Twenty Ways to Scratch That Itch
May 1, 2018
By Jonathan Sackier
The muse thankfully visits me so that I can write my AOPA Fly Well and this newsletter column. Stirred by Bond movies, books, songs, or even events from years gone by. My motivation? To keep you aloft longer. If I can keep your attention, can I motivate you about body matters? In this case a shampoo in the shower and a dear friend I had to share it with. The story, not the shower! I want to go on a rant about associations, not the kind we belong to, AOPA, but the kind that forms a link in our minds, cranial currents, neural networks. Salt and pepper, cup and saucer, Mickey and Minnie, and scratching an itch. “What?” I hear you say.
As a doctor, I am fascinated how diseases manifest their presence, sometimes obvious, sometimes seemingly obscure. And itching, or pruritus as we pompous docs call it, captivates my attention. Transmitters in the nervous system tell your brain part of the skin is receiving weird inputs. A deeply troubling symptom, it leads many aviators to send me emails, so I thought I would address this ticklish topic. And as pilots, if you are bothered by an itch, stay out of the cockpit until the matter is resolved. You need to focus on keeping the dirty side down and not clawing at your flesh!
- So, I was having a shower the other day at a hotel – okay, no wisecracks; yes, I shower every day – reached for the shampoo and, having squeezed the tube, did a double take. Why? Because the damn stuff contained white tea and aloe. Now, the aloe makes sense, as it’s a cactus extract known to soothe inflamed skin, although until reading the packet no part of my scalp was bothered. But TEA? Look, I am British and love a cuppa, but have never been inspired to brew a pot and tip it over my head. Tea does not, to my knowledge, either improve or address inflammation but this episode got me thinking about how things we apply to our skin may cause inflammation. Yes, Chanel No. 5 is designed to inflame men when they detect the delicious aroma on a special woman, but sometimes perfume, cosmetics, and other substances can cause an allergic reaction. Avoiding the offensive substance is key to reducing further problems and locally applied creams may help.
- Likewise, foods can cause allergic reactions, a topic I covered recently, and this can present with itchy skin and various other symptoms. Seafood is a common agent provocateur and may be associated with an allergy to various iodine-based contrast agents used in radiologic procedures, so tell your doc if you have this problem. Peanut allergies have become widely known and vegetarians also have to contend with allergies to tofu, milk, eggs, wheat, and soy. Do you notice meat-eaters never ask if they can have a hamburger that tastes like tofu? And having an allergy to certain things like chocolate or sweet cakes would be unbearable!
- Several drugs can cause pruritus, including a wide range of antibiotics, antifungals, and anticonvulsants. A particular type of itchiness is formication. Read it carefully and take your mind out of the gutter! Derived from the Latin word formica, meaning “ant,” it is the sensation of insects crawling around your skin. It has many causes but may be initiated by taking various drugs.
- Dermatitis is a chronic skin disorder causing itchy, scaly rashes. Diaper rash is an example and although we want to encourage young people to fly, there is a limit to how young an eagle we may attract to the left seat!
- Eczema is a reactive skin condition worsened by heat. In addition to steamy summer days, or overheated rooms, other things such as fever can raise body temperature and inflame delicate flesh.
- Psoriasis is an autoimmune disease that causes skin redness and irritation, usually in the form of plaques, or discs. This can be very itchy and may be associated with arthritic problems, most often in the small joints of fingers or wrist. If diagnosed with this condition, please ensure that any medication your doctor prescribes is aircraft operator friendly! Talk to your AME, or check out the AOPA medication database.
- The advent of mobile phones and texting modalities like WhatsApp have truncated language to a series of ephemeral thumbs-up emojis and LOL’s. In dermatographia, the slightest pressure on the skin induces an irritating swelling which tends to subside with time and is usually nothing to worry about. Unlike using an inappropriate emoji in error!
- Sarah Knight’s hilarious and uplifting book, The Life Changing Magic of Not Giving a F*ck wisely advises that it is far healthier to not get bent out of shape by caustic elements in life that are beyond one’s control. You cannot change how people behave or speak, merely how you react to them. And it is the same with certain impermanent diseases. If, as an adult, you are unfortunate enough to contract viral infections such as measles or chickenpox that manifest with profound irritation, you may have little choice but to tolerate the itch. Read Ms. Knight’s book; if it doesn’t crack you up, I will buy the drinks when we meet!
- I am a fungus fanatic – love every variety of mushrooms. But some fungi are definitely not appealing and can cause intense skin complaints – ringworm (despite its name, this is a fungus), candida, and athlete’s foot are examples. Stick to portobellos and the like!
