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Itching (Pruritus)

About 330 years ago, the physician Samuel Hafenreffer said that itching was 'an unpleasant feeling that provokes scratching'. Up to now there has been no better definition. The technical term for it is 'pruritus', from the Latin word 'prurire' meaning burning.

Although itching is a very agonising skin sensation, appearing with many skin diseases, only little is known about the mechanisms causing it. The skin contains so-called receptors (this can best be translated by 'perception points') for different sensations like pain, cold, warmth or pressure.

For a long time the parts responsible for the sensation of pain have been thought to be those causing itching, with pain and itching being two varieties of the same sensory perception. But one great difference is that itching can only be triggered in the skin.

In the meantime, latest scientific findings have pointed out that perhaps there are independent nerves for itching, but not all communicating substances and their interplay are known. The phenomenon of the starting of itching has not yet been solved.

Normally itching is answered by scratching or rubbing. This is followed by inflammatory reactions of the skin, which causes the distribution of histamine (a so-called transmitter) and other substances increasing inflammation, and the consisting itching is intensified.

Causes of itching

What ever the sensational points may look like, in any case a stimulus (mechanical or chemical) has to be produced on them. Mostly an inflammation of the skin causes the itching. The transmitters of the inflammation cells, especially histamine, produce the itching by stimulating the sensational points. The stimulus is first lead to the spinal cord by nerve fibres and then to the cerebrum where it is perceived as itching.

The itching mechanism can be triggered by:

  • all kinds of skin inflammation
  • medicine and food
  • environmental allergens (e.g. pollen of flowers and grass)
  • immune- or allergy substances (antibodies, lymphocytes)
  • substances from insects and parasites
  • contact substances (allergens like dyeing, perfume, scents)
  • persistent skin damages (desiccation, sun burn)
  • metabolic products from internal diseases
  • Stress (works as an intensification)

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Itching in EB

Itching can be seen in many varieties of EB. People with EBS Dowling-Meara are especially afflicted, but it can also present a huge problem with a junctional or dystrophic form.

The main reasons for pruritus in EB patients are probably dry skin, healing or crusted wounds, inflammations and persisting skin damage caused by the constant wound healing.

Some people with EB say that itching starts usually at the same time as the healing process. In this case, itching is thought to be triggered by two factors: Firstly, in EB skin there is always a situation similar to a light inflammation (not caused by bacteria). Inflammation accompanies the healing process. Secondly, there is often dryness in the wounds causing a slight contraction of the lip of the wound. Both inflammation and dryness could be reasons for itching during the healing process.

In any case, one should always take other triggers into account when the itching period gets long. Anaemia caused by iron deficiency can also be a reason for itching in EB, and other possibilities should also be considered, because EB does not exclude the occurrence of other diseases.

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What can be done against itching?

Depending on the presumed reasons for the itching, we recommend different approaches: skin care treatments, medication or behaviouristic measures.

General precautions

  • Drink enough! (against desiccation)
  • Don't overheat rooms, moisten the air
  • Don't use desiccating remedies like gels, alcohol-based ointments, powder
  • Thrifty use of soaps
  • Don't bathe too long and not too hot, take a cold shower after it (if possible) as the pores close and keep the moisture in the skin
  • Moist, cooling poultice with NaCl or black tea (black tea should be left for about 15 minutes and chilled, it contains tanning agents that soothe itching)
  • Airy clothes made of non-irritable materials such as cotton and silk (e.g. Dermasilk)
  • Bed-linen made of cooling materials (e.g. Microair)

Local therapy

Skin care products (examples):

  • Excipial U Lipolotio®
  • Excipial Crème®
  • Excipial Fettcreme®
  • Eucerin Lotio 10% Urea®
  • Eucerin Spezialcreme®
  • Excipial Hydrocreme®
  • Excipial Lipocreme®
  • Excipial Liposalbe®
  • Excipial U - Hydrolotio®
  • ECR Creme® (Golden Dolphin)
  • NutrientCreme® (dline)
  • LipoLotion® (dline)
  • HydroLotion® (dline)
  • BasicLotion® (dline)
  • ZincCreme® (dline)
  • Harnstoff (Urea) Eucerin 10%
  • Balneum Hermal F®
  • Balneum Hermal plus®
  • Balmandol Ölbad®
  • Eucerin Ölbad®
  • Nutrient Plus® (dline)

Drug Therapy

  • Short-term steroid therapy is often very effective
  • Antihistaminic pills, juices, drops
    This type of medicine also stops inflammation; it helps against itching in two ways: by stopping the activity of histamine as well as the inflammation process. Some of them can tire you out, so they are better used in the evening. Examples:
    - Loratadin (Clarityn®, Loratyn®
    - Cetirizin (Zyrtec®, also obtainable as a generic)
    - Desloratadin (Aerius®)
    - Diphenhydramin (Dibondrin®, in the evening)
  • Hydroxyzin (Atarax®)
    Also makes you tired; use it in the evening. Strictly speaking, this is a tranquilliser, but does not make you addicted and can also be given to children.

Behaviouristic Measures

To break the cyrcle of itching – scratching – more itching – more scratching:

  • don't scratch but press or rub the skin
  • don't scratch immediately but wait (the itching might end)
  • scratch an object instead of the skin
  • cut your fingernails short
  • eventually wear cotton gloves at night
  • learn methods to relax (autogenous training, progressive muscle relaxation by Jacobsen, Yoga etc.)

In addition to that there are many other substances, especially ointments, lotions and bathing additives. Some of these mixtures (mostly recommended by relatives or mixed by pharmacists) are a sensible complement to the lists given above.

Itching often grows worse in the evening. It may help to develop going-to-bed rituals to start the night quietly and relaxed.

Last but not least, one should always come forward when the skin itches. It
might not be easy to find a satisfying solution for the problem, and you may have to face setbacks but, with patience and confidence, an improvement is often possible.

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Source of information:

Anja Diem, MD, EB House Austria, Salzburg

We have no commercial interest in promoting specific products. These have all proved to be useful and well-accepted in the treatment of people with EB.

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