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The truth about itching

Understanding and Managing Skin Itching Itching, medically known as pruritus, is an uncomfortable sensation that prompts the desire to scratch. It is a common problem with a wide range of various potential causes, ranging from skin conditions to systemic diseases. In this article we are delving into the truth about itching, we will look into the mechanisms of itching, explore its causes, and provide insights into preventive and therapeutic strategies. The Mechanisms of Itching Itching is a complex process that involves the skin, nervous system, and brain. The sensation is primarily mediated by nerve fibers in the skin called C-fibers, which transmit signals to the spinal cord and then to the brain. Several mediators, including histamine, cytokines, and neuropeptides, play crucial roles in this process (1). Histamine, released by mast cells in response to certain stimuli such as allergens or irritants, binds to receptors on nerve endings, initiating the itch sensation. Cytokines and neuropeptides, released during inflammation or skin damage, can also stimulate itch receptors (2). Neuropathic itch occurs when there is damage to the nervous system itself, leading to persistent and sometimes intense itching. This type of itch is often seen in conditions like multiple sclerosis, shingles, or post-stroke syndromes (3). Common Causes of Itching The truth about itching, is that there are wide array of causes for itchy skin. We will now look into each one in detail. Dermatological Causes Dermatological causes refer to skin-related conditions or issues that result in symptoms like itching, redness, or irritation. These causes originate directly from the skin itself, rather than from internal diseases or neurological problems. Examples include eczema, psoriasis, dry skin (xerosis), and contact dermatitis. In simpler terms, it means the itch or problem is coming from the skin due to irritation, inflammation, or other skin disorders. Systemic Causes Systemic causes refer to conditions or diseases that affect the entire body (or multiple systems within the body) and can lead to symptoms like itching. Unlike dermatological causes, which originate from the skin, systemic causes are internal and often involve organs or bodily systems, such as the liver, kidneys, blood, or thyroid. In short, systemic causes are internal problems in the body that can trigger itching or other symptoms in the skin. Neurological and Psychogenic Causes The truth about itching is that it can also have neurological and psychogenic causes. These refer to conditions where itching is triggered by problems in the nervous system or psychological factors, rather than being caused by a skin issue or internal organ dysfunction. Neurological Causes These are itching problems related to the nervous system, where damage or dysfunction in the nerves themselves causes the sensation of itch. For example: Psychogenic Causes These are related to psychological factors, meaning that the itching is linked to mental health or emotional conditions: In short, neurological causes are related to nerve or brain issues, while psychogenic causes are linked to emotional or mental health factors. Prevention and Treatment of Itching Preventive Strategies The truth about treating itching, is that there are various ways to treat, manage or even prevent itching. Once you understand why you are itching (the underlying cause), it is easier to find the most appropriate treatment. Topical Treatments 1. Corticosteroids Pros: Cons: 2. Calcineurin Inhibitors (e.g., tacrolimus, pimecrolimus) Pros: Cons: 3. Antihistamines Pros: Cons: Systemic Treatments 1. Immunosuppressants (e.g., cyclosporine, methotrexate) Pros: Cons: 2. Biologics Pros: Cons: Summary of treatments Each treatment approach offers benefits and has its limitations. Topical treatments are often the first line of defense due to their convenience and targeted relief, while systemic treatments are reserved for more severe or persistent cases. Careful consideration of the patient’s condition, side effects, and long-term needs is essential when choosing the best therapy. Conclusion The truth about itching is that it is a multifaceted symptom that can significantly impact quality of life. Understanding the underlying mechanisms and identifying the root cause are crucial for effective management. Whether the itch is due to a dermatological condition, systemic disease, or neurological issue, there are various preventive and therapeutic strategies available. By maintaining skin hydration, avoiding known irritants, managing stress, and utilizing appropriate medical treatments, individuals can effectively manage and alleviate itching. References

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The Benefits of Shea Butter for Eczema

