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  Itching

Itching comes from the Latin word meaning “pruritus”, a medical term which is an intense, distracting irritation or tickling sensation that may be felt all over the skin’s surface, or confined to just one area. It is often a distressing symptom that can cause discomfort to the person. Itching leads most people to scratching and this cause breaks in the skin that may result to secondary infection especially for immunocompromised persons. Tolerance to different amounts of itching varies in different individuals and the threshold for tolerance can be changed due to stress, emotions and other factors.

Itching Skin diseases
Itching


The main mechanism why itching occurs is due to the release of histamine from mast cells in the skin. Histamine is the chemical mediator that causes the itch, redness, increase warmth and swelling of the area. It binds to local nerve endings on specific receptors. As with pain, the spinothalamic tract is where a histamine-induced itch travels, but in fibers specific for itch.

Common causes for itching can be:
• Skin conditions (psoriasis, eczema, sunburn, atopic dermatitis, chickenpox, derma titis herpetiformis, tinea (fungal) infections, urticaria or hives, lichen planus, lichen simplex chronicus). Most are of these are inflammatory in nature.
• Insect bites (from mosquitos or chiggers) .
• Allergic reactions to contact with specific chemicals also known as contact dermatitis (e.g. Urushiol from Poison Ivy or Poison Oak).
• Scabies or infection with lice or worms (hookworm larvae).
• Allergy to medications ( e.g. aspirin, codeine)
• Photodermatitis (sunlight reacts with chemicals in the skin, leading to formation of irritant metabolites)

Generalized itchiness that occurs all over the body may indicate a medical condition such as diabetes mellitus, liver disease, kidney failure, jaundice (high concentrations of bilirubin is a skin irritant), thyroid disorders and rarely cancer. Blood disorders such as leukemia, polycythemia (causes increase histamine release), lymphatic conditions such as Hodgkin’s disease may sometimes cause itching as well. On the other hand, generalized itching can also be caused by something as trivial as bathing too often. Too much hygienic such as frequent bathing may remove the natural oils and may make the skin too dry and scaly. Localized itching occurs in some persons who comes in contact with detergents, wool or other rough-textured, scratchy material. Adults with hemorrhoids, anal fissure or persistent diarrhea may notice itching around the anus called “pruritus ani”. If this happens in children it is most likely due to worms. “Pruritus vulvae” which is intense itchiness in the external genitalia in women may be due to candidiasis, hormonal changes, use of certain spermicides or vaginal suppositories, ointments, or deodorants. In cold weather, younger people may also notice dry, itchy skin. In pregnancy, pruritus is likewise a common complaint.

A complete medical history and physical examination will help diagnose properly the underlying problem of itching. Helpful diagnostic tests are stool and a variety of blood examinations.

Specific treatment of itching depends on its etiology. In general, itchy skin should be treated gently. Antipruritic agents or antihistamines are the first line of drugs for itching. An example is diphenhydramine (Benadryl), most of these antihistamines also passes the blood-brain barrier hence, make people sleepy. Ice or cold compress or any cooling or soothing lotion can be applied to the affected area to avoid the urge to scratch. Often, itching can intensify itching and even cause further damage to the skin leading to an endless cycle of itch—scratch—more itching. Topical corticosteroids may help reduce the inflammation. Most cases of itching go away when the underlying cause is treated successfully.

The most common cause of itching probably is dry skin. There are a number of simple things a person can do to ease the annoying itch:
• Don't wear tight clothes
• Avoid synthetic fabrics
• Don't take long baths
• Wash the area in lukewarm water with a little baking soda
• For generalized itching, take a lukewarm shower
• Try a lukewarm oatmeal (or Aveeno) bath for generalized itching
• Apply bath oil or lotion (without added colors or scents) right after bathing.

Patients who tend toward itchy skin can avoid it by:
• Avoiding daily bath
• Use only lukewarm water when bathing
• Use only gentle soap
• Pat dry, not rub dry, after bathing, leaving a bit of water on the skin
• Apply a moisture-holding ointment or cream after the bath
• Use a humidifier in the home.

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