Stop! – Don’t scratch that itch.

“That unbearable itch… I can’t take it any longer! I have to give in… I have to scratch!” Sound familiar? Well, itchy skin disorders are among the most agonizing experiences we can experience. In fact we scratch our itches purely to create a sensation of pain, which actually trumps the itch, albeit temporarily. The aftermath of scratching does have its consequences, some of which are quite bad indeed.

Everybody loves a good back scratch from time to time. This sure-to-create a purr-like-a-cat sound from our loved ones is usually totally fine. It feels good and no real damage is probably done, and in fact it probably helps create intimacy by meeting some primal grooming need that we all share.

Scratching becomes bad when the act starts to have a negative impact on our skin by either aggravating an already existing disorder, like eczema and psoriasis, or actually creating a new problem, like lichen simplex. There comes a point when the scratching to overcome an itch has to stop.

Some skin conditions like the various forms of eczema and dermatitis, psoriasis, and urticaria can be extremely itchy. This sensation can literally drive people crazy! People may actually scratch so deep that they start to bleed, which is where one of the problems lie. The deeper the scratch, the greater the chance of a scar. Once the deeper aspects of the skin, called the dermis, is broken, the creation of a scar is usually unavoidable. Many times these scars are permanent, being visible long after ones skin problem has cleared up.

Continued scratching also makes the skin rough and dry, becoming thick like leather. This is a patient induced problem termed lichenifaction, and obviously complicates the original skin problem.

Another issue is that scratching can spread bacteria, giving rise to an infection. We can really see this when a yellow crusting appears over top of the rash. This is usually the tell tale sign of  staphylococcus aureus, otherwise known as the “golden staph”. Our bodies also have a tendency to react, in a sort of allergic way, to these types of infections by making the eczema spread rampantly throughout the whole body. I myself have seen patient’s  small, singular, dime sized sores become widespread after scratching, an event dermatologists call auto-sensitization.

Many people scratch as a coping mechanism for stress and nervousness. They actually scratch so much, in one particular area like the nape of the neck, side of the forearm and lower backside, that a rash is created. This rash then becomes itchy of its accord, thus creating a viscous cycle of scratch – itch – scratch. This condition is known as neurodermatitis, or lichen simplex.

So how do we avoid creating all the above problems of scarring, infection, lichenifaction and the development of new problems? Simple, stop scratching! I know, I know, this is certainly easier said than done, but it is in fact crucial for a proper outcome. Some methods that can be useful for you to gain control over the itch are as follows:

• Mindfulness. Learn how to become aware of your actions, so as to empower the ability to make clearer choices. This can greatly help the reactionary jump to unconsciously scratch ourselves to death.
• Whenever one feels the urge to scratch, apply some type of lotion or ointment that can help clear the itch away. Of course this should be something that will not create its own set of extra problems, like the steroidal creams may do. I make a few different lotions and/or soaks for my patients using Chinese herbal medicines that are know to subside itch and lessen inflammation. Some of these contain peppermint oil, which has been shown to have remarkable anti-itch properties when used properly.
• Exercising regularly can help lower stress, which in turn can help lessen the need to scratch.
• Limit the amount of overly stimulating foods that you consume like alcohol, coffee and too much onions and garlic, as they may aggravate the skin.
• Moisturizing regularly and appropriately when your skin is dry, as dryness leads to itchiness and actual rashes, like that of asteatotic eczema.
• Wear softer and more natural materials close to your skin. This could include cotton, silk and bamboo. These materials breath better, so as to not trap pathogens against your skin, and are less irritating so as to not induce itchiness.

Of course  stubborn skin issues like eczema, psoriasis, lichen plans, lichen simplex, and prurigo may need special attention other than just external fixes. These may need internal medicines, preferably herbal and preferably prepared by someone experienced in treating the skin. While the avoidance of scratching goes a long way in protecting the skin, as well as preventing problems from worsening, many skin issues have roots inside the body and thus need appropriate internal treatment in order to achieve lasting long term benefit.

Wishing you health,
Dr. Trevor Erikson