When your skin itches, do you just scratch it?

We are all familiar with itchy skin.

We all have experienced itching to varying degrees throughout our lives.

What exactly causes this disease?

Is it serious?

How to deal with it in daily life to relieve it?

These are certainly issues that we are particularly concerned about.

Clinically, many skin diseases can cause itching, with many types and complex causes:

1 Allergic diseases: such as urticaria, dermatitis, eczema, and drug allergies; 2 Skin infections: such as tinea pedis, tinea corporis, and scabies; 3 Neuropsychiatric factors: such as neurodermatitis and prurigo; 4 Visceral diseases: such as diabetes, hypothyroidism, hyperthyroidism, hepatobiliary diseases, renal insufficiency, and tumors; 5 Other conditions: dry weather, high temperature, etc.

Here we only talk about senile skin pruritus.

Clinically, itching without primary skin damage is called pruritus. It is a neuropsychiatric skin disease, the main cause of which is dry skin. It is a skin neurosis. The sebum membrane secreted by sebaceous glands on the human body surface, together with the various protective functions of the skin, becomes the first barrier of the human body against the outside world.

Senile pruritus is caused by multiple diseases rather than a specific disease. Senile pruritus is the result of complex interactions of multiple systems, and its pathogenesis includes changes in sex hormone levels, "inflammatory aging" of the immune system, skin bacterial infection and changes in dominant flora, peripheral and central nervous system diseases, metabolic abnormalities caused by chronic diseases, adverse reactions to long-term medication, and the synergistic effects of negative emotions.

It is difficult to describe the degree of pruritus. The medical description of pruritus and the specific grading standards are shown in Table 1.

Knowing the causes and pathogenesis of senile pruritus, how can we take care of and treat it in our daily life? It is not a simple scratch.

#01Daily Care Moisturizer

Choose appropriate moisturizing products to repair and protect the skin barrier, restore the pH value of the skin to a weakly acidic state, reduce skin sensitivity, and apply them all over the body once in the morning and evening to effectively improve or relieve itching.

Due to their different living backgrounds and education levels, elderly patients have received very little exposure to skin care concepts and have no concept of skin care.

In view of the pathophysiological changes in the skin of the elderly, the importance of elderly skin care should be strengthened, and skin barrier protectants should be used long-term throughout the treatment process.

Cold Environment

A cold environment can reduce blood vessel dilation, reduce perspiration that irritates the skin, and calm the skin.

In the hot summer, you can do some outdoor activities in the morning and evening. When the outdoor temperature is too high, try to do some indoor activities.

In winter, keep the room temperature at 22-24℃ when heating indoors. Use humidifiers or plant flowers to maintain indoor humidity to reduce the evaporation of skin moisture.

When the itching is severe, it may even break the skin. You can use cold compresses or ice compresses to relieve the itching and calm the skin to prevent the itching from getting worse.

Avoid all kinds of stimulation

Try to choose pure cotton products and avoid wearing woolen and chemical fiber products;

Avoid washing with hot water, salt water or soap which may irritate the skin.

In autumn and winter, the elderly should not take a bath too often. They can take a bath two to three times a week. They should not take a bath in too hot water or scrub their bodies hard with towels or soap. Excessive force will wash away the lipid film on the surface of the skin, making the skin drier and inducing or aggravating itching.

Keep your mind relaxed

The elderly can do appropriate exercise, leisure and entertainment to relax their minds, reduce mood swings, and have an optimistic and positive attitude.

Blocking the itch-scratch cycle

Strengthen publicity on behavioral changes and inform elderly patients to reduce scratching as much as possible, as it will aggravate the damage of the skin barrier and aggravate the scratch-itch cycle.

Daily Diet

Traditional Chinese medicine emphasizes that "medicine and food have the same origin", believing that Chinese medicine and food have the same origin. Food ingredients can both treat diseases and be used as food. Like medicine, they have the characteristics of "four properties and five flavors".

For example, patients with diabetic skin itching can regulate blood sugar by controlling their diet; eat a light diet, avoid spicy and irritating foods such as alcohol, chili peppers, hot pot, etc., eat more vegetables and fruits rich in vitamin C, and keep bowel movements smooth.

