Itchy Skin

Itchy skin is something that drives people to the dermatology office and is responsible for billions of dollars of sales for over the counter skin care creams and lotions. In some of the cases, the cause is eczema (atopic dermatitis), for others it can be dry skin or allergies to something they are coming in contact with. For some people, simple modifications of the lotions they use or how they care for their skin will solve this vexing problem. For others, skin biopsies and prescription strength medications will be needed.

Overall, the most common reason that people itch is that their skin is dry. The skin is a dynamic organ and when it is exposed to a dry environment, it will give up moisture to the surrounding air. Typically, this happens in the dry winter months but it can also happen at altitude or when the relative humidity is low. Fortunately, this is easy to fix and by using mild soaps such as Cetaphil or Aquanil instead of the more drying soaps, the skin will maintain its natural oils and feel better. There are many, many moisturizers that can help restore the skin barrier and among the ones that I like are Cerave, Vanicream and Theraplex (Disclosure: I have a financial interest in Theraplex). Each of these products is unlikely to cause sensitive skin to flare and all are great at helping increase the skin’s moisture content. I recommend that any moisturizer be applied while the skin is moist- typically within 15 minutes of showering or bathing. There are a few other options that I also recommend for very dry skin and these include Lac Hydrin and AmLactin. Both have lactic acid in them and they are great for the arms and legs but you should avoid using them if your skin is red and inflamed.

Medications are another source of itchy skin. Many medicines can cause itching either by causing hives, creating a drug reaction or simply as an ongoing side effect. Ones that should be noted include the various drugs used to lower cholesterol. As so insightfully pointed out by my colleague and friend , Dr Mary Lupo, when doctors give people drugs to lower their cholesterol they are depriving the skin of one of the main ingredients required to maintain its barrier. Whether it is Lipitor or any of the other drugs used for this purpose, the dryness associated with their use will require some additional skincare to help with the itching. Any of the products mentioned in the preceding paragraph will help and one other (Sarna) can also be a great help in this situation.

Sensitivity to various chemicals including dyes, fragrances and formaldehyde can also cause the skin to itch. Unfortunately, carving out a world devoid of these chemicals can be a challenge. I have posted a sheet to help people do this on my website (www.palmbeachcosmetic.com) and you are welcome to try some of the suggestions or bring it to your dermatologist for comment. In general, switching to Tide Free or All Free can help avoid the fragrances or dyes that are common problems. Avoiding Nutrasweet and tomato sauce (rich in fragrance and dye) can also help. Formaldehyde and formalin are two related compounds that are notorious for making the skin itch and they are found in many everyday products. Since they are also carcinogens, it is good to avoid them.

Itching can also be a sign of an underlying medical issue. Thyroid disease will frequently manifest itself in this manner. Malignancies such as lymphomas, pancreatic cancer and others can rarely present to the doctor as an itch that wont go away. Typically, however, it is combined with other symptoms such as weight loss or night sweats and the combination of these should prompt further questions by your doctor.

Atopic dermatitis (eczema) is a frequent cause of itching and it can be associated with asthma and hay fever. Typically, there is a family history of this and there may be other manifestations in the skin which can include extra lines under the eyelid and on the hands. Commonly eczema affects the insides of the elbows, the backs of the knees and the sides of the neck. Treatments for eczema vary but usually include a topical steroid and moisturizers that are bland. Occasionally, oral antihistamines may be used and in some of my patients I use other drugs such as Singulair or oral steroids to help control the symptoms. Recently, there has been a surge of infections with Staph (including MRSA) in people with eczema and when this occurs it needs to be promptly treated with appropriate antibiotics. Bathing with a teaspoon of bleach may help to control the bacteria on the skin and this is suggested for people that get repeated infections.

Itching skin can be one of the most debilitating conditions that present to my office. I usually try to figure out why the skin is itching and frequently the solutions are obvious. However, when they are not I will try to find out if there is some other reason for the itch.

If you have an itch, it is important to discuss the causes and potential treatments with your dermatologist and to spend more time taking care of your skin. Frequently, there are a few changes that you can make that will result in a significant improvement in your skin.

View/Download
Eczema Treatment Instructions Form (pdf) 



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Dry Skincare Form. (pdf)