- If bitten by an insect, the body reacts by releasing histamine and other chemicals in an effort to deal with the insult, and this results in all the signs of inflammation: rubor (redness), calor (heat), dolor (pain/itchiness), and tumor (swelling). For fear of inviting the ire of women reading this, I shall not point out that it is only female mosquitoes who bite...did I say that out loud?! Oops. Other annoying arthropods include bedbugs, lice, and scabies. Pinworms, another irritating invertebrate, induce nocturnal nether region itching.
- Wandering through the woods in rapt conversation with someone dear to you, or a solitary stroll in said environs, can lead to an unpleasant surprise. A brush with various plants can lead to a temporary, but potent itch from stinging nettles or enduring irritation from plants like poison ivy which release a sticky oil, urushiol. Often, only a steroid dose pack will quell the problem. As obnoxious as these may be, they are inconsequential compared to Queensland, Australia’s Dendrocnide moroides, more prosaically known as the “suicide plant,” whose sting can induce pain that lasts for years. Fancy a trip there? If the trees don’t get ya, the crocs will!
- Humans can manifest internal illness by changes in the skin, a matter I addressed last year ("Hello Muddah, Hello Fuddah: Twenty Reasons to Keep an Eye on Your Skin”). If flow of bile from liver to gut is blocked by scar tissue, tumor, or stone, bile “backs up,” leading to a yellow complexion which in turn causes irritation. Call a yellow cab and get urgent medical attention.
- Liver diseases such as cirrhosis can also join the party, presenting in similar fashion to bile duct issues. If you notice the whites of your eyes aren’t...get thee to a doctor at warp speed, cap’n, and damn the dilithium crystals!
- Some of us like to eat kidneys, others not, but for all, kidney failure leads to accumulation of toxins, and the resultant skin warning signs, such as various rashes, nodules and itching, should be taken seriously. Failure to deal with this is akin to ignoring declining manifold pressure. It will end with tears before bedtime. And then perpetual sleep...get my drift?
- Keeping failing body parts in mind, problems with your thyroid gland, the butterfly-shaped organ located in front of the windpipe, can be a tricky dicky and induce a range of skin problems including dryness and itching. This was covered in a Fly Well article (“Float Like a Butterfly, Sting Like a Bee,” AOPA Pilot, June 2017, page 26).
- Various cancers, such as lymphoma, as well as the drugs used to treat them, can reveal their presence with various skin manifestations. This makes the point that any new symptom that does not rapidly resolve merits a trip to your medic. Believe me, doctors are not at all offended by seemingly minor problems – we would much rather that scenario than see someone who presented too late to be helped. A sore throat that is just a sore throat is better than seeing someone present late with a throat cancer.
- Reduction of circulating blood, anemia, can produce many subtle problems, avatars, if you will, of a problem in the shadows long before one appears pale and breathless; skin issues are among those.
- Children are largely adorable, but once they become teenagers, the word “irritating” comes to mind with some frequency. Maybe it is a harbinger of things to come that during pregnancy some women experience itching. If they have preexisting eczema, pregnancy may worsen symptoms, but it can appear in the absence of other conditions or disease states.
- Diabetes mellitus – meaning “copious sweet urine” due to the contained sugar – is rampant in our society and causes many problems with the heart, blood vessels, kidneys, eyes, nervous system, and skin. This has been a recurring theme in my columns – consider keeping weight under control and reduce intake of sugar and let the only sweet thing about you be your dreams, not your urine!
- Finally, problems with the nervous system can cause errant messages to be sent to the brain, fooling it into perceiving false stimuli which patients perceive as tingling, pain, burning, or itchiness, phenomena known as paraesthesiae. Examples would include multiple sclerosis or shingles, which can follow a prior episode of chickenpox; make a wish that this is not in your future as it can be very uncomfortable.
As you can see, the possibilities are wide and varied, and I have only included a small sample. Always seek to treat the disease first and deal with aviation medical issues second. Medications to treat the symptom of itching usually work by suppressing inflammation (e.g., steroids) or impacting histamine release (antihistamines, which are often sedating). Consider fitness to fly, every time you fly, and never do so when not 100% fit and certainly not if taking forbidden medications.
Sometimes, having an itch you want to scratch refers to an intangible element in your life, something you need to do, a conversation you feel compelled to have. It is, in my opinion, always preferable to say what you mean and mean what you say and get it off your chest. But if you have a persistent and tangible itch on your chest, and it endures or disturbs your sleep, scratch the urge to scratch it and instead, see your doctor.