Itch is not a disease. Yet it is a symptom of many diseases. It can be so unbearable and devastating; tormenting one’s life, day and night causing eczema, sleep deprivation, stress, anxiety etc.
Itch is irritating and often overwhelmingly, ‘unbearable’ to the sufferers. Invariably one would scratch on the itchy skin. The scratching is highly pleasurable. However, scratching aggravates itchiness. The more one scratches, the itchier it becomes. The itchier it becomes, the more one would scratch.
Look! This is a vicious cycle: Itch causes scratching. Scratching causes itch. They go round and round in a circle and never come out. If you are caught in this vicious itch-scratch cycle, it is too bad. The itching and scratching can only continue and get worse. It is like a screw, screwing deeper and deeper – and never coming out.
We can stop doing things that we do once or twice. However, if we do something pleasurable repeatedly many times, it gets ingrained in our subconscious mind. In other words, habituation occurs.
If we scratch many times in many days, scratching will become a habit, just like cigarette smoking, gambling, drinking alcohol or taking ecstatic drugs. The pleasurable kick-back of such habitual behaviour hooks us on. We become addicted and can call ourselves scratching addicts!
Once addicted, the itching and scratching continues, often over a long time – 10, 20, or more years until one is lucky enough to meet a skin doctor who is skilled in behavioural therapy. Itching and scratching present symptoms of many skin diseases like eczema, insect bites, fungal infection, pemphigoid, etc.
However, there is one particular condition that deserves special emphasis here, in the interest of health education, is dryness or what we doctors called xerosis.
The common causes of dryness are often self-induced. Many people do the wrong things over and over again, due to their sheer lack of knowledge and understanding of their own skin. However, ignorance does not exempt one from suffering.
When we are older, our skin tends to itch more. Older skin is drier. More and more of the ‘oil factories’ of our skin shut down as we age. The oil secreted by our skin’s oily glands helps to prevent excessive water loss from our skin surface. The lack of it leads to skin dehydration. Our skin becomes too dry and fragile like a dry piece of biscuit. Dry skin is brittle. It cracks and flakes easily. The skin becomes scaly and the underlying nerves get irritated as the dry skin flakes. Thus, dry skin itches. And it often itches a lot.
When the skin’s ‘oil factories’ shut down, there is no oil on our skin. Due to that, the dust and scales on our skin are not greased on to our skin surface. Thus, they are easily washed off with only water. Water easily showers them off with no soap or bath lotion. Soap and bath lotion contain sodium lauryl sulfate (SLS), a surface tension reducing agent that lathers to break up sticky greasy oil.
Thus, soap and bath lotion are strong degreasing agents. Their main function is to remove excessive oil from our skin that holds the dust and scales tenaciously to our skin. Together they are rubbed off as detritus after degreasing with SLS during a bath. Too frequent bathing or showering with excessive soaping is bad for the dry skin of an elderly person.
The little protective oil produced by the depleting and insufficient oil glands of the elderly should not be overzealously washed off. Sadly, the Asian saying of “no soap, not clean” remains a strong belief among many of our elderly folks with dry skin. Bathing with warm or hot water adds further insult to dry skin.
It is hard to wash off oil on a cold dish plate with cold water. Washing it with warm or hot water is the answer. Warm or hot water also has a strong degreasing function. Yet many of our elderly folks with dry flaky skin continue to bathe and shower with warm or hot water plus plenty of soap or bath lotion. They often spend long hours soaking themselves in their bathtub full of lathering hot water.
What are they doing? Surely they will come out, itching and scratching all over, and then presenting themselves to their doctor with scratch marks all over.
Hot baths are soothing to aching muscles and joints that is almost universal among our elderly folks. Thus, they like it so much and many are often addicted to it to the extent that they find it hard not to continue indulging in it.
However, the irritating problem of dry itchy skin is not just confined to our elderly folks. I am seeing an increasing number of young children with the same problem. Children like to play with soap bubbles. They enjoy a hot lather bath as much as the elderly. Left alone in the bathroom, they often spend long hours playing with soap bubbles in a bathtub of warm water. I have often heard parents complaining, “My kids often finish my whole bottle of bath lotion in one bath”.
Children need to be educated too, to avoid over soaping themselves in hot water. Itch in children is even more difficult to manage as they are often not as disciplined in controlling themselves against the self-indulgent pleasure of scratching. They are often not mature enough to comprehend the cause and effect of the problem.
Scratching is injurious and traumatic to the skin. The injury ranges from micro pin-point breaks of controlled scratching to deep excoriations due to compulsive aggressive scratching. Our skin responds by opening up fine blood vessels to supply the injured areas with plenty of white blood cells to defend it against infection by microorganisms and to institute the repairing process. Thus, the affected areas become red, warm, thickened and itchy that continue to worsen with chronic persistent habitual scratching.
Tablets, creams and injections alone are often insufficient to overcome the problem. Such sufferers require some form of counselling or behavioural therapy. Truly, the art of healing often goes beyond the use of creams, pills and needles.
My next column will be: Skin ageing – ‘The sun and clock’.
Dr. Victor Ti, MD, MFAM (Malaysia), FRACGP (Australia), Dip P Dermatology (UK), Dip STDs/AIDS (Thailand), Dip. AARAM (USA), LCP of Aesthetic Med.(Malaysia) is an experienced expat specialist generalist (Family Physician) of BH Clinic, Phnom Penh. As a specialist generalist, he is skillful at diagnosing all general diseases and excluding the sinister ones. Apart from the general diseases, Dr. Victor is also known for his skills in skin diseases, sexually transmitted diseases, minor surgery and aesthetic medicine. He can be contacted via messenger m.me/bhclinic1, Tel: 023900446 or Whatsapp: +60164122977