Kenneth Beer, M.D. is a board-certified dermatologist and dermatopathologist in Palm Beach, Fla., and the director of scientificskin.com, an online skincare company. He is also the director of The Cosmetic Bootcamp, which trains physicians in best practices for cosmetic medicine. Dr. Beer is an instructor in dermatology at the University of Miami, and he is an A.B. Duke Scholar at Duke University. He obtained his medical degree from the University of Pennsylvania School of Medicine, and received his dermatology and dermatophathology training at the University of Chicago. Visit Dr. Beer's office at palmbeachcosmetic.com.
 
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Stop That Nagging Itch

Monday, 02 Jul 2012 08:24 AM


Itchy skin can be maddening. It drives people to the dermatologist’s office and is responsible for billions of dollars of sales for over-the-counter creams and lotions. Common causes include eczema (atopic dermatitis), dry skin, and allergies.
For some people, simple modifications in the lotions they use or how they care for their skin will solve this vexing problem. For others, skin biopsies and prescription-strength medications will be needed.

The Trouble With Dry Skin
Overall, the most common reason that people itch is because their skin is dry. The skin is a dynamic organ and when it is exposed to a dry environment, it will give up moisture to the surrounding air. Typically, this happens in the dry winter months, but it can also happen at altitude or when the relative humidity is low.
Fortunately, this is easy to fix and by using mild soaps such as Cetaphil or Aquanil instead of the more drying soaps, and the skin will maintain its natural oils and feel better.
There are many moisturizers that can help restore the skin barrier and among the ones that I like are CeraVe, Vanicream, and Theraplex.
They won’t cause sensitive skin to flare and all help increase the skin’s moisture content. I recommend that any moisturizer be applied while the skin is moist – typically within 15 minutes of showering or bathing.
For very dry skin I recommend Lac-Hydrin and AmLactin. Both have lactic acid in them and they are great for the arms and legs, but you should avoid using them if your skin is red or inflamed.

Medicine Mayhem
Many medicines can cause itching either by causing hives, creating a drug reaction, or simply as an ongoing side effect. This is particularly true of the various drugs used to lower cholesterol.
As pointed out by my colleague and friend, Dr. Mary Lupo, when doctors give people drugs to lower their cholesterol they are depriving the skin of one of the main ingredients required to maintain its barrier.
Whether it is Lipitor or any of the other drugs used for this purpose, the dryness associated with their use will require some additional skincare to help with the itching. Any of the products I’ve mentioned will help, and Sarna Anti-Itch Lotion can also be a great aid in this situation.

When Chemicals Creep In
Sensitivity to various chemicals including dyes, fragrances, and formaldehyde can also cause the skin to itch. Unfortunately, carving out a world devoid of these chemicals can be a challenge.
In general, switching to Tide Free or All Free Clear detergents can help avoid the fragrances or dyes that are common problems. Avoiding NutraSweet and tomato sauce (rich in fragrance and dye) can also help.
Formaldehyde and formalin are two related compounds that are notorious for making the skin itch, and they are found in many everyday products. Since they are also carcinogens, it’s good to avoid them. For more tips on limiting exposure to chemicals, see the tip sheet on my Web site.

Medical Causes
Itching can also be a sign of an underlying medical issue. Thyroid disease will frequently manifest itself in this manner. Malignancies such as lymphomas, pancreatic cancer, and others rarely trigger an itch that won’t go away. Typically, however, it is combined with other symptoms such as weight loss or night sweats, and the combination of these should prompt further questions by your doctor.
Atopic dermatitis (eczema) is a frequent cause of itching and it can be associated with asthma and hay fever. Typically, there is a family history of this and there may be other signs, including extra lines under the eyelid and on the hands.
Commonly eczema affects the insides of the elbows, the backs of the knees and the sides of the neck. Treatments for eczema vary but usually include a topical steroid and moisturizers that are bland.
Occasionally, oral antihistamines may be used and in some of my patients I use other drugs such as Singulair or oral steroids to help control the symptoms. Recently, there has been a surge of infections with staph (including MRSA) in people with eczema and when this occurs it needs to be promptly treated with appropriate antibiotics.
Bathing with a teaspoon of bleach may help to control the bacteria on the skin and this is suggested for people who get repeated infections.

More Tips
1. Use body temperature or lukewarm water for bathing. Avoid taking long, hot baths. Daily bathing is recommended.
2. Use a small amount of super-fatted soap for cleansing. Remember to rinse the skin well. Recommended soaps include: Dove Body Wash and Cetaphil body wash.
3. After bathing, pat the skin dry with a soft towel. Do not briskly rub the skin.
4. You may apply an appropriate bland moisturizing ointment or cream like Vaseline Petroleum Jelly, Theraplex Clear, Aquaphor, Eucerin, Cetaphil, or CeraVe cream. This will work best if applied three to five minutes after the bath/shower while the skin is still damp.
5. If you have hard water in your area, a water softener may be beneficial.
6. Avoid fabrics that may irritate the skin (e.g. wool).
7. Avoid smoky environments.
8. Minimize amount of skin exposed when outside air is very cold and dry.

Itching skin can be one of the most debilitating conditions I see. If you have an itch, it is important to discuss the causes and potential treatments with your dermatologist and to spend more time taking care of your skin. Frequently, there are a few changes that you can make that will result in a significant improvement in your skin.

To learn more about Dr. Beer, visit www.idealskin.com and www.palmbeachcosmetic.com.




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Dr-Beer
Itchy skin can be maddening. It drives people to the dermatologist’s office and is responsible for billions of dollars of sales for over-the-counter creams and lotions. The good news is that for most itchy skin, you can make it stop with a few simple changes.
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Monday, 02 Jul 2012 08:24 AM
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