The itch-scratch cycle

Keep the nails short if you're prone to scratching.
Keep the nails short if you’re prone to scratching.

Have you ever noticed that the more you scratch, the more a spot itches?  That in turn leads you to scratch even more, and thus you get the vicious itch-scratch cycle.

This vicious itch-scratch cycle also makes eczema worse.  While you might think sheer will could interrupt this cycle, that is actually a very tall order.  For any of you who have eczema, or have had a bad bug bite, you know what I mean.

So what can you do about it?

– Treat the itch. Work with your doctor to find the right combination of prescription and non-prescription methods to treat the itch.  These may include topical medications and pills too.

– Create a barrier.  Wraps over an offending area can create a barrier.  Similarly, gloves over the fingers can help.

– Decrease the trauma of your scratching by keeping your fingernails short. This will also help keep your nails from cutting open your skin, which can increase the likelihood of an infection.

What other methods have worked for you?

The kidney and your skin

Image from wikipedia user Sanjayach

The skin has been described as a window into internal disease. You can’t see your internal organs with your naked eye but the skin is available for examination.

The skin can reflect disease in virtually every organ system of your body. Kidney disease can be reflected on the skin in many ways. Here are some of the presentations of kidney disease on the skin:

1. Itch (pruritus) – Individuals with chronic kidney failure often experience itching. The itching can be quite difficult to treat and can affect all the skin. I’ve had patients tell me that it feels like the itch is coming from “deep within.” The itch can lead to scratching which leads to further itching, etc. (the itch-scratch cycle)

2. Dry skin (xerosis) – The skin can become dry and scaly and lead to itch in and of itself. Liberal use of moisturizers can help.

3. Dark, yellowing or pale skin – Kidney disease can be associated with darkening (hyperpigmentation) of the skin, yellowing of the skin (thought to be from carotenoids), or pale skin from low blood counts.

4. Nail changes – Lindsay’s half and half nails are described in patients with renal failure — the far half of the nail is pink or reddish while the half of the nail closer to the cuticle is white.

Other conditions such as calciphylaxis, perforating diseases (“perforating disorder of renal disease”) or calcinosis cutis are also related to kidney disease.

Scabies: the mite that burrows into your skin

Image of the scabies mite under the microscope. Courtesy of Wikimedia user Kalumet.

Yes, mites can live in your skin and make you itch! In the case of the scabies mite (Sarcoptes scabiei), it makes you itch by burrowing into your skin, laying eggs, replicating, and pooping. Your body recognizes all this foreign material and releases compounds that lead to itch.

How do you get scabies? Well, you can get scabies through close proximity to someone else that has scabies. Risk of transmission is most significant with close contact (e.g. bed mates, etc.) Mites and eggs can stay alive and still be infectious for 1-2 days off of the skin (e.g. on clothing, linens, etc.).

Most people only have 10 or less mites on their body. Scratching causes some of the mites to fall off. Some folks who aren’t able to scratch and keep the number of mites in check end up with hundreds of scabies mites! Yikes! That’s a condition called crusted scabies or “Norwegian scabies.” The term Norwegian scabies has fallen out of favor since Norwegians aren’t more likely to get scabies to the best of my knowledge.

What should you do if you think you have scabies? Go see your doctor and let him/her know you’re concerned about scabies. Your doctor may scrape part of your skin to look for mites or their eggs or feces.

What does scabies look like? Scabies infestation can present as itchy bumps, water bubbles or burrows. Common areas include the web spaces between the fingers, the wrists, belly button, genital area, under the breasts, and armpits.

How is scabies treated? There are creams and also pills that treat scabies. Depending on your specific case, your doctor may prescribe one of these medications or both. Close contact should be examined and treated as well. Clothing and linen should be washed in hot water and dried on high heat (or alternatively, stored in an air tight container for more than 3 days). Your doctor can also recommend medications to help with the itch.

Oh Mosquito!

We caught a bit of a break weatherwise up here in the Northeast today. It’s October and we hit a high in the high 70s! (I know this is not big news to those of you who have nice weather year-round but I have to take what I can get!) Anyways, I thought it was time for a t-shirt and shorts and a nice walk through the park with a friend. We stopped down to sit down at a bench under the trees and 30 minutes later… yes, we both had that feeling that we’d been bitten. Shucks. Turns out that the mosquitos are still out and about.

Now, if I weren’t so gung-ho about making a point of wearing a t-shirt and shorts in October in Boston, I would have worn a long sleeved shirt and pants to cover up exposed skin. Sitting in the shady area underneath of the trees and by the grass probably didn’t help either. I don’t normally carry bug spray either, but some DEET containing bug repellant would have been helpful.

We’ll see where exactly these bug bites crop up over the next day or so…  I’ll be juggling between cold compresses, Sarna and trying not to scratch the heck out of the bites!