the fabric.” – Dr. Vishakha Gigler

Expert Opinion

Expert Opinion #42

“The basic difference between a cream and a lotion is that cream is thicker. This allows for better emollition and hydration.” – Dr. Vishakha Gigler

How to Treat Winter Itch

Expert Corner

How to Treat Winter Itch

If you suffer from winter itch, autumn is the ideal time to start preparing your skin for Old Man Winter to arrive. Winter itch is a disorder with many names, including winter eczema, asteototic eczema and eczema craquele.  It is more common in patients with a history of atopic dermatitis (also known as eczema) and in the elderly, but it can also occur in anyone whose skin has been exposed to cool, dry air.  Winter itch commonly occurs on the legs, but it can crop up anywhere on the body.

Low humidity, cold temperatures, and central heating during the winter cause your skin to lose moisture. If your skin is exposed to decreased levels of humidity for several days, it can become severely dry, flaky and inflamed.

There are some simple ways to prevent or minimize the symptoms associated with winter itch:

  • Use a gentle cleanser in the bath or shower. This is much gentler on the skin than regular soaps.
  • Moisturize your skin at least once a day. It is important to know that not all lotions and moisturizers are equal. Use a thick, bland moisturizer and avoid lotions with fragrances. Products with ceramides can be especially good for eczema and winter itch. The ideal time to moisturize is right after a bath or shower. Pat your skin dry so that it is still a little wet, then apply a moisturizer.  This will “trap” the moisture into your skin.
  • Avoid fragrance, fabric softeners and dryer sheets.
  • Use a hypoallergenic laundry detergent.
  • Use a humidifier.

Hopefully, with these simple measures, you will have an itch-free winter. If you do still get the winter itch, you may need to see your doctor for a prescription-strength steroid cream.

Safe in the Sun

Safe in the Sun #21

“Wear a beach cover-up when headed for an all-day outing in the sun. I actually love the sun shirts that have SPF woven into the fabric.” – Dr. Vishakha Gigler

Expert Opinion

Expert Opinion #42

“The basic difference between a cream and a lotion is that cream is thicker. This allows for better emollition and hydration.” – Dr. Vishakha Gigler

How to Recognize and Treat Shingles

Expert Corner

How to Recognize and Treat Shingles

Shingles, otherwise known as herpes zoster, is an infection of the skin that is caused by the varicella zoster virus. This is the same virus that causes chicken pox, pictured above. After causing chicken pox, the virus lives quietly in the nerve roots. For many people, the virus remains in the nerve roots forever. For others, the virus reactivates and causes shingles. Reasons why the virus can reactivate include:

  • A weakened immune system
  • Stress
  • Immunosuppression
  • Medicines
  • Aging

Shingles initially presents as pain, itching, or tingling on a part of the skin. In that area, a strip or small area of rash may appear. Classically, the rash only involves one side of the body, though it may cross the midline. The rash starts as redness, then blisters, then crusts. Flu-like symptoms including fever, headache, and body aches may occur before or along with the rash.

Diagnosis of shingles is usually clinical—meaning a doctor will know it when she sees it. However, the doctor may do a skin scraping or a viral culture to confirm the diagnosis.

Shingles is treated with a prescription antiviral medication. This treatment should be started as soon as possible to decrease symptoms, duration, and complications. In addition, the doctor may recommend pain medications and anti-itch medications.

Shingles in the forehead, nose, or eyelid could signal eye involvement. Shingles in these areas, or in the eye itself, should be evaluated by a doctor immediately.

Shingles usually resolves without any sequel. The most common complication is postherpetic neuralgia.Postherpetic neuralgia is chronic pain in the area of the rash. Skin infections may also occur, especially if the lesions are picked at. Other complications are extremely rare and include vision problems and neurological problems.

Shingles is contagious, but you cannot catch shingles from shingles. Instead, you can catch chicken pox from someone with shingles if you have never had chicken pox or the vaccine. I recommend that people with shingles keep the area covered until it is healed. In addition, they should avoid people who have never had chicken pox (or the vaccine) and all pregnant persons.

Vaccines are currently available for chicken pox and shingles (separate vaccines for each). The chicken pox vaccine is routine for children and recommended for adults who have never had chicken pox. Theshingles vaccine is FDA approved for people over 50 to prevent shingles.

