Itch
About Itch
Itching can interfere with everyday activities, including:
- Sleep: Itching tends to worsen at night, making it hard to fall asleep and stay asleep.
- Work and school: Persistent itching can make it hard to concentrate.
- Physical activities: Exercise, sports, and play (for children) may increase itching.
Itching can make you anxious, which can make itching worse. Fortunately, itching decreases over time. In the meantime, there are treatments to help reduce itching.
Treatment options for Itch
Pressure Therapy
Pressure therapy is a standard treatment to prevent hypertrophic scars (mainly burn scars). Pressure therapy involves wearing garments made from elasticized fabrics or wearing masks/collars made from hard materials maybe with a silicone top layer. The exact reason why pressure works is still not fully understood. It’s thought that pressure controls collagen synthesis and limits the supply of blood, oxygen and nutrients to the scar tissue. It may also have a role in reducing inflammation.
Silicone Therapy
Scars and skin graft donor sites need regular creaming (moisturisation) to prevent the area from drying, cracking and becoming sore. The oil glands in your skin which usually provide moisture can be damaged or destroyed by the injury. The surface layer of the skin which prevents water loss is damaged. Therefore, the healed skin lacks the moisture needed. Silicone works by sealing in the moisture and hydrating the scar. Through providing occlusion (covering) and hydration to the outer layer of the epidermis evaporation of water is reduced from the skin. Silicone treatment aims to flatten, soften and reduce the redness and discomfort of your scar over time. Silicones possess many skin-friendly properties; they are easy to use and remove, painless, can be worn for long periods, are resistant to microbial growth, and are waterproof.
Moisturizers
Moisturisers increase the water content (hydration) of the stratum corneum (top layer of the skin) which fills the spaces between partially desquamated skin flakes and makes the skin appear smoother. In normal skin there is minimal water loss through the epidermis to the surrounding atmosphere. Due to damage to the skin barrier, young and inflamed scars have higher amounts of water loss; this is increased by dry skin. There is a wide range of over-the counter moisturisers available, some products claim to reduce the appearance of scars.
For newly healed wounds and scars that are exposed to sunlight it is vital to use a moisturiser with SPF protection. Because the melanocytes (pigment-cells) are unbalanced and fragile in these areas, they can over-react to normal sun exposure. This can cause the new skin or scar to become permanently darker in colour (hyperpigmented).
Topical Ointments and Creams
Several prescription and over-the-counter topical agents are available, many claim to alleviate symptoms, improve the appearance of scars and accelerate wound healing. Topical therapies have the advantage of being easy to use, are easily available and deliver the ingredients directly to the scar. Patients often decide (maybe based on word of mouth) themselves on which topical agents to use rather than through recommendations from a scar specialist. Topicals are not usually effective on their own and other treatments are also usually necessary. Some information on common topicals is given here:
Scar Massage
Scar massage is a non-surgical technique used in day-to-day scar and burn care. There are multiple techniques that can be used and that are quite easy to apply.
Corticosteroid Therapy
Corticosteroid therapy has been commonly used for years to treat hypertrophic and keloid scars. Corticosteroids suppress inflammation, reduce collagen synthesis and inhibit cell proliferation; itch and thickness of scars is reduced. Corticosteroids can be given through injection, steroid tape or topically (by cream). Intralesional injections (injections into the scar) are common treatments for linear scars, hypertrophic scars and small keloids. Other treatments alongside corticosteroid therapy are often required for large keloids and thick hypertrophic scars.
Pulsed Dye Laser (PDL)
The Pulsed Dye Laser (PDL) is a highly effective and low risk laser for the treatment of a wide range of vascular lesions. PDL releases brief pulses of selectively absorbed optical radiation which can cause selective damage to pigmented structures (blood vessels) and cells. The PDL is used to treat port-wine stains, facial telangiectasias and haemangioma. Newer PDLs with longer wavelengths and extended pulse durations have made deeper tissue penetration possible and improved clinical outcomes with reduced risk. PDL treatments are performed with a topical anaesthetic.
Ablative Fractional Laser (AFL)
The Ablative Fractional Laser (AFL) is a wounding laser, which delivers micro fractional columns of laser light to the top layers of the skin. This treatment works by creating thousands of microscopic areas, through heat, where the top layer of the skin is ablated (removed). These tiny areas of damage are surrounded by untreated skin, this allows healing of the skin. Traditional ablative laser resurfacing can take on average up to three weeks to heal. Types of ablative treatments include the carbon dioxide (CO2) laser and the erbium laser. AFL is performed under local anaesthesia.