The Seven Year Itch

The titular 1955 movie directed by Billy Wilder is a great piece of American cinema and of course, features Marilyn Monroe at her beguiling best. 

The title emanates from the belief, often justified with all sorts of psychological data, that long-term relationships of the romantic type suffer turbulence at the seven-year mark and changing “altitude” is the suggested resolution. My focus today is the itch, which may, on occasion, have an intimate component (see comments about Tinea below)!

In the medical world, we have $100 words for everything, and our phrase for itching is pruritus, maybe followed by the anatomical location of the sensation; hence pruritus ani means “itchy bottom”! It was the German physician Samuel Haffenreffer who described itching in 1660 as “an uncomfortable sensation that provokes a desire to scratch.” This is sadly a rather circular definition as scratching is characterized as that act used to address an itch!

Although initially believed to be on the pain spectrum, we now know that itching has its own nerve channels called “C fibers,” and often it is the release of a chemical called histamine locally that potentiates the feeling. Having the urge to learn to fly is like an itch that must be scratched; but scratching a real itch often makes it worse as more histamine is released.

There are many causes of itching from the minor to life-threatening. Often it is something very benign like dry skin, which becomes more common with increasing age but can be treated with a moisturizing cream. Pilots are quite likely to experience this due to arid air at cockpit altitude, which is why airline toilets and amenity kits include cream to address this. If a new itch develops, it is worth thinking whether one has purchased new clothes or tried a new soap, laundry detergent or other domestic chemical, as these are common reasons for an allergic itch.

Some common North American irritant plants contain urushiol, an oil that induces histamine release and local swelling. The famous Allan Sherman song “Hello Muddah, Hello Fadduh” addressed an itch caused by poison ivy, which together with poison oak and sumac can induce an unpleasant reaction in those sensitive to urushiol. Sometimes, several exposures may be required before the effect is felt, but when it arrives the sensation is wretched with extreme pruritus and a linear, red, raised rash. Even the slightest touch can transfer the toxin to other parts of the body or merely touching the fur of a beloved pet can convey the guilty oil.

Various insects can produce profound itchiness, mosquitoes being the most common. However, a walk in the woods can expose one to chiggers, the larval form of a mite that use their saliva to bore a hole into your skin and then have a mighty feast. I once experienced this after a hike in the Blue Ridge Mountains, and to look at my profoundly itchy feet and see a multitude of tiny moving dots with developing red spots was quite scary. Hot soapy water may help, but often steroids are needed either as a local cream or a course of tablets. Other similar experiences can be had after bed bug bites, which are more common amongst road warriors like pilots (“Sleep Tight,” AOPA Pilot magazine, November 2011 page 36). Other infestations may include scabies, which requires specific treatment, or many other critters. Airfields are minefields in this regard as bugs like to camp out in the grassy areas adjoining tie-downs and hangars just waiting for unsuspecting pilots to wander along.

Various common skin fungal infections can be the culprit with names like “jock itch” or Tinea cruris (a fungal infection in the groin or other warm, moist areas), “athlete’s foot” or Tinea pedis. However, one does not need to be an athlete – they affect the obese, people who tend to sweat a lot, or those in sedentary situations, like pilots. Similarly, several viral infections from measles to HIV/AIDS can make one very itchy as may several chronic diseases like diabetes or kidney failure.

Deficiencies of iron and various vitamins (A, B12 and D) can cause an itch as may pregnancy and a host of medications, most commonly due to an allergic reaction such as to penicillin and associated antibiotics. A particular kind of drug-induced itch is formication, a sensation of ants crawling over the skin, common with cocaine use.

Any interference with liver function, whether due to hepatitis infection, a blockage from a gall stone or tumor can cause jaundice, a yellowing of the skin, often associated with nasty itching, and sometimes cancer without jaundice can have the same effect because the malignancy produces toxins that affect the body in many ways. Finally, psychological issues can lead to an itch developing.

If a new itch develops and the cause is not immediately apparent as above, it is not easily mitigated with a cream or other simple over-the-counter treatment or it persists, see your doctor. Taking a careful medical history and performing a diligent examination will reveal the reason in most cases, but because the basis for the itch may be occult and malicious, diligence in identifying the basis is necessary. If an itch is associated with any generalized illness or is so irritating it may cause a distraction to you as PIC, self-ground until resolved. If a medical appointment is sought or specific treatment required, be sure to report to your AME at the next appointment. Of course, if a serious cause is to blame, self-ground until all is resolved.

Those who read my column know I enjoy finding musical links to the topic of the day, as above with Allan Sherman. Yes, Willie Nelson performed a song called “Seven Year Itch” and the Scorpions (who were purportedly funded by the CIA to record “Winds of Change”) laid down “The Scratch.” But the best itch-related song title I found was “Hell’s Itch” by the magnificently named “King Gizzard and the Lizard Wizard.” Scratch the itch to go flying but take that other itch to your doctor so that you can fly well!

You can send your questions and comments to Dr. Sackier via email: [email protected] and listen to his weekly podcasts on health issues at The EMJ Podcast available on Spotify, Apple, Amazon Music, www: or wherever you get your podcasts.

Jonathan Sackier

Dr. Jonathan Sackier is an expert in aviation medical concerns and helps members with their needs through AOPA Pilot Protection Services.
Topics: Pilot Health and Medical Certification, Pilot Health and Medical Certification

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