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Eczema is a common skin condition characterized by inflamed, itchy, and dry skin. Finding effective treatments can be challenging, but many people are turning to natural remedies like shea butter to help manage their symptoms. What is Shea Butter? Shea butter is a natural fat extracted from the nuts of the African shea tree. Known for its rich, creamy texture, it’s packed with vitamins and fatty acids that are beneficial for the skin. The unrefined, raw form of shea butter is particularly potent, as it retains the maximum concentration of nutrients. How Does Shea Butter Help with Eczema? Shea butter’s effectiveness for eczema lies in its anti-inflammatory, moisturizing, and skin barrier-enhancing properties: Using Shea Butter for Eczema To get the most benefit from shea butter, it’s important to use a high-quality, unrefined product. Our Eczema Skin Restoring Jelly is formulated with raw unrefined shea butter, ensuring that you receive all the natural goodness it has to offer. Here’s how to use it: Why Choose Our Eczema Skin Restoring Jelly? Our Eczema Skin Restoring Jelly isn’t just any shea butter product. It’s specifically designed for those struggling with eczema. By using raw, unrefined shea butter, we ensure that every application provides maximum nourishment. Unlike other products that may contain refined shea butter with reduced potency, our jelly delivers the full spectrum of shea butter’s benefits, helping you manage eczema naturally and effectively. References:

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Shea Butter

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What is Shea Butter? Evidence of the production of shea butter actually dates back to the 14th century! Shea butter is a fat extracted from the nut of the African shea tree. This tree (Vitellaria Paradoxa) is indigenous to West Africa. Another name for the tree is “karite tree” which originally means “tree of life”. Shea butter is also known as “women’s gold” because it provides employment and income to millions of women across the African continent. Shea butter is graded from A – E based on its level of refinement. The refining process removes the healing properties and its odd natural smell. What sets Shea Butter apart from other seed oils? Most seed oils are divided into two fractions; a saponifiable fraction and an unsaponifiable fraction. The saponifiable fraction contains most of the moisturizing properties (moisturizing fraction) while the unsaponifiable fraction contains most of the healing properties (healing fraction). Shea butter has an exceptionally large healing fraction (5% to 17% depending on region of harvest) compared to 1% or less in other seed oils. This fraction contains a large amount of nutrients, vitamins and phytonutrients essential for healing, allowing shea butter to be used as treatment for various skin conditions. What are the benefits of using shea butter? Shea butter is incredibly moisturizing due to its high fatty acid content. The structure of the butter allows it to melt at body temperature allowing easy application and quick absorption. Shea butter also acts as a “refatting” agent, which means it restores your skin’s natural oils. Shea butter is rich in Vitamin A which promotes cell growth and elasticity. A recent study has also shown that shea butter can inhibit the reproduction of keloid fibroblasts (scar overgrowth). Shea butter also has rich anti-inflammatory properties. Shea butter is rich in antioxidants and moisturizing properties, helping your skin generate new and healthy cells. Studies have also found UV protection properties within shea butter, also promoting tissue cell regeneration. The triterpenes found in shea butter has been shown to promote the production of collagen, the main structural protein in our bodies. Together with the promotion of cell regeneration and collagen production, shea butter reduces the appearance of wrinkles and fine lines. Shea butter is rich in Vitamin E which neutralizes free radicals that cause cellular damage. Shea butter contains cinnamic acid which provides some protection from harmful UV rays by absorbing and reflecting them. With an SPF of around 3 – 4, shea butter can be used as an addition to your normal sunscreen for a more synergistic solution. Acne is primarily caused by an imbalance of the natural oils in your skin, known as “sebum”. Shea butter helps to restore the natural balance of these oils. Shea butter is high in anti-inflammatory properties that help to soothe your skin. Studies have also shown that shea butter can reduce the reaction to skin irritants, and due to its quick absorption shea butter can bring relief to flare-ups. Shea butter is noncomedogenic, which means it doesn’t clog pores. There have been no documented cases of allergic reactions to the topical application of shea butter, even though shea is a tree nut. The anti-inflammatory properties also help to reduce the reaction to skin irritants. Why is shea butter so beneficial? Which of our products contain shea butter? Sources:

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Topical steroids (part 2 of 2)

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In this 2 part series we are investigating topical steroids, as well as topical steroid withdrawal. In our previous article, Part 1, we discussed what it is, how it works, in what forms it is available, what it is used for and how to use it. In this article, Part 2, we will discuss the dangers of overuse. TSW – Topical Steroid Withdrawal The term “topical steroid withdrawal” (also referred to as topical steroid addiction, steroid withdrawal syndrome or red skin syndrome) refers to a constellation of symptoms that may emerge in the days and weeks after a person stops the use of topical corticosteroids. Due to a lack of research and no clear diagnostic criteria, it’s not yet known what amount of steroid use causes TSW, how many people have the condition and what percentage of people using topical steroids may develop it. However, according to a systematic review of topical corticosteroid withdrawal published in the Journal of the American Academy of Dermatology and initiated by National Eczema Association (NEA): “TSW is more commonly seen in adult women who apply mid- or high potency topical corticosteroids to the face or genital region. The condition seems to be associated with more prolonged use of daily topical steroids, topical corticosteroids to more sensitive areas or use of topical steroids without tapering or periodic breaks.” The first description of the condition occurred in 1979. A systematic review (meta-analysis) in accordance with evidence-based medicine frameworks and current research standards for clinical decision-making was performed in 2016 and was republished with updates in 2020. What is topical corticosteroid withdrawal? Topical corticosteroid withdrawal refers to a rare adverse reaction relating to the use of a topical steroid after it has been discontinued. It can occur after prolonged, inappropriate, and/or frequent use/abuse of moderate- to high-potency topical corticosteroids. Most reports of side effects follow the prolonged use of an unnecessarily potent topical steroid for conditions not warranting such strong treatments. There are two distinct clinical presentations of topical steroid withdrawal: How does TSW develop? Topical steroid withdrawal, also known as red burning skin and steroid dermatitis, has been reported in people who apply topical steroids daily for 2 weeks or longer and then discontinue use. Symptoms affect the skin and include redness, a burning sensation, and itchiness, which may then be followed by peeling. It appears to be a specific adverse effect of topical corticosteroid use. People with atopic dermatitis are most at risk. First signs of over-use Topical steroid addiction (TSA) is characterised by uncontrollable, spreading dermatitis and worsening skin inflammation, which requires a stronger topical steroid to get the same result as the first prescription. This cycle is known as steroid addiction syndrome. When topical steroid medication is stopped, the skin experiences redness, burning, a deep and uncontrollable itch, scabs, hot skin, swelling, hives and/or oozing for a length of time. After the withdrawal period is over, the atopic dermatitis can cease or is less severe than it was before. Topical steroid addiction has also been reported in the male scrotum area. Other symptoms include nerve pain, insomnia, excessive sweating, anxiety, severe depression, fatigue, eye problems, and frequent infections. Signs include the following: Although it may even be prescribed for these conditions, a topical steroid can cause, aggravate or mask skin infections such as impetigo, tinea, herpes simplex, malassezia folliculitis and molluscum contagiosum. When used correctly, in appropriate doses and potency, for short periods of time, along with preventative treatment measures, topical steroids remains the first-line treatment for infected eczema. When is it dangerous Stinging frequently occurs when a topical steroid is first applied, due to underlying inflammation and broken skin. Contact allergy to the steroid molecule, preservative or vehicle is uncommon, but it may occur after the first application of the product or even after many years of regular or intermittent use. To prevent tachyphylaxis, a topical steroid is often prescribed to be used on a week on, week off routine. Some recommend using the topical steroid for 3 consecutive days on, followed by 4 consecutive days off. However, even with the break in use, long-term use of topical steroids can lead to secondary infection with fungus or bacteria (see tinea incognito), skin atrophy, telangiectasia (prominent blood vessels), skin bruising and fragility. More serious side effects Hypothalamic–pituitary–adrenal axis (HPA) suppression Cushing’s syndrome Ocular effects: Topical steroid drops are frequently used after eye surgery but can also raise intraocular pressure (IOP) and increase the risk of glaucoma, cataract, retinopathy as well as systemic adverse effects. Tachyphylaxis: The acute development of tolerance to the action of a drug after repeated doses. Significant tachyphylaxis can occur by day 4 of therapy. Recovery usually occurs after 3 to 4 days’ rest. This has led to therapies such as 3 days on, 4 days off; or one week on therapy, and one week off therapy. Other local adverse effects: These include facial hypertrichosis, folliculitis, miliaria, genital ulcers, and granuloma gluteale infantum. Long-term use has resulted in Norwegian scabies, Kaposi’s sarcoma, and other unusual dermatosis. What are the clinical features of topical corticosteroid withdrawal? One of the difficulties is determining whether the skin reaction observed is due to the stopping of topical corticosteroids, or is simply a worsening of the underlying skin disease for which the topical steroids had been prescribed. Complications of topical corticosteroid withdrawal Patients with red burning skin after topical corticosteroid withdrawal may be distressed by the intensity of itch, lack of sleep, and difficulty in treatment. They may also develop secondary infection. How is topical corticosteroid withdrawal diagnosed? The definition of topical corticosteroid withdrawal requires the following features to be present: Skin biopsy is generally unhelpful to distinguish from a flare of the underlying skin disorder as the histopathology overlaps. Patch testing may identify some cases of contact allergy to the topical agents being applied to the skin, eg topical corticosteroid or other topical medications, moisturisers, cosmetics. What is the treatment for topical corticosteroid withdrawal? There is no agreed treatment for topical corticosteroid withdrawal, apart from ceasing the topical corticosteroid. However whether this should be tapered or abrupt has not been determined. Japanese reports suggest there is minimal difference in the outcome, so the recommendation is immediate cessation. A tapering course of oral steroids is helpful, as the addiction appears to relate only to the use of topical corticosteroids. Oral tetracyclines and low-dose isotretinoin have been used in steroid rosacea and perioral/periorificial dermatitis. Supportive measures such as cold compresses and psychological support are often recommended. Prevention or treatment of secondary infection may require oral antibiotics. Our Eczema Skin Restoring Cream

