How to Tame the Psoriasis Itch

Prescription and Home Remedies That Work

Woman with ice pack on elbow
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It is perfectly natural to want to scratch an itch. However, the problem with psoriasis is that scratching 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 several days, psoriasis is a lifelong condition. It can flare up at any time and lead to changes in the skin that can be uncomfortable, unsightly, and embarrassing. In some instances, it can be so bad as to interfere with sleep, sex, and the very quality of life. Fortunately, there are things you can do help thwart the itch.

Understanding Itch

An itch in medical terms is referred to as pruritus. It can be triggered by many things, including infections, allergies, chronic diseases, drugs, and even pregnancy. In a great many cases, there will be 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 allergy), causing them 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 know is that nociceptors are most abundant in the transition between the outer layer of skin (epidermis) and the layer of skin just below (dermis). Not surprisingly, this is 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 we recognize as psoriasis.

The autoimmune assault is believed to overstimulate dermal receptors, causing persistent and often severe itch. 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 is available to reduce the psoriatic itch. Some are classified as antipruritics, meaning that they treat the itch itself. Others address the dryness and flakiness that can exacerbate the itch.

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).

Here are some more of the more common anti-itch remedies:

  • 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.
  • 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), purchase over the counter, 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 added boost, keep the creams in the refrigerator for an extra-comforting, cooling effect.
  • Oatmeal baths can be useful in treating widespread plaques, 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, apply a layer of moisturizing cream to lock moisture in.
  • 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 over the counter, are effective in treating itch but need to be used sparingly to avoid skin thinning (atrophy). Never use a topical corticosteroid on your face unless your doctor tells you to.
  • Remeron (mirtazapine), a noradrenergic and specific serotonergic (NaSSA) antidepressant, 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 but one that is also effective in relieving neurological pain. In rare cases, it may be used for people with severe psoriasis if chronic pain and itching are intolerable.

In addition, phototherapy, a form of treatment using ultraviolet (UV) radiation, is also 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.

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 use a handcloth dipped in ice water can help enormously.

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

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

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

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