“Scratching is one of the sweetest gratifications of nature, and as ready at hand as any,” Montaigne wrote. “But repentance follows too annoyingly close at its heels.”
It starts last week. A few itchy red lumps or bumps or baby hives and I don’t think that much about it. Just apply some steroid cream I have on hand. But by Wednesday night, it haa grown into a nasty rash all across my trunk and under my arms, with a few scattered patches on my legs. I make an appointment for a virtual visit with an NP for Friday afternoon, but unfortunately, she isn’t able to get a good enough look at the rash so she prescribea an antiviral and a stronger steroid cream. Saturday, I meet with my daughter for lunch and to walk along the mall near my house. I am in such discomfort, trying to fight off the overwhelming urge to itch. Sunday and I am at Urgent Care, wanting more than anything to jump out of my skin. The itch borders on painful and I find myself jerking my body in an effort to somehow separate from my skin, to sloph it off in a primal reptilian manner. I CAN’T LIVE IN HERE ANYMORE! After we check off an exhaustive list of possibilities, the doctor says the rash is most probably attributable to one of the psychiatric medications I am on and that I have to work through my psychiatrist to figure out what to do.
Though scratching can provide momentary relief, it often makes the itching worse. Dermatologists call this the itch-scratch cycle. Scientists believe that itch, and the accompanying scratch reflex, evolved in order to protect us from insects and clinging plant toxins—from such dangers as malaria, yellow fever, and dengue, transmitted by mosquitoes; from tularemia, river blindness, and sleeping sickness, transmitted by flies; from typhus-bearing lice, plague-bearing fleas, and poisonous spiders. The theory goes a long way toward explaining why itch is so exquisitely tuned. You can spend all day without noticing the feel of your shirt collar on your neck, and yet a single stray thread poking out, or a louse’s fine legs brushing by, can set you scratching furiously.
But how, exactly, itch works has been a puzzle. For most of medical history, scientists thought that itching was merely a weak form of pain. Then, in 1987, the German researcher H. O. Handwerker and his colleagues used mild electric pulses to drive histamine, an itch-producing substance that the body releases during allergic reactions, into the skin of volunteers. As the researchers increased the dose of histamine, they found that they were able to increase the intensity of itch the volunteers reported, from the barely appreciable to the “maximum imaginable.” Yet the volunteers never felt an increase in pain. The scientists concluded that itch and pain are entirely separate sensations, transmitted along different pathways. The Itch
I text her when I get home and she calls me back to me immediately. We suss out that it is probably one of the meds which the pharmacy switched to a different generic brand. We think we have narrowed it down to one medication and she calls the pharmacy and finds they have some of the old generic left. By now it’s close to six and they’re closing. My psych calls back to say she’s researched what ingredients are in both scripts and they contain identical ingredients.
… the itching was so torturous, and the area so numb, that her scratching began to go through the skin. At a later office visit, her doctor found a silver-dollar-size patch of scalp where skin had been replaced by scab. M. tried bandaging her head, wearing caps to bed. But her fingernails would always find a way to her flesh, especially while she slept.
Monday morning I am back at the pharmacy asking if they can look through my other prescriptions to determine if there has been any switch in what they gave me this month. No. That isn’t it. Monday afternoon I make an appointment to see a dermatologist. Of course, by Tuesday the itching isn’t quite as bad but the rash is still there so I keep the appointment.
This incident reminds me of a fascinating article I read some years back in the New Yorker aptly titled “The Itch.” It’s quite a lengthy piece and I recall reading it on a plane trip back from New York. The article is about a woman who develops an itch on her scalp and the various treatments she undergoes to try to figure out what is causing it.
Other researchers traced these fibres to the spinal cord and all the way to the brain. Examining functional pet-scan studies in healthy human subjects who had been given mosquito-bite-like histamine injections, they found a distinct signature of itch activity. Several specific areas of the brain light up: the part of the cortex that tells you where on your body the sensation occurs; the region that governs your emotional responses, reflecting the disagreeable nature of itch; and the limbic and motor areas that process irresistible urges (such as the urge to use drugs, among the addicted, or to overeat, among the obese), reflecting the ferocious impulse to scratch.
I just returned from the dermatologist. They had me strip down so they could get a sense of the scope of this darn thing. Said I was right to come in even though the rash itself has faded considerably and the itching is minimal.
What’s the worst itch you ever had?
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