In addition, you should eat appropriate amounts of foods that nourish the yin, moisten the lungs and strengthen the spleen, such as lily, white fungus, papaya, red dates, black fungus, etc. High-fat foods also need to be consumed in moderation, as the vitamin A and vitamin E in them can prevent and treat dry skin and aging.

In autumn and winter, the elderly should drink enough water to replenish moisture and moisturize the skin.

#02 Treatment options

There is currently no unified treatment standard for pruritus in the elderly, but it is clear that the treatment of pruritus, while eliminating the cause, suppresses the itch by strengthening skin barrier repair, regulating immune system function and neural pathways.

01 Topical medication

In case of inflammatory skin lesions, short-term topical glucocorticoid preparations can be used. Adverse reactions include glucocorticoid dependence, skin atrophy, increased sensitivity, capillary dilation, etc., or topical calcineurin inhibitors, such as tacrolimus ointment, can be used. In addition, traditional Chinese medicine topical preparations such as dehumidifying and antipruritic ointments, although the efficacy is not better than glucocorticoid preparations, are safer.

02 Systemic medication

Commonly used antihistamines, such as the second-generation antihistamine cetirizine and the first-generation antihistamine chlorpheniramine, can be used orally in severe cases. Cyclosporine and thalidomide can be used with caution. During use, the doctor's instructions should be followed and the dosage should not be adjusted without authorization to aggravate adverse reactions.

With the advent of the era of biological therapy, treatments with targeted drugs such as dupilumab and small molecule drugs such as JAK inhibitors have also been reported, but their high prices and potential risks have limited their clinical use;

Antiepileptic drugs, such as gabapentin and pregabalin, are nerve pathway blocking drugs that mainly exert their nerve blocking effects by regulating calcium channels and inhibiting glutamate synthesis;

Other drugs such as the antidepressant drug troserine and the chemoradiotherapy antiemetic drug ondansetron can be used to treat elderly patients with pruritus, but their clinical applications are relatively rare.

03 Physical therapy

Ultraviolet light therapy can be used 2 to 3 times a week. Light therapy is easy to tolerate and has few adverse reactions and drug interactions. During the treatment, pay attention to wearing protective glasses, covering the external genitalia, adjusting the irradiation dose according to the patient's treatment response, avoiding scratching, and avoiding light-sensitive foods. Other physical therapies include transcutaneous electrical nerve stimulation.

04 Traditional Chinese Medicine

Based on the theory of qi, blood and collateral disease in traditional Chinese medicine, the treatment concept of "unblocking collaterals" is used to generate yang qi, regulate the collaterals and nourish the skin. TCM syndrome differentiation and treatment combines multiple treatment plans, mainly taking Chinese medicine decoctions or external treatments, such as external washing, bathing, fumigation, pricking, cupping, acupoint injection, etc.

For pruritus in the elderly, don't just scratch it and think it will go away.

On the premise of excluding pathological and physiological diseases, basic nursing work should be done conscientiously, such as building a house and laying the foundation, skin care, moisturizing and repairing the skin barrier are the basis; cooperate with appropriate medical treatment methods to relieve itching, or even cure itching, improve the quality of life of elderly patients, and spend a happy old age.

References:

Wang Hongwei, Zhang Jiechen. Expert consensus on diagnosis and treatment of pruritus in the elderly[J]. Chinese Journal of Dermatology and Venereology, 2018, 32(11): 1233-1237. DOI: 10.13735/j.cjdv.1001-7089.201808168.

Environmental and Occupational Dermatology Group of the Dermatology and Venereology Committee of the Chinese Association of Integrated Traditional Chinese and Western Medicine. Expert consensus on the use of antihistamines in dermatology[J]. Chinese Journal of Dermatology, 2017, 50(6): 393-396.

Author: Pu Xinlu, Department of Dermatology, Chongming Hospital, Shanghai Health and Medical College

Reviewer: Zhang Guolong, Director of the Photomedicine Department of Shanghai Dermatology Hospital, Deputy Secretary-General of the Dermatology Rehabilitation Committee of the Chinese Rehabilitation Medicine Association

Editor: Jia Jing, Illustration: Li Chuan (Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine)