Itching
Itching is an irregular tingling or uneasy irritation of the skin that causes a desire to scratch the affected area. Itching is a limiting problem for many people with EB, often interfering with the ability to concentrate, work, play and sleep. It may be caused by various factors:
- Wound infection
- Medication side effect
- Sensitivity from exposed wound/nerve tissue
- Iron deficiency Anemia
- Layers of bandages
- Sensitizers
When and if possible, treat and eliminate the underlying cause of the itch. Often, with EB, that is not possible and one must be creative in addressing this problem.
Manage the itch
Non-medication recommendations:
- Avoid harsh soaps and perfumed products
- Eliminate wool and rough garments
- Launder clothing and linens in mild detergents and fabric softeners
- Run laundry through an extra rinse cycle
- Wash with mild soaps such as Dove or mild cleansers such as Cetaphil
- Take lukewarm baths being sure to rinse thoroughl
- Take a skin-soothing oatmeal or cornstarch bath
- Add ½ cup table salt to bath water (standard size bathtub half filled)
- Avoid prolonged exposure to excessive heat and humidity
- Take up an enjoyable hobby that distracts from the itching
- Replace one sensation with another:
- Gently tapping the area
- Cool the area
- Have wounds evaluated by a physician and treat infection (bacterial, fungal, yeast) if present.
- Apply a soothing lotion/product after the bath
- Eucerin Calming Creme
- Emu Oil
- Aveeno fragrance free moisturizing lotion
- Aquaphor
- Lubriderm
- Keep it cool
- Maintain a cool environment (air conditioned)
- Refrigerate creams and ointments
- Apply refrigerated hydrogel sheet (Vigilon, nu-gel, etc.)
- Apply cold compresses (not for infants)
Medications:
Consult your physician to discuss these options!
Antihistamines
- Antihistamines such as Benadryl, Atarax and Periactin are usually effective against itching. These drugs are categorized as first-generation antihistamines and cause sedation, drowsiness and impaired thinking (more prevalent in adults than children). Over time, the side effect of sedation lessens. When taken with sedating antihistamines, alcohol and tranquilizers will increase this side effect.
Many people find it most helpful to take a sedating antihistamine before bedtime.
- Antihistamines such as Loratidine (Claritin) or Cetirizine (Zyrtec) are second-generation antihistamines, do not cause sedation and may be effective against itching. Zyrtec has been reported to be especially effective for daytime use when taken at higher dosages (20 mg rather than 10mg).
- Some individuals have reported decreased itching when taking a non-sedating antihistamine (such as Zyrtec) in the morning, and then taking a sedating antihistamine (such as Atarax) in the evening.
Antihistamines may lose their effectiveness over time and a different one may need to be tried.
Other medications:
Although no formal clinical studies have been done with the following medications for pruritus (itchy skin) in EB patients, they have been reported to help in some situations.
- Doxepin Hydrocholoride is marketed primarily as a tricyclic antidepressant but is also a potent histamine receptor antagonist. Many people with EB have achieved relief or improvement of itching when this medication is taken at bedtime.
- (Topical doxepin cream (Zonalon) is not recommended, as it has been reported to cause allergic contact dermatitis: Horn HM, Tidman MJ, Aldridge RD. Allergic contact dermatitis due to doxepin cream in a patient with dystrophic epidermolysis bullosa. Contact Dermatitis. 2001 Aug;45(2):115.)
- Elavil (amitriptyline HCl) Amitriptyline is similar in potency to doxepin as a potent histamine receptor antagonist and has also been reported to be beneficial for some.
If the problem persists and none of the above options are effective, the patient should ask his/her physician to discuss the use of the following medications with an EB specialist:
- Neurontin (gabapentin)
- Zofran (ondansetron hydrochloride)
- Paxil (paroxetine hydrochloride)
- Remeron (mirtazapine)
- Thalidomide
