These days, you can feel the crisp and cool autumn weather. However, there are unwelcome unwelcome guests in this autumn. That’s ‘itchiness’. The more dry air, the more frequent complaints of itching.
Itching (pruritus) is a very common symptom that causes the urge to scratch or rub the skin. It is easy to think of itching lightly, but for those who actually experience it, it is a severe pain. It can also be exacerbated by stimuli commonly occurring in daily life, such as light touch, temperature changes, and mental stress. Chronic itch for more than 6 weeks is often associated with various skin diseases, systemic diseases, anxiety, obsessive-compulsive disorder, and aging.
Representative skin diseases that cause chronic itching include dry skin, atopic dermatitis, psoriasis, urticaria, contact dermatitis, lichen planus, prurigo nodosa, scabies, insect bites, and athlete’s foot. Systemic diseases include chronic kidney disease, chronic liver disease, cholestasis, diabetes, hyperthyroidism and hypothyroidism, solid cancer, leukemia, lymphoma, polycythemia vera, anemia, and acquired immunodeficiency.
Also, neurological causes such as multiple sclerosis, brachial radius itch, paresthesia back neuralgia, and herpes zoster may cause itching. A variety of psychological causes, including obsessive-compulsive disorder, can also cause itching. Even in the absence of these diseases, as aging progresses, skin dryness and skin acidity (pH) changes due to deterioration of the skin barrier, Th2 (T helper cell 2)-mediated inflammatory response due to aging of the immune system, and tactile cells (Merkel cells) As a result, itching may appear.
In most cases, there is itching all over the body, but there are cases where only a specific area is itchy. Itching tends to worsen mainly at night, in warm environments, and under conditions of stress and anxiety. In addition, stimuli that cause itching are recognized by the skin and are recognized by the brain through neurotransmission pathways, and the brain sometimes interprets these sensations as burning or stinging sensations. Chronic scratching or rubbing may cause lichenification, which makes the skin hard and thick, and psoriasis nodosa, which thickens in the form of papules or nodules.
Kim Hye-seong, a professor of dermatology at the Catholic University of Korea Incheon St. Mary’s Hospital, said, “Itch may precede blood cancer or solid cancer, but itchiness does not necessarily mean there is cancer. In fact, most itch patients are not cancer, but aging, allergic tendencies, kidney or liver disease, and systemic diseases or skin diseases such as diabetes. This is because the parasympathetic nervous system is excited and I am completely focused on myself.”
Treatment for itching may vary depending on the cause. Therefore, it is important to find the cause through a detailed history taking, checking drug history, physical examination, and various tests. To identify the cause of the skin disease, KOH smear test, scabies test, and skin biopsy can be performed. In particular, if you have severe itching, stay as a patient caregiver in a nursing home, or work as a caregiver, you must be tested for scabies.
If there is no skin disease accompanied by blood tests, kidney, liver, thyroid, and anemia levels are checked, diabetes through urine test, chest X-ray test, hepatitis and syphilis, HIV (human immunodeficiency virus) antibody test, etc. enforce In addition, if necessary, screening tests are performed to differentiate malignant diseases. In addition, it is important to identify neurological and psychological factors.
For treatment, it is important to combine treatment to eliminate the cause of itching and relieve symptoms. Antihistamines are widely used drugs to control itching, but unfortunately, the effects of antihistamines are limited in chronic itch patients. Therefore, chronic pruritus patients have been taking a lot of immunomodulators such as cyclosporine, gabapentin and amitriptyline, which regulate the neurotransmission system.
Recently, there have been studies showing that the biologic agents Dupilumab and Omalizumab are helpful in suppressing itching associated with atopic dermatitis or chronic urticaria, and Janus kinase (JAK) inhibitors that can regulate several inflammatory mechanisms was found to have a significant effect on itching.
As topical topical agents, steroids and calcineurin inhibitors can relieve itching by suppressing the inflammatory response, and local anesthetics, capsaicin creams and patches may also help. In addition, calamine lotion, menthol lotion, and Intrinsic Ivy Gel, which relieve itching through a cooling effect that cools the skin, are effectively used for chronic itching patients. Phototherapy can also be safely tried to treat itch by reducing the inflammatory response and reducing nerve activity.
However, these various systemic and topical treatments may have different effects depending on the cause and pattern of itching. Therefore, it is important to receive individualized treatment for each patient through consultation with a dermatologist.
Kim Hye-seong, a professor of dermatology at the Catholic University of Korea Incheon St. Mary’s Hospital, said, “In the case of an antihistamine prescribed primarily for itchiness, there may be symptoms such as drowsiness, drowsiness, dry mouth and bitterness, but in the case of a new drug, there are no such side effects. The focus should be on controlling the symptoms, and with proper treatment, you can live comfortably without itching. The prognosis for pruritus is much better if it is treated in an early stage, so it is recommended to consult a dermatologist for appropriate treatment.”
Itching can be exacerbated by high temperatures, so it is recommended to wear thin, light clothing and cool the skin. Avoid jewelry or tight-fitting clothing, and avoid exposure to irritating fabrics such as wool. Also, since the act of scratching itself worsens the itching, it is better to place a cold towel on it or rub it with your palm rather than scratching. Keeping your nails short and wearing gloves while sleeping may help. Avoid taking a long bath or rubbing the skin for a long time because itching worsens when the skin is dry, and apply a moisturizer regularly and frequently. Tension and anxiety are also exacerbating factors for itchiness, so it is recommended to get enough sleep and minimize smoking and alcohol.
Tip. Itching self-diagnosis list
– Itching persists for more than 6 weeks.
– Not getting enough sleep due to itching.
– Daily life is inconvenient due to itching that does not resolve even when scratched.
– Thickening of the skin at the scratched area or nodules.
– Even if you apply a sufficient amount of moisturizer, the itchiness does not improve.
– The skin is fine, but the itching is severe.
– Symptoms such as itching, weight loss, dizziness, fatigue, severe thirst, and jaundice.
– Families or people living with you also complain of severe itching.
(If these symptoms appear, diagnosis and treatment of the cause of the itch is necessary.)
<도움말 : 김혜성 가톨릭대학교 인천성모병원 피부과 교수>