Safe in the Sun

Safe in the Sun #21

“Wear a beach cover-up when headed for an all-day outing in the sun. I actually love the sun shirts that have SPF woven into the fabric.” – Dr. Vishakha Gigler

Expert Opinion

Expert Opinion #42

“The basic difference between a cream and a lotion is that cream is thicker. This allows for better emollition and hydration.” – Dr. Vishakha Gigler

What is Atopic Dermatitis? (Part 1)

Expert Corner

What is Atopic Dermatitis? (Part 1)

Atopic dermatitis, or eczema, is often described as “the itch that rashes”. It is an extremely common rash. It occurs in about 10 to 20 percent of children under the age of 10 in the United States and about one to three percent of adults in the world. It affects at least 28 million people in the U.S. alone.

Eczema usually presents itself in childhood. 60 percent of patients with eczema develop it before they are one year of age, and 90 percent develop it before they are five years old. However, some patients do develop eczema later in life. Atopic dermatitis is characterized by areas of intense itching. Children with eczema will often rub their skin against their bedding, carpeting, or other things. The itching can be so severe that children may have trouble sleeping.

Eczema characteristically involves the scalp, face, neck, and the insides of the elbows, knees, and ankles. The involved areas are dry, red, and sometimes scaly. Scratching can lead to a secondary infection. In long-standing eczema, the skin may lighten or darken. The skin may also thicken or appear leathery.

Atopic dermatitis is a chronic condition. It often comes and goes for many years. For most people, however, the symptoms will ultimately improve by adolescence or adulthood. Atopic dermatitis is much more common today than it was 30 years ago. Dermatologists are not sure why this is. We do know that there are certain factors that increase a child’s risk of getting eczema. These risk factors are:

  • Family history of eczema, asthma, or hay fever
  • Living in a developed country, living in a city (especially if there are high levels of pollution), or living in a cold climate
  • Females are more likely to have atopic dermatitis than males

Studies suggest that food allergies do not cause atopic dermatitis, but certain foods (milk, nuts, shellfish) can make eczema worse. The dermatologist or allergist may perform food allergy tests.

Eczema is a chronic condition. At times, the rash may be better or even gone, while at other times the rash may flare up with severe symptoms. The management of eczema must reflect this—at times, the treatments must be more intense, and at other times, simple measures will do the trick. The management, like the disease, is chronic.

Prevention

Prevention is one of the most important parts of managing eczema.  The measures that I list below may seem very simple, but they are crucial.

  • Use a gentle cleanser to wash yourself. Do not use harsh soaps.
  • Moisturize at least once per day. Use a thick hypoallergenic moisturizer. Recent studies have demonstrated the importance of ceramides for atopic dermatitis. I prefer a cream with ceramides. The best time to moisturize is right after a shower or bath, after pat drying, when the skin is still a little wet. This will “trap” the moisture in.
  • Avoid fragrance or scented products.
  • Use a hypoallergenic laundry detergent.
  • Avoid dryer sheets or fabric softeners.
  • Use hypoallergenic mattress and pillow covers.
  • Wear soft clothing that does not scratch your skin.
  • Avoid things that flare your eczema. For some people, this is pets, grass or carpeting. For others, it may be certain foods. Please consult your doctor before changing your diet.

Treatment

Treatment of mild atopic dermatitis (mild itching or rash):

  • Increase frequency of moisturizing.
  • Over-the-counter anti-itch creams or gels can help alleviate the itch and may help prevent a worsening of the eczema.
  • Over-the-counter steroid creams.
  • Prescription strength non-steroid creams (elidel, protopic, epicerum, atopiclair and mimyx).
  • Mild prescription-strength topical steroids.
  • Antihistamine pills/syrup before bed.

Treatment of moderate or severe atopic dermatitis:

  • Increase frequency of moisturizing.
  • Anti-itch creams.
  • Prescription-strength topical steroids.
  • Antihistamine pills/syrup before bed.
  • See below for other treatments and considerations.

Other Considerations

Sometimes, there may be a secondary bacterial or fungal infection. Your doctor can diagnose this. Symptoms of a secondary infection include pain, flare of the rash or yellow crusting. These should be treated properly with topical or oral medicines from your doctor.

Other Treatments

Sometimes, eczema is very severe, or cannot be controlled by the measures above. In those more severe cases, doctors can prescribe oral medications to help. In addition, there are light treatments that may be done in the doctor’s office.

Managing eczema can be difficult, and patients need to learn when their skin is clear, flaring or not responding to treatment. Treatment will depend on the current severity of eczema.

Safe in the Sun

Safe in the Sun #21

“Wear a beach cover-up when headed for an all-day outing in the sun. I actually love the sun shirts that have SPF woven into the fabric.” – Dr. Vishakha Gigler

Expert Opinion

Expert Opinion #42

“The basic difference between a cream and a lotion is that cream is thicker. This allows for better emollition and hydration.” – Dr. Vishakha Gigler

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