Itching cause not always skin deep

Dr. Peggy Spencer
Daily Lobo Columnist

Dear Dr. Peg,

For the past couple of years, I’ve had a problem with itching. I use hypoallergenic detergents and soaps and am not allergic to any common clothing fibers. I use a lot of (hypoallergenic) body lotion in case dry skin is the problem. Yet, I still get incredibly itchy, usually in the evening, for no reason at all. There is no rash of any kind, just this itch. It’s usually on the backs of my legs or the insides of my arms.

Benadryl sometimes helps relieve it, but normally I just end up scratching a lot, which is starting to concern my roommates. I’ve been in to see someone about it several times, but every time I’ve been told that, without a rash, diagnosis isn’t possible, so it’s probably “just a psychosomatic response to stress.” Is it really a stress-related issue? Or is there something else going on that’s being missed?
-Itchy

Dear Itchy,
It always bugs me when I see “just” and “stress” in the same sentence. That minimizes the importance of a major force. Sure, it could be stress. You are in college, after all. Isn’t stress your middle name? Stress can cause lots of wild and wondrous effects in the student body, from itching to insomnia, back pain to bronchitis.

I never discount the stress factor. On the other hand, I don’t jump to that conclusion, either. There are lots of other causes for itching, and all of those should be explored before attributing the prickle in your skin to the pressures of life.
There are three basic kinds of factors that can cause the skin to itch: internal factors, the skin itself and external factors.
Internal factors Stress would be one of these.

This is partly related to the body’s release of histamine, a chemical also involved in the allergic response. Released whenever you’re exposed to allergy-inducing substances, like pollen, animal dander, food or medicine, this substance circulates throughout the body. It causes itching and hives on the skin in addition to the usual sneezing and stuffiness of seasonal allergies.

Since you are usually itchy in the evening, you might look at your home environment for a possible trigger. Does your roommate use an extra-strong perfume? Could your cleaning solution vapors be an inhaled culprit, or perhaps your favorite evening study blanket or snack?
On rare occasion, itching can be a sign of a more serious internal problem like liver disease, so if all else fails, see your doctor.
External factors Your skin, the largest official organ in your body, is your primary defense — your first contact with the outside world. Anything that assaults your perimeter can damage the skin, and often the damage results in itching. Merely brushing up against a poison oak plant or a thistle blossom can raise a welt or worse. I had a patient once who squatted in the dark to pee while backpacking and couldn’t see that the leaves tickling her were poison ivy. That skin reaction is called contact dermatitis, and can be quite excruciating as I’m sure you can imagine.

Soaps, shampoos, creams, lotions and other skin care products might not mix well with your particular skin. For some people, it’s metals like nickel in jewelry or watch bands. You’re smart to consider hypoallergenic products, but even those might raise a response. Some people have more sensitive skin than others. Experimentation with different products might yield an answer.

Biting invaders are another potential external problem. These include mosquitoes, fleas, gnats, scabies, bedbugs, no-see-ems and pinworms, to name a ferocious few. Biters usually leave visible traces, like red bumps or rashes. Same goes for infectious agents like fungi and bacteria. Fungal infections like jock itch or athlete’s foot, and bacterial infections like folliculitis (infection of hair follicles) can be seen as well as uncomfortably felt.

The skin itself
Are you from here?
If you came from somewhere like Georgia, where there is actually some moisture in the air, you will have noticed that the air in New Mexico is dry. Dry air wants moisture, and it will suck the moisture right out of your skin. Dry skin is itchy skin. Even if you are a native New Mexican, the low humidity will get to you, especially in the winter time, when building heaters dry out the indoor air even more.
Sun exposure at any time of year can further dry out the skin, and sunburn itself can itch.

You can hydrate your skin from the inside out or the outside in. Drink plenty of fluids all year round, at least six glasses a day and more if you exercise. Water is preferable. Consider buying a humidifier. Breathing moisturized air will minimize loss of body moisture from your lungs and will also help keep your nasal passages clear. Run the humidifier in a bedroom with closed doors 24-7 for best effect.
To moisturize from the outside in, first of all take advantage of your body’s natural oils. Long, hot, scrubbing showers will strip the natural lubricants off of your skin, as will soap. I’m not suggesting you never bathe, but try taking shorter showers, in warm or tepid water, and using mild soap only when and where you really need it.

While you’re still wet, apply a moisturizer to your damp skin. Dermatologists usually recommend those thick creams that come in tubs, or you can use oils like almond oil or baby oil. Some dermatologists even suggest Vaseline, which acts as a sealant, preventing moisture loss from your surface. Pat dry.

If you need additional moisturizing, add lotion to your dry skin. Don’t forget the sunscreen factor if you’re going to be out for an extended period.

Diseases of the skin like psoriasis and seborrhea can cause itching. These usually require prescription creams.
You don’t have to have a rash to have an itch, as you are clearly aware, but itching alone begets more itching. If you itch, try not to scratch. Itching is a complicated response that involves the skin, the nerves, the spinal cord and the brain.

Pain will inhibit the itch response, as you know if you have ever slapped a mosquito bite. So will cold temperature and some anti-itch creams. Antihistamine pills, like the Benadryl you take, can also decrease your symptoms, but often make you drowsy, a side effect many students can’t afford.

My grandmother used to recommend a cool bath with oatmeal or baking soda in it. Your grandmother probably has her own effective home remedy.
I hope this has been helpful, but if your skin is still crawling, please call Student Health and Counseling at 277-3136 or come in and see us. We’re across from the SUB. We even have skin specialists here once a week.
Don’t suffer in silence!

Peggy Spencer, MD is a family physician. She has been a UNM student health physician for 17 years. Drop your questions in her box in the lobby of Student Health and Counseling, or e-mail her directly at pspencer@unm.edu. All questions will be considered, and all questioners will remain anonymous. This column has general health information only and cannot replace a visit to a health care provider.