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Skin care: treatment of itching SKIN CARE: TREATMENT OF ITCHING
The treatment of an itch will take two general forms. Firstly, it is essential to treat the cause, whether it is curable or only controllable. Secondly, the itch itself should be relieved so that further skin damage does not occur, and the individual may remain sane.
Specific measures of treatment include adequate explanation of what is wrong and what is proposed to be done, 80 that the patient is involved with, and understands the aim of, the treatment.
Physical restraints, particularly with children, are most helpful as a means of preventing scratching and further skin damage. This may involve, for example, splinting of the arms; thick wrapping of the worst affected areas, or the wearing of boxing gloves to bed.
Cooling of the worst affected areas or of the whole body has a fairly specific anti-itch effect. This may be achieved by cold compresses, tar baths, and the avoidance of hot showers, electric blankets and excessive clothing. Simple applications such as calamine lotion, with menthol or phenol, also give relief due to their chilling action. The avoidance of hot drinks and alcohol can be most helpful.
Various common proprietary preparations may have a nonspecific soothing action on an itch. These include calamine lotion, zinc cream, tar creams and antihistamine creams. The latter should be completely avoided, as should local anaesthetic creams, because of their strong capacity to sensitize the skin and cause a contact dermatitis. Similarly, provocative influences such as friction from rough clothing should be avoided.
Topical corticosteroids (cortisone creams or ointments) These are very effective in diminishing the itch associated with certain conditions. This is probably due to their non-specific anti-inflammatory action. Some conditions, however, such as hives or drug allergies, are unresponsive. On the other hand, if they are used for treating an itch—condition which is itself responsive to corticosteroids, then both the primary disorder and the associated itch will settle. On rare occasions oral corticosteroids may be required, not for the itch itself, but to suppress the underlying disorder causing an itch.
Anti-histomines. These specifically antagonize histamine, one of the known chemical causes of itching. Unfortunately they also have a sedative affect, which is enhanced by alcohol. There are currently about 20 antihistamines available, and there is unfortunately very little evidence from which to make a rational choice between them. They do, however, fall into several different structural or chemical groups. This is useful to know, as individuals will vary in the way they respond to various anti-histamines.
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