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What does medical science know about pruritus?

- Itching can be localized (limited to one area of the body) or generalized (in which itching occurs all over the body or in several different areas). Generalized itch, for obvious reasons, is more difficult to treat. Itch receptors are unmyelinated, unspecialized free nerve endings, found near to the dermal-epidermal junction. It was widely believed in the past that pain and itch are transmitted by the same nerve pathway, and also low intensity stimulation of unmyelinated polymodal C fibre results in itch sensation whereas high intensity stimulation causes pain. However, in recent experiments, two populations of fibres have been identified when single unmyelinated C fibres are stimulated, a majority which respond by causing pain sensation and a small minority stimulation of which causes itch. Itch-transmitting, polymodal, unmyelinated C fibre enter the dorsal horn of the gray matter of the cord, synapse there with secondary neurons which cross over to the contralateral spinothalamic tract and ascend to the thalamus. There, tertiary neurons relay the sensation of itch to the level of consciousness in the cortex.

Psychoneurophysiological aspects of itching are complex and poorly understood. The involvement of large, fast-conducting myelinated sensory fibres in modulation of the discharge of the unmyelinated itch- or pain-transmitting fibres presynaptically is generally acknowledged. However, the more recent discovery of enkephalins has complicated the picture. These opioid pentapeptides (including leu-enkephalin and met-enkephalin, which are extensively distributed in the peripheral and central nervous system, are capable of stimulating the opioid receptors in the central nervous system) exert a regulatory action on pain and itch traffic through the central nervous system. Stimulation of these receptors down regulate pain but may up-regulate itch.

How is generalized itching treated? For persistent or severe itching, see your health care provider for a precise diagnosis and specific treatment instructions. In the meantime, you can take some steps to help deal with the itch:

• Avoid scratching or rubbing the itchy areas. Keep fingernails short to avoid skin damage from scratching. Family members or friends may be able to help by calling attention to your scratching.
• Wear cool, light, loose bedclothes. Avoid wearing rough clothing, particularly wool, over an itchy area.
• Take lukewarm baths using little soap and rinsing thoroughly. Try a skin-soothing oatmeal or cornstarch bath.
• Apply a soothing lotion after bathing to soften and cool the skin.
• Use moisturizer on the skin, particularly in the dry winter months. Dry skin is a common cause of itching.
• Apply cold compresses to an itchy area.
• Avoid prolonged exposure to excessive heat and humidity.
• Try over-the-counter oral antihistamines such as diphenhydramine (Benadryl), but be aware of possible side effects such as drowsiness.
• Try over-the-counter hydrocortisone cream on localized itchy areas.
• Try Assuage Perianal spray

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