Disclaimer: These are "Off-Label" uses of medications

Soothing the Itch: The Best Treatments You've Never Heard About

By Dr. Derrick Adams, Board Certified Dermatologist

So you itch? It may be more than skin deep.

Itching is a sensation quite poorly understood by modern medicine. The burden on patients is very real and taxing to even the most stoic of individuals. All species of mammals apparently experience itching for a variety of reasons. Some of my most perplexing and challenging patients are my “itch patients”. I affectionately call them this because I, as well as usually a dozen other dermatologists, have failed to identify what plagues them. The proverbial “million dollar workup” and conventional treatments of our day have failed them. Often they are labeled “crazy”, “psychotic”, and “delusional”.  It is not uncommon to be accused of methamphetamine abuse if doctors cannot figure out the cause: much easier to blame the patient than our own shortcomings right?

Studies show that individuals with chronic itching have a quite poor quality of life index when measured against cancer and heart failure patients. I am often told “Doc, I’d rather be in pain than itch”. After a recent episode of poison oak I suffered, I empathize with this statement much more closely. The mechanisms of chronic pain have received careful study and billions of dollars from pharmaceutical companies and the National Institutes of Health over the last decades. Chronic itch, in comparison has received a fraction of that. Anybody that suffers chronic pain and has to deal with the circus of medical regulations regarding testing and acquisition of heavily regulated DEA substances can attest to the level of anxiety provoked by the system. But at least there is some cheese at the end of the rat-like maze. One thing that makes chronic itch so frustrating is that there is usually just an endless labyrinth of dead ends with no relief to be found.

After ruling out a nightmarishly long list of potential causes for itching, most patients end up with conventional treatments that have changed little over the last thirty years. Antihistamines (benadryl and Claritin for example), lotions, topical cortisones, and oatmeal baths are the main treatments. Some forward-thinking doctors utilize antidepressants and antipsychotic medications with varying degrees of success. I applaud their efforts and insights to recognize that itching is not only a skin-deep issue.

If you are getting nowhere with your doctor despite their best efforts, I would like you to gently bring this following list up with your doctor. First of all, I want you to ask yourself if you have been truly compliant with their recommendations before bringing this up. Most providers will appreciate the honesty you display if you admit you have been less than stellar keeping up with their plan. It allows them to still feel like a partner in your dilemma, rather than an impotent whipping boy.

I’d like to offer this disclaimer: I have not pioneered many of the following treatments. Most of these were recommended to me by patients after much trial and error. Some are old family remedies and many are off-label use of other medications I have found that work on the sensation of itching. Not all of them will work for you. There is no magical panacea I’ve yet discovered; rather it often takes a combination of the following to bring the desired relief sought by patients.  When I started upon my journey of medical training 17 years ago, I never would have believed that simple itching would be one of the most confounding problems I face.

-Capsaicin cream: Sold under a variety of names and available at many drug stores and supermarkets. Capsaicin is the purified compound from a hot chili pepper that creates that burning sensation on your tongue without the actual application of fire. It was originally used to treat the lingering skin pain induced by a shingles outbreak. I find it works wonders on chronic itch. The only drawback is, of course the pain it induces. Remember the saying from earlier, “Doc, I’d rather be in pain than itch!” Well this treatment is perfect for that level of itching. Paradoxically, the more often you apply it, the less painful it becomes. I recommend twice daily application and anticipate the burning to subside by the second or third day. If your skin cannot tolerate the chili pepper extract, wash it off with vinegar, not water. Using water on this cream is like trying to douse a grease fire with tap water. If you can tolerate a few days of this, you stand a great chance at knocking out your itch.

- Sasquatch Itch Cream: Sold online and at a very few select shops nationwide, “Sasquatch Itch Cream” is probably the best cream to quench any itch. There is simply no other cream out there that delivers the relief of this product.  Although it sounds like a novelty product, Sasquatch Itch Cream was formulated I developed it while serving as an Air Force dermatologist for the treatment of poison oak and poison ivy rashes while troops where in the field.  After a particularly fierce season of poison oak on base, the commander charged the me with finding something that “keeps the boys out of the medic tent and in the field”.  After several years of tinkering with the formula, I actually left the military and patented the cream. The armed forces are still allowed access to the formula however in a legal agreement reached between the two parties. It has only been available to the public for about a year now. I find that Sasquatch Itch Cream works best if it is kept in your ice chest or refrigerator and pulled out for immediate usage. When I had my poison oak rash, Sasquatch Itch Cream was like my fire extinguisher. It also is good for insect bites, especially mosquitoes. Available online at: www.sasquatchcream.com     

