published Monday, March 17th, 2014

The big itch: Dermatologist thinks itching should be studied as a disease, not just a symptom

Photo illustration for the story, "The Big Itch."
Photo illustration for the story, "The Big Itch."
Photo by Doug Strickland.

Got an itch?

Go ahead. Scratch.

"I never tell patients to stop scratching as this sometimes is the only means patients have to relieve their itch," says Dr. Gil Yosipovitch, chairman of the Department of Dermatology at Temple University School of Medicine and the director of the Temple Itch Center, which he founded in Philadelphia, Pa.

But "scratch away" isn't his only prescription.

"I often urge patients to attempt to distract themselves by using relaxation techniques," Yosipovitch says.

While it may feel wonderful, scratching doesn't offer long-term relief from chronic itching which, by doctor standards, is any itching that lasts for more than six weeks. A recent German study suggests that, for 17 percent of adults, itch is not just an annoyance, but a life-altering situation that can be caused not only by skin disorders but also by kidney and liver disease, diabetes, lymphoma, HIV and nerve damage.

Because the various mechanisms of itching are not well understand, he says it should be studied and treated as a disease instead of a symptom of a disease. "This is a rather new concept that we are spearheading," says Yosipovitch about research at Temple Itch Center.

Chronic itching -- called "pruritis" by doctors -- reduces the quality of life and "is as debilitating as chronic pain," Yosipovitch said in a 2013 article that he and Dr. Jeffrey D. Bernhald wrote for the New England Journal of Medicine.

"Deranged sleep patterns and mood disturbances, including anxiety and depression, are common and may exacerbate the itching," they wrote.

Former Chattanoogan Vicki Altman, now of Dahlonega, Ga., suffers from chronic itching due to hives, rashes, pollen, dander and latex. She says the over-the-counter ointment "After Bite" is her go-to relief. On the occasions it doesn't work, she says she must get a steroid shot.

Bruce Underwood, of Chickamauga, Ga., says CeraVe lotion helps keep his itching under control, while Lisa Gyure, of Hixson, says the prescription medication Atarax (hydroxyzine) works best for her.

"(It) should be able to knock any itching out," she says. "It is the strongest antihistamine available."

Yosipovitch says medications and ointments will help some itching and notes that new ones are being developed. But his belief in holistic treatments such as relaxation techniques is based on the fact that, in some cases, itch is truly all in the mind. Damaged nerve fibers cause the brain to misinterpret signals as itch and, when relief cannot be found, depression and anxiety can kick in.

Yosipovitch says new concepts take time to be adopted and his idea of itch-as-disease is still in the building-support phase and, "hopefully, more dermatologists will come to embrace this concept."

"Similarly, when the pain field was developed around 40 years ago, the concept before was that pain is just a symptom of multiple diseases," he says.

"One of the major missions of the Temple Itch Center is to raise awareness among physicians (not just dermatologists), as well as patients and families about the importance of diagnosing and managing chronic itch and to disseminate knowledge in this field," says Yosipovitch, who co-authored the book "Living with Itch: A Patient's Guide" with Shawn G. Kwatra.

Attempts to get response from several local dermatologists to Yosipovitch's premise of itch-as-disease fell flat. Of the dermatologists contacted, only one responded.

"Many times, people just have itching but we can't figure out what causes it," says Dr. Cara Hennings, a Chattanooga dermatologist. "It can be intractable and incapacitating. Itch has also been shown to be worse than pain, and it is hard to treat.

"I definitely think that more research needs to be done on itching and more treatments need to be available for people with chronic itch."

Because pain follows the same routes as itch, scientists have long debated the connection between the two sensations. At first, the two were believed to use totally different sets of nerve fibers; then that changed to the belief that they share nerves and that itch is simply a weaker form of pain.

But in 1997, German researchers discovered nerve fibers that transmit only itch. More recently, nerves have been identified that can transmit itch or pain.

And, because the two are linked so mysteriously, researchers also have learned that inhibiting pain may trigger itch.

"When people take pain medications, such as morphine, pain is relieved but people can start to itch," "Living with Itch" says.

Suzanne West of Signal Mountain says she suffers from itching as a result of allergies.

"If I take my allergy meds, I usually have no itching, but if I go without my meds for a couple of days, I have scratched myself until bleeding," she says. "I immediately take Zyrtec and Benadryl and, usually within a half hour, I am much better, although sometimes the itching has gotten so bad I have to jump in the shower with scalding hot water to help take away the itch."

Researchers have long known that painful stimulation can relieve itch, and it's the basis of many itch therapies -- very hot or cold shower, and capsaicin, the compound that makes peppers hot.

She also applies a topical ointment to help relieve itching.

Unfortunately for her and others, Knoxville and Chattanooga are high-ranking cities in Tennessee for allergies, reports livestrong.com.

"I never had a problem until we moved here from Miami (in 1985)," West says. "I have been told by my allergist that, if I lived in a different climate, my allergies would not be nearly as bad as they are here. ... About six years ago, I broke out in a full body rash, and that is why I now have an allergist and take meds every day. The full-body rashes and itching happens to me about five times a year. When the pollen count and mold count is high, I rarely leave the house."

In an interview last month with the New York Times, Yosipovitch said help is in sight for people suffering from itch.

"This is just the beginning of a big era," he says. "In the next five years I predict there will be drugs targeted specifically for itch. We're in the middle of the tip of an iceberg."

McClatchy-Tribune News Service contributed to this report.

Contact Karen Nazor Hill at khill@timesfreepress.com or 423-757-6396.

about Karen Nazor Hill...

Feature writer Karen Nazor Hill covers fashion, design, home and gardening, pets, entertainment, human interest features and more. She also is an occasional news reporter and the Town Talk columnist. She previously worked for the Catholic newspaper Tennessee Register and was a reporter at the Chattanooga Free Press from 1985 to 1999, when the newspaper merged with the Chattanooga Times. She won a Society of Professional Journalists Golden Press third-place award in feature writing for ...

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