SEP 15, 2014 12:00 AM PDT

Current Treatment of Chronic Itch Just Scratches the Surface

WRITTEN BY: Peter Micheli
Itch, scratch, itch scratch. It can be a vicious cycle. Everyone's been bothered by some form of itch, but we usually know it's temporary. It could be a short-lived annoyance like a mosquito bite, or it may be something an over-the-counter cortisone cream can take care of. Even if it's poison ivy, we know it will eventually clear up. But, what if we are constantly tormented by an itch that won't go away? Chronic itch (pruritus) can have a dramatic impact on its sufferers' quality of life, much like chronic pain can. A big problem caused by chronic itch is how it can interfere with sleep, keeping those with it up all night and significantly impacting their mood and functioning during the day. But, chronic itch does not get the same kind of attention or respect as chronic pain does.

Chronic itch can have many different causes including inflammatory skin diseases, metabolic diseases, liver and kidney diseases or lymphoproliferative and myeloproliferative disorder. It can even be based on psychiatric reasons. Diagnostic procedures can include physical examination, blood work, biopsies and imaging. A main goal in the treatment of itch is to break the itch-scratch cycle. Therapies can include topical or systemic treatments.

Dr. Gil Yosipovitch is a leading researcher in the field of itch and co-author of the book, "Living With Itch: A Patient's Guide." He was recently interviewed on NPR where he discussed his efforts to have the problem of chronic itch taken more seriously and to have more effort focused more on the search for a cure. He is trying to get itch recognized as a separate area of specialization, much as chronic pain is, and for it to be treated regardless if the underlying cause cannot be immediately addressed, much like relieving pain is approached.

He says, "It's interesting. I think there are two aspects to it. Yes, there is a component of pain, but there is also - and that's unique, I think, to itch - is that there is a component of pleasure and scratching an itch. We find it relieving, but there is something in addition. Our studies and other groups' may suggest there is a - also a brain mechanism involved in the pleasure of scratching an itch and they are involving in this repetitive behavior, so it's a bit addictive to start scratching. And when a doctor tells a patient, stop scratching, it's easy to say that, but in fact, it's not easy to do because it really liberates -the scratching - some chemicals. Chemicals like opoids, like morphine-like. In fact, a lot of the patients say the only way to relieve her itch for couple of hours is significant scratching." Yosipovitch thinks an ideal treatment for itch would be something that mimics the relief in the brain that scratching provides, without damaging the skin, possibly some kind of pill that acts neurochemically.

Although it might not be proven scientifically, Yosipovitch sees overlap between people with chronic pain and those with chronic itch. So, someone with fibromyalgia or irritable bowel syndrome may
also complain of chronic itch, the common denominator being hypersensitization of the nerve fibers where the nerves are "acting wacky; they're just firing all over." And like with some of these diseases, patients may not be taken seriously unless there are visible signs of the problem, such as a rash. Sometimes, though, the causes of itch may be neurologically based, but many neurologists may not be interested in treating itching sensations. Yosipovitch goes on to say, "I would say that, I think one of the purposes of putting itch as a focus of my work is to raise awareness among other specialties, that they have to address this topic, including my colleagues in neurology, including other experts, even pain experts; that they have to understand that sometimes patients have both pain and itch, like, post Shingles. And they sometimes would dismiss the patient - say, oh, well if you have an itch, I'm not bothered with it; we just want to deal with the pain. But, I see that as part of the same spectrum."
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