DR ANGELO SMITH M.D

WHPL

◼“local discomfort or irritation of the skin, prompting the sufferer to scratch or rub the affected area. It is the main symptom of skin disease”

◼“a peculiar tingling or uneasy irritation of the skin that causes a desire to scratch the affected area”

“It feels as though every nerve ending in my body is attacking me intensely at my ankles, feet, lower legs, neck, under the breasts (even the nipples tingle). It's absolutely horrendous! My hands grow red as a beet and the itching nearly takes the skin off my hands as I scratch.”

“ It’s like someone tickling you under the skin”

◼Debate continues over whether there are specific nerve endings for itch

◼Possibly more than one mechanism

◼ Free nerve endings fibres most concentrated in wrists and ankles Unmyelinated C fibres

to dorsal horn in spinal cord

◼ Scratching is a spinal reflex response ascends to cerebral cortex via spinothalamic tract

◼ Skin inflammation

◼ Psychological concerns

◼ Chemical mediatorsSubstance POpioid and non-opioid peptidesSomatostatinNeurokinin AHistamineSerotoninProstaglandins

◼ External mediators

Environmental heat or dryness

◼ History including onset, duration, pattern, effect on sleep, previous skin disease, contacts, other medical problems, drugs, response to treatment so far.

◼ Skin examination features of rash, post-inflammatory changes, signs of scratching

◼ General examination

◼distress◼excoriation◼lichenification◼shiny nails ◼weals◼nodules

◼age◼self-control / social setting /

distractions◼other medical conditions /

ability to scratch◼site of itch◼specific skin condition◼duration

◼skin disorders◼systemic disorders◼psychogenic◼habit / itch-scratch cycle

◼ infestations: scabies, lice, threadworms

◼eczemas◼urticaria◼psoriasis (sometimes)◼ insect bites – papular

urticaria ◼pityriasis rosea◼viral exanthems

◼ infestations: scabies, lice, threadworms

◼eczemas◼urticaria◼psoriasis (sometimes)◼ insect bites – papular urticaria ◼pityriasis rosea◼viral exanthems

◼ infestations: scabies, lice, threadworms

◼eczemas◼urticaria◼psoriasis (sometimes)◼ insect bites – papular urticaria ◼pityriasis rosea◼viral exanthems

◼ infestations: scabies, lice, threadworms

◼eczemas◼urticaria◼psoriasis (sometimes)◼ insect bites – papular urticaria ◼pityriasis rosea◼viral exanthems

◼ infestations: scabies, lice, threadworms

◼eczemas◼urticaria◼psoriasis (sometimes)◼ insect bites – papular urticaria ◼pityriasis rosea◼viral exanthems

◼ infestations: scabies, lice, threadworms

◼eczemas◼urticaria◼psoriasis◼ insect bites – papular urticaria ◼pityriasis rosea◼viral exanthems

◼ infestations: scabies, lice, threadworms

◼eczemas◼urticaria◼psoriasis (sometimes)◼ insect bites – papular urticaria ◼pityriasis rosea◼viral exanthems

◼ infestations: scabies, lice, threadworms

◼eczemas◼urticaria◼psoriasis (sometimes)◼ insect bites – papular urticaria ◼pityriasis rosea◼viral exanthems

Slapped face syndrome

◼infestations: scabies◼eczemas / nodular prurigo/

xerosis◼urticaria◼psoriasis (sometimes)◼lichen planus◼bullous pemphigoid◼polymorphic light eruption

◼infestations: scabies◼eczemas / nodular prurigo/

xerosis◼urticaria◼psoriasis (sometimes)◼lichen planus◼bullous pemphigoid◼polymorphic light eruption

                                                                                          

                                                                                                                                                                            

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lesion description additional description

opaleness   

owheal opale red opolycyclic

 

opurpura   

◼infestations: scabies◼Eczemas / xerosis◼urticaria◼psoriasis (sometimes)◼lichen planus◼bullous pemphigoid◼polymorphic light eruption

◼infestations: scabies◼eczemas /nodular prurigo/

xerosis◼urticaria◼psoriasis (sometimes)◼lichen planus◼bullous pemphigoid◼polymorphic light eruption

◼infestations: scabies◼eczemas/ nodular prurigo/

xerosis◼urticaria◼psoriasis (sometimes)◼lichen planus◼bullous pemphigoid◼polymorphic light eruption

◼Eczemas / xerosis◼urticaria◼psoriasis (sometimes) ◼infestations: scabies◼lichen planus◼bullous pemphigoid◼polymorphic light eruption

◼Anogenital/ pruritus ani:Threadworms, lichen sclerosis, lice, contact dermatitis

◼Hands: eczemas, scabies, contact dermatitis

◼Flexures: atopic/ seborrhoeic eczema, scabies

◼Scalp: lice, seborrhoeic dermatitis, psoriasis

◼Any area: discoid eczema, lichen simplex chronicus, contact dermatitis

◼liver disease◼renal failure◼iron deficiency ◼metabolic:protein, zinc, calcium, vitamin deficiencies

◼thyroid disease

◼diabetes◼malignancies:

lymphoma, PRV, leukaemias, myeloma

◼pregnancy◼neurological ◼drugs

◼epidemic forms - hysteria

◼delusional parasitosis◼habit - itch/scratch cycle

◼Treat the cause

◼Treat the itch

◼keep looking for a cause

◼avoid aggravating factorstemperature, humidity, bedding,

clothing

◼reduce damage from scratchingclothing, bandaging, cut nails

◼topical agents◼systemic agents◼psychological interventions

◼emollients◼antihistamines - doxepin (Xepin)◼unknown mechanism -

crotamiton (Eurax)calamine

◼counter-irritant - capsaicin, menthol

◼local anaesthetics ◼paste bandages

◼Opiod antagonists◼Ondansetron◼Rifampicin◼Cholestyramine◼Tricyclic antidepressants◼Thalidomide◼Phototherapy

◼Biofeedback◼Behaviour therapy◼Relaxation techniques◼Acupuncture◼Hypnotherapy◼Homeopathy ◼Self-help groups