Skin deep, or deeper? – Dealing with itch

Volume 6 Issue 1 January 2016

Consultation Liaison Psychiatry Focus: ‘Dermatology’

Itchy skin is a problem that most of us have to deal with at some point in our lives. Apart from being socially embarrassing and troublesome, at times it can be a clue to the discovery of certain underlying medical problems. Of course, every itch is not something to scratch the brain about; most itches are harmless and tend to go away on their own. A lot of skin diseases tend to be itchy – fungal infections, infestations by certain mites, allergic disorders, and various types of dermatitis and so on.

However, if one feels itchy all over and can’t see anything on it that looks particularly abnormal, then the first step is to look more closely. If one finds that the skin is dull and flaky, then the patient might be suffering from dry skin or ‘xerosis’ which is the most common cause of generalized itching. If the skin is not dry, there is no particular skin disease and the patient is still scratching away, then other conditions have to be looked into. A variety of medical conditions can cause itching including liver disease, kidney disease, thyroid problems, diabetes, anemia, certain neurological and psychiatric diseases and very rarely, certain kinds of cancers. Interestingly, one non-‘medical’ condition exclusive to women that can cause itching is pregnancy.

Another point to note is that anxiety and depression can worsen itching due to any other cause, it is important to elicit whether the patient has been worrying a lot or experiencing mood changes. If anxiety and depression are contributing to the itch, then it needs to be addressed appropriately which may result in decrement of the itch. Itch may increase during periods of stress and may result in scratching. Scratching offers temporary relief, but reinforces the cycle of itch and scratch, which leads to lower threshold of scratching in periods of stress.

Comprehensive evaluation with thorough history and examination is important to address these cases. There is some role of psychotropics like tricyclic antidepressants (eg. amitriptyline), and anxiolytics (eg. clonazepam, etizolam etc.) along with psychotherapeutic and behavioral techniques to address chronic itch.