How to Tame the Psoriasis Itch

Prescription and Home Remedies That Work

It is perfectly natural to want to scratch an itch, but doing so when it's caused by psoriasis can make the condition worse, leading to infection and scarring. In some cases, it can cause new lesions to form, a phenomenon known as the Koebner response.

Unlike some rashes, which you may be able to tolerate for a short period of time, psoriasis is a lifelong condition. It can flare up at any time and lead to changes in the skin that can be uncomfortable, aesthetically undesirable, and embarrassing. In some instances, its symptoms—including itching—can be so bad that they interfere with your quality of life. Fortunately, there are things you can do to help thwart the itch.

Why Psoriasis Itch Occurs

The clinical name for an itch is pruritus. It can be triggered by many things, including infections, allergies, chronic diseases, drugs, and even pregnancy. In a great many cases, there is no known cause.

An itch originates in nerve receptors in the skin known as nociceptors. These receptors are known to be stimulated by histamine, a substance secreted by the immune system during an allergic response that causes the receptors to misfire. While this explains why an allergic rash is so itchy, it is unclear why an itch may occur with other conditions.

What scientists do know is that nociceptors are most abundant in the transition between the outer layer of skin (epidermis) and the layer of skin just below it (the dermis). Perhaps not surprisingly, this is also the region where psoriasis originates.

As an autoimmune disorder, psoriasis is caused by an immune assault on normal cells in the dermis. The resulting inflammation triggers a chain reaction in which skin cells in the dermal/epidermal transition begin to multiply faster than they can be shed. What results are the dry, flaky plaques recognized as psoriasis.

The autoimmune assault of psoriasis is believed to overstimulate dermal receptors, sometimes causing itching. The itch may be intensified by flaking and dryness (xerosis), which allow environmental irritants into tiny cracks and fissures.

Anti-Itch Products

The good news is that an increasing number of treatments are available to reduce psoriatic itch. Some are classified as antipruritics, meaning that they treat the itch itself. Others address the dryness and flakiness that can exacerbate itching.

Some of these options require a prescription, while others are available over the counter (OTC). In either case, make sure that your doctor is aware of any and all medications you are taking, whether they are oral (taken by mouth) or topical (applied on the skin).

The most common anti-itch remedies include the following.

  • Antihistamines are medications used to treat allergies that target the nerve pathways linked to itching. Some versions have a sedative effect, which may help if the itching is keeping you up at night. Benadryl (diphenhydramine), purchased OTC, is a popular choice.
  • Emollient-rich moisturizing creams containing lanolin, glycerin, or petrolatum are able to relieve dryness and lock in moisture for longer-lasting relief. For an extra-comforting and cooling effect, keep your cream in the refrigerator.
  • Oatmeal baths can be useful in treating widespread plaques and softening and soothing skin with a gentle exfoliating effect. Products containing ground colloidal oatmeal, such as Aveeno Soothing Bath Treatment, are especially popular. Immediately after drying, while skin is still moist, apply a layer of lotion to lock moisture in for longer-lasting comfort.
  • Anti-itch creams come in OTC and prescription formulations. OTC brands typically contain menthol or camphor. Benzocaine or hydrocortisone can be found in both OTC and prescription remedies. Check with your doctor before using an OTC product, as some may contain ingredients that irritate the skin.
  • Topical corticosteroids, available by prescription and OTC, are effective in treating itch but need to be used sparingly to avoid skin thinning (atrophy). It's important to use the steroid only as instructed, and never use a topical corticosteroid on your face unless your doctor directs you to. Certain steroids can be too strong for the face.
  • Aspirin may help alleviate the inflammation that promotes itchiness. It is a far better choice than other nonsteroidal anti-inflammatory drugs like Aleve (naproxen), which can trigger flares.
  • Remeron (mirtazapine), a noradrenergic and specific serotonergic antidepressant, or NaSSA, may be used to treat itchiness in people with moderate to severe psoriasis if all other options fail.
  • Neurontin (gabapentin) is a prescription drug typically used to treat seizures that is also effective in relieving neuropathic pain. In rare cases, it may be used for people with severe psoriasis if chronic pain and itching are intolerable.
  • Phototherapy, a form of treatment using ultraviolet (UVB) radiation available in a dermatologist's office, is effective in relieving itchiness while tempering the inflammation that drives psoriasis. It is commonly used for moderate to severe cases that fail to respond to conservative treatments.
  • Time in natural sunlight can also help psoriasis and the itching associated with it. Spending about 15 minutes in the sun daily is usually enough to show benefit. You should not apply sunscreen to any areas of skin affected by psoriasis during this treatment, but you can apply it elsewhere (for example, on your face). If you stay out in the sun for longer than 15 minutes, remember to apply sunscreen to all exposed skin.

Home Remedies

Beyond store-bought products, there are a number of home remedies that can also help. Ice packs and cold compresses remain the quickest and easiest solutions, numbing nerve endings while cooling raw and inflamed skin. Even using a washcloth dipped in ice water can help enormously.

Avoid applying ice directly to the skin. Cover the ice pack in a towel and move it around constantly, icing each section of the skin for no longer than 10 to 20 minutes at a time to avoid frostbite.

Some people rely on short-term occlusion therapy. This is a technique in which you apply a layer of moisturizing or medicated cream to the skin and wrap it in cling film. The wrap is then covered with a sock, glove, or loose elastic bandage and can be worn for several hours or overnight.

While a bath can be effective in loosening scales, it is best to avoid regular hot baths or showers. However, cool showers can help temper the itch as well as reduce overall inflammation. It is important to note that showering and bathing actually promote skin dryness, so always apply moisturizer after drying off, while skin is still moist, to minimize dryness and itch.

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