A tickle of hairs, threads or an insect on the skin, a light tension due to dry skin or even the idea of itching in a sleepless night almost automatically triggers scratching. The rather harmless irritations with physical or physiological cause accompany us at every turn. It is an interesting fact though that these irritations are transmitted like a signal to others if people talk about it or if somebody watches someone scratching. It might be an archaic reaction to ward off parasites like lice, mites and fleas etc.
The problem starts if the skin develops itchy wheals (urticaria) due to external influences. The contact with the hairs of nettles causes itching and soreness due to the transferred biogenic amines histamine and serotonin together with formic acid and acetylcholine. Similar reactions can be observed after the contact with jellyfish in the sea. The natural histamine of the body is released after insect bites, parasite infestation and allergic reactions of the skin to foreign substances. Orally absorbed substances may cause pins and needles (pruritus) all over the body. Pharmaceutical agents but also food starting from spices and herbs up to red wine may belong to these substances depending on the sensitivity of the individual person. Chickenpox, shingles and other infects will result in itching pustules and get on the nerves of the individuals concerned. Sometimes it is personal stress that tempts people to a nervous scratching behind the ears similar to the constant reach for a cigarette.
If cosmetic products cause itching on the skin it is frequently a question of irritating ingredients as e.g. tensides which have degreasing effects on the skin and therefore cause dry skin after the shower. Beyond that, allergic reactions to essential oils, extracts and preservatives should be mentioned.
Skin problems as e.g. inflammatory acne, neurodermatitis and psoriasis as well as barrier disorders, cornification disorders, sunburns and reactions of the skin to the own perspiration are widely spread. Accompanying symptom is itching, especially on those areas where the skin appearance has deviated from its normal condition. Reactions are intensified by inappropriate clothing or cosmetics whereas inappropriate in this context rather means not appropriate to the particular needs instead of poor quality.
Identify the triggers
Besides the well-founded and precise skin analysis it takes a good deal of common sense and observation to identify the individual causes. Frequently it is also a mental problem. The more the individuals affected concentrate on their itching problems the more their nerves play tricks on them. They belong to the most difficult customers of beauty institutes and are in need for rather sensitive and convincing consultation. Most of the times they already went through a diagnostic odyssey and have tried innumerable products. On top of it, every once in a while spontaneous irritations and reactions to beauty treatments or products may occur in the daily practice routine which means that the cosmetician is well advised to get as much information as possible to this subject in order to be prepared for such cases. On the other hand however it can be assumed that after their successful treatment the customers who were affected by itching may then be counted among the best advertisers. Even if cosmetics can only support the treatment, the potentials of the adjuvant corneotherapy and preventive care should not be underestimated.
With the exception of mentally triggered cases, itching always is a sign for a very sensitive skin and a disturbed skin barrier. That is why the treatment is focused on a healthy skin barrier. Following this concept the local irritations occurring with comedones (acne), neurodermatitis (infections due to scratching) and psoriasis (hyperactive skin) are treated with the appropriate and preventively active agents.
Permanently dry and tense skin also pertains to the barrier disorders. In this case the natural moisturizing factor of the skin (NMF) needs to be supplemented with the amino acids of creams with high lipid content which are free of emulsifiers, perfumes and preservatives. Additional relief on a long term base may be achieved by reducing the cleansing and bathing frequency and the use of non-foaming cleansing substances. In order to avoid a counterproductive swelling of the skin it is recommended to reduce the water temperature as well as the bathing and showering time to a minimum. Very hard water and low humidity are quite a problem whereas humidity levels can be elevated by lowering the room temperatures in the winter season. Quite frequently also the impact of clothing is overlooked: light, non-chafing and comfortable clothing may have very positive effects not only during the day but also during the night. It may even be an alternative to sleep without the pajama.
Itchy fungal infections of the skin on feet and in the pubic region are mostly due to excessive personal hygiene, a permanently moist micro climate or increased perspiration. The same applies for fungal infection on the scalp which can be diagnosed by the scales it causes. As fungi even can perforate the skin barrier it is important to continue with a long-term recovery-focused and profound skin care after the treatment with antibiotics. Appropriate products here are barrier creams with skin-like structure containing D-panthenol as well as the vitamins A, C and E. The strategy of a comprehensive care focused on the recovery of the skin has also proved successful for the treatment of fresh and itchy scars.
Atopic (neurodermitic) skin already is a rather advanced barrier disorder. Besides the caring substances to restore the skin barrier the lipid enriched creams may contain anti-inflammatory agents like evening primrose oil, linseed oil and boswellia resin extracts. The advantage of these agents is that they provide the skin with lipid substances with the effect that non-physiological paraffin oils can be avoided. Urea reduces the itching. A specific sensitivity to emulsions is identified by temporary soreness after their application and in this case it is recommended to select water free oleogels which are also an alternative for the juvenile skin.
A mixture of barrier cream, evening primrose nanoparticles and urea already gives relief within minutes after painful mosquito bites.
Psoriasis-prone skin can be treated in the same way although the lipid content of the creams should be adapted to the individual skin condition. Complementary to the above mentioned skin care are liposomal lotions containing fumaric acid to be applied after the cleansing. Actually, they are fat-free products. Adequate preparations for the atopic skin are lotions with barrier substances.
Anti-inflammatory agents are helpful against acne. In case of greasy skin it is recommended to avoid creams at all and just apply the pure active agents. While the skin is recovering from inflammations and efflorescences also the itching will stop and above all the urge for scratching. The cornification disorder as the root of the disease can be treated with linoleic acid provided that it is combined with a carrier substance like native phosphatidylcholine. Helpful in this case also is salicylic acid which has keratolytic and anti-pruritic effects.
Irritative contact dermatitis as e.g. diaper dermatitis develops after the skin has been constantly irritated by external substances mostly in connection with a watery environment. If the individual immune system responds to this condition allergic contact dermatitis will develop. The recovery of the intact skin barrier has first priority also in these cases. Astringent substances like tea products or hamamelis extract are helpful in those areas where the skin starts to crack.
Temporary skin rashes will last for some hours only and can be found on forearms and legs after the skin was exposed to cold temperature. They are accompanied by severe itching and reddish wheals the size of a pinhead. Although they are rather unpleasant they will not require any cosmetic treatment. Protection by a long-sleeved shirt or sweater will be adequate in this case. On the other hand, increased skin temperature may also intensify latent itching. A traditional home remedy can be recommended here, i.e. hot and cold showers as a means to have the skin accustomed to temperature changes. Topically applied capsaicin (chilies) results in severe itching that will last for hours, paracress (anti wrinkle agent) leads to light tickling that lasts for some minutes and after this effect the treated skin areas will be completely insensitive.
Tickling and itching around the eye area can be attributed to intolerance to contact lenses, hay fever (pollen) or a deficit of lachrymal fluid which is also known as dry eye syndrome and can be treated with a spray of phosphatidylcholine-containing liposomes and hyaluronic acid to be applied on the closed eye lid.
And last but not least intestinal parasites may cause a very unpleasant itching in the anal area. On the other hand, perianal barrier disorders frequently are a consequence of excessive hygiene. The itching involved may even turn into pain if long-term pressure is exerted. Barrier creams will help in this case.
As a matter of principle the treatment procedures should be reduced to a minimum in order to avoid additional irritation of the skin. Abrasive treatments (peelings or micro dermabrasion) on individuals sensitive to itching should also be limited to a minimum. Besides examining the nutritional habits also metabolic disorders in liver and thyroid glands as well as kidney damages and diabetes should be considered in order to find the causes for the individual sensitivity.
Dr. Hans Lautenschläger