- Phototherapy: Ok, so this is pretty much a glorified tanning bed. Dermatologists hate tanning beds right? Well it turns out that in cases of severe itch, 2-3 sessions of 15-20 minutes can be the difference between insanity and a fighting chance at conquering the itch. Ultraviolet radiation is immunosuppressive to the skin and inhibits a celled called a Langerhans cells from pushing the first domino down in a long string of events that make you scratch. Be careful not to burn though. There is no reason to get skin cancer to cure your itch. The most effective phototherapy treatments occur without even tanning of the skin, so do not use this an excuse to start conventional tanning. Many dermatologists have phototherapy booths. I happen to practice in a rural area and recommend several reputable tanning salons where the owners understand the risks and benefits of this treatment.

-Menthol: The anti-itch lotions with menthol (like Sarna and Gold Bond) are excellent and I have no quarrel with them in general. But when they fail, I have patients purchase the old rubs for sore muscles. They usually contain menthol in concentrations of 2-4%, compared to 1-2% for the leading anti-itch lotions. This is another cheap alternative to conventional medicine and an “off-label” use. The use of menthol for skin irritation goes back thousands of years in ancient China. I recommend mixing it with camphor or “Sasquatch Itch Cream” if you need relief from poison oak or poison ivy or insect bites.

- Camphor: Camphor is quite a useful compound. It can serve as an air freshener, moth repellant, cooking ingredient, embalming fluid, and even a temporary treatment for itchy skin. It is derived from the wood of the camphor laurel, usually found in Borneo or Taiwan. Some other plants contain camphor, such as rosemary leaves and various mints. Camphor is absorbed through the pores and gives a cooling sensation similar to menthol.

- Lidocaine or Benzocaine: Yes, this is the same stuff doctors use to numb your mouth and skin. And it works wonders on the skin. I find patients like these because they are readily available at supermarkets and pharmacies. Most people purchase the gels sold for sunburn relief and get good results with it. If one particular area is really making your life miserable (like a spot on your scalp, buttocks, or genitalia) I suggest buying LMX or topical 5% lidocaine cream. It runs about $45 but may be worth it.

-Valium or Xanax: This is a far from an accepted treatment for itching. I use it very sparingly but find it useful because it helps patients sleep and it lowers their anxiety about their chronic itch. In the notoriously vicious cycle of itch-scratch-itch, scratching begets itching, and the visa versa. Often doctors cannot ascertain what the initial itch was caused from but it has taken on a life of it’s own.  Valium and xanax may not alleviate the primary itch but it gives people a fighting chance at managing it in a more calm fashion. Any doc who has managed chronic itch patients appreciate that many have a coexisting anxiety disorder, either predating or caused by the itch itself. Patients also do better knowing that have some relief from the anxiety if needed. Often just the knowledge of having this “escape” available is enough to keep them comfortable. Medical marijuana has reportedly been able to accomplish the same thing but I have not yet recommended it for any patients.

-Naltrexone: Because the neural pathways for chronic itch are so poorly understood, it should come as no surprise that the opium receptors are somehow involved. This treatment dwells in medical textbooks but is rarely used. Because chronic opiods often cause intense itching themselves, many experts shy away from this option. Naltrexone is approved for the treatment of alcohol and opiod (pain killer) addiction. It is an antagonist to the opiod receptors so it makes sense that it may dampen the itch sensation. I have had mixed success with it in my practice. It is expensive and difficult to get covered for any off-label uses by insurance companies.

-A cold beer! I say this partially in jest. Really anything cold applied to the skin will help (a frozen bag of peas, a cold can of soda or beer, an ice pack).

 Again, none of these treatments are broadly smiled upon by the medical establishment. But remember, this is the same medical establishment that usually has little to offer anyway and has neglected chronic itch for decades. Dermatologists are leading the charge in discovering the underlying causes, mechanisms, and treatments to bring relief to millions. The military has brought civilization many new cures as well as ways to kill each other. Sasquatch Itch Cream for poison oak and poison ivy is one such example. Perhaps many patients will eventually turn out to be “delusional”, “crazy”, “psychotic”, and methamphetamine users? Based on my experience, I think most chronic itchers will eventually be classified within a whole spectrum of syndromes that are currently not elucidated or understood. After all, women experiencing premenopausal dysphoria were once considered “hysterical” and institutionalized. Perhaps soon the treatment of itch will emerge from the Stone Age. Until then, hang in there.