Itch’s Impact

In a recent study in the Archives of Dermatology, researchers at Emory University and the Veterans Affairs Medical Center, in Atlanta, surveyed patients with itch-or pruritus, as it’s called in the clinic-lasting for more than six months (DOI: 10.1001/archdermatol.2011.178). On average, those patients said they would be willing to forfeit 13% of their life expectancy to live without itch.

No one could relate more with those findings than chronic itch patient Priscilla Pruritus-at least that’s what we’ll call her here. “I would be willing to sell my house to get rid of this problem,” she says.

Priscilla chose an alias because of the stigma associated with having itch. Unlike diseases such as breast cancer, for which there are support groups and an abundance of sympathy, “you tell somebody you have pruritus,”she says, "and they don’t get it or they’ve never heard of it.” She’s even lost friends: Some people don’t want to be around the condition, and the itch makes it difficult for her to go out and be active.

Priscilla, 66, was walking her dog one day three years ago near her home in California and tripped on the lip of the sidewalk, falling on the concrete and jarring her head. About two weeks later, the itch started. A patch on the top of her scalp, which has since grown to about 3 inches in diameter, “tingles” almost constantly, she says. “I sit on my hands some days so that I won’t scratch,” she says. “You can’t imagine the willpower that I have."

For a while, Priscilla went to her local dermatologist, thinking that the condition was trivial and would clear up. When the itch didn’t improve and she began to grow more desperate, in 2009, she sought the help of Timothy G. Berger and Martin Steinhoff, researchers and physicians in the Dermatology Clinic at the University of California, San Francisco, Medical Center.

Since the start of her pruritus, including the time she’s spent under Berger and Steinhoff’s care, Priscilla has tried 13 topical creams and 17 oral medications and has had 92 injections. But the itch just won’t go away. Some treatments have had severe side effects such as anemia, and some have made the condition worse. Priscilla says she plots her itch level-no itch gets a 0 and excruciating itch merits a 10-on legal-sized paper with accompanying notes on her treatments. That chart is now about 10 feet long, with all the pages taped together end to end.

In Priscilla’s case, the exact cause of the itch is unknown-it doesn’t correlate to a disease or chemical trigger. At this point, the doctors think her condition is neurological, potentially stemming from her fall and most definitely exacerbated by stress, sweat, heat, and sunlight.

In extreme cases, when a disease is unresponsive to therapeutics or a specific diagnosis is elusive, Steinhoff says, doctors generally treat itch in a trial-and-error fashion. They go down a list of potential treatments, depending on the situation, until they find one that works. Steinhoff’s clinic, which Priscilla says is “the best of the best,” tries to avoid the frustration of trial and error by using a rational therapeutic approach that it has developed. This method involves carefully recording a patient’s history with a questionnaire and doing extensive blood and itch tests. Steinhoff says he thinks that "different subtypes of itch exist and have to be treated, ideally, with different drugs."

Currently, Priscilla uses topical creams containing the anesthetic lidocaine and the counterirritant capsaicin on her scalp five times per day. "My day is centered around my topicals," she says. She gets up twice per night to put them on, and she takes half a Xanax before bedtime just to fall asleep. When she spoke with C&EN in late June, Priscilla rated her itch a 9. Steinhoff, who has tried a number of other drugs but had to stop using them because Priscilla had side effects, has been testing some ethanol injections in her scalp, and she is waiting as patiently as possible for the numbing effects to take hold. One injection, however, generated a scab on Priscilla’s scalp that cost her a patch of hair.

“Itch is a big, big medical problem,”Steinhoff says, adding that it could be an attractive market for pharmaceutical companies. "We need better drugs with fewer side effects, and therefore we need to understand the mediators and receptors involved," he adds, emphasizing the importance of research in his clinic.

But until better therapeutics are available, Priscilla will have to stay out of the sun and heat of summer and hope one of Steinhoff’s treatments will provide relief.