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Topical steroids (part 1 of 2)

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In this 2 part series we are investigating topical steroids. In our previous article, Part 1, we discussed what it is, how it works, in what forms it is available, what it is used for and how to use it. In this article, Part 2, we will discuss the dangers of overuse. What is it Corticosteroid hormones are naturally occurring hormones produced by the adrenal glands within the body. Topical corticosteroids are synthetic (man-made), and it is a type of anti-inflammatory drug, that suppresses the immune response and are classified based on their skin vasoconstrictive abilities. Topical steroids are the topical forms of corticosteroids. It is also called glucocorticosteroids, and cortisone. Corticosteroids were first made available for general use around 1950. Topical steroids are the most commonly prescribed topical medications for the treatment of rash, eczema, and dermatitis. It is used based on the potency, area of the body where it will be applied, and type of skin condition being treated. This medication is available in creams, ointments, solutions and various other forms. How does it work? Topical corticosteroids work through different mechanisms: Forms of the medication: Creams are better for skin that is moist and weepy. Ointments are thicker and greasier, and are better for dry or flaky areas of skin. The strength of the products range from 0.1% (1mg of hydrocortisone in each gram) to 2.5% (25mg of hydrocortisone in each gram). Pharmacies sell hydrocortisone skin cream up to a maximum 1% strength. There is a stronger hydrocortisone cream called hydrocortisone butyrate. However, this is only available with a prescription. Sometimes hydrocortisone is mixed with antimicrobials (chemicals that kill germs). This is used to treat skin problems caused by bacterial or fungal infections. As a general rule, the weakest possible steroid that will do the job, whould be used. Sometimes, It is appropriate to use a potent preparation for a short time to ensure the skin condition clears completely. What is it used for Corticosteroids is used to treat a variety of skin conditions: insect bites, poison oak/ivy, eczema, dermatitis, allergies, rash, itching of the outer female genitals, anal itching. However, it can make some skin problems worse like impetigo, rosacea and acne. Hydrocortisone skin treatments should only be used on children under 10 years old if a doctor recommends it. Creams you can buy are not supposed to be used on the eyes, around the bottom or genitals, or on broken or infected skin. How to use it Unless instructed otherwise by your doctor, follow the directions on the patient information leaflet that comes with the medicine. This will give details of how much to apply and how often. The use of the finger tip unit may be helpful in guiding how much topical steroid is required to cover different areas of the body. Topical steroid is applied once daily (usually at night) to inflamed skin. Most people only need to use the medicine once or twice a day for 1 to 2 weeks. Occasionally a doctor may suggest using it less frequently over a longer period of time, after that, it is usually stopped, or the strength or frequency of application is reduced. The medicine should only be applied to affected areas of skin by gently applying a smooth, thin layer onto your skin in the direction the hair grows. If you’re using both topical corticosteroids and emollients, you should apply the emollient first. Then wait about 30 minutes before applying the topical corticosteroid. Infection may need additional treatment. Topical steroids should not be used for longer periods than prescribed by your doctor or indicated on the leaflet. Overuse can lead to the development of serious medical conditions. In our next article, we will discuss the dangers of overuse of topical steroids. References:

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