Itchastitch

May 3, 2012 12:31 PM

Has anyone ever had an itchy skin problem, with or without a medical diagnosis, seen a shrink about it when dermatology didn't seem to be helping much, and the shrink treatment helped?

I'm not talking about being aided by practical, common-sense advice the shrink might give, such as "stop wearing itchy clothes". Nor am I talking about techniques to stop scratching/picking/plucking, which anyone can read about on the Internet, and which don't help much if the itch is bad.

I ask this question because dermatologists sometimes tell their itchy patients to see a shrink. Does it ever work? Especially if there is an actual chronic dermatological condition (not just "itchy skin, dunno why")?

I suppose if the shrink helps you figure out some way to decrease stress in your life that you couldn't figure out on your own, then that might work. But what about medications, or hypnosis? Do any psychotropic meds ever help with itching? (My derm did prescribe a prescription strength oral antihistamine and prescription strength topical cortisone drops. We don't know if that will be enough.)

Also, if you pick the shrink your dermatologist recommends, is there any chance that the shrink was recommended because the dermatologist knew that this shrink specializes in this sort of thing? Is there a good reason a derm would recommend a particular shrink, or is it based on affiliations?

posted by whatdidyouforgettoday to health & fitness (16 answers total)

I have no personal experience with this sort of thing, but you might want to read The Itch, by Atul Gawande, which talks about the neurological basis of itching and about behavioral/psychological/neurological treatments for itching.

But from what I understand, there are definitely brain-based (i.e. psychological or neurological) interventions for itching, even when the itching is the result of bodily illness. I would guess that some psychologists are going to have more expertise in this area than others, and I would hope that the dermatologist would make recommendations accordingly, but I have no idea.

Warning: the article has really graphic descriptions of extreme itching (and scratching to the point of super-gross injury), such that I got itchy just googling for it.
posted by mskyle at 12:40 PM on May 3, 2012

IANAD, nor did I go to a shrink for my affliction, but I had horrible atopic dermatitis (general itchiness and chemical sensitivity) towards the end of college--I was VERY stressed, both by school and my social/living situation at the time--my anxiety was at an all-time high (and my lifestyle was probably not the healthiest either, which I suspect did not help). I tried all sorts of creams, switched to unscented everything, etc. and nothing worked.

Someone (an older, wiser adult) told me at some point, "I bet $100 this will go away when you graduate"....and it totally did. My life is pretty low-stress now and I have not had a problem since, but have found that when I do occasionally have bouts of anxiety, I do get the itchies back again.

Wish I could provide something more concrete than my own personal experience, but I very much believe in the psychological-physical connection. Interestingly, the only thing that brought me any relief (besides benadryl) when the dermatitis was at its worst was drinking--that sounds so terrible, but I was drinking like, half a bottle of white wine every night and the only thing I can think is that it really, really relaxed me. I will watch this thread because I'm very interested in what others may have to offer you in terms of an explanation.
posted by lovableiago at 12:48 PM on May 3, 2012 [1 favorite]

FWIW, I had a general practitioner say something to the effect of 'maybe it is psychological' when I went in with weird pain and I took it that he didn't really know what to do/say/diagnose. (Because he did not order any further tests/labwork or prescribe anything). So it is not just a derm thing.

But since your doc is genuinely trying to help you and gave you prescriptions I think there might be something to it. I can’t really answer your questions, sorry. But I think there can be benefit in a) talking about the itching b) learning techniques how to deal with the itching c) talking about the stuff that does put stress on you (Sometimes we might not even realize how much stress is affecting us and the body has weird ways to react to it). And I see you put the tags 'anxiety' and 'stress' in here, so maybe there is stuff worth talking about.

Is there anything to lose in trying it? I don't think so. I second that psychologists have different areas of expertise. If you feel uncomfortable with the one recommendation, you could always call several others in your area and ask if this is something they have experience with. Good luck!
posted by travelwithcats at 1:04 PM on May 3, 2012

It didn't help with the itching, but the meds from the shrink helped me deal with the fact that I had been itching for months and none of the meds the dermatologist was prescribing were helping.
posted by capsizing at 1:11 PM on May 3, 2012

When I had completely infuriating yeast/not yeast/ dermatitis itching, 10mg (low dose) prozac helped a ton. Because with itch, there's this cycle between mind/anxiety and physical irritation that it can be really tough to break the chain. (Even when there is a diagnosed condition, stress and mental focus can create a sort of negative biofeedback and affect physical symptoms.)

It's really helpful to get rid of the either/or model of mind and body, because they can totally cause effects in the other domain.
posted by IANYsock at 1:22 PM on May 3, 2012 [1 favorite]

In a larger context - did you see this post:
A hidden children's health crisis.

It gives a broader context for the idea that the relationship between stress/mental state and illness is more far-reaching than commonly understood.
posted by IANYsock at 1:25 PM on May 3, 2012

Has anyone ever had an itchy skin problem, with or without a medical diagnosis, seen a shrink about it when dermatology didn't seem to be helping much, and the shrink treatment helped?

Sort of. A few years ago I developed a scalp condition and when OTC treatments didn't help I saw a dermatologist (who I had seen for somthing else). She was kind of weird about it, which I didn't get. She gave me some trial shampoo and it didn't work. Since she has my medical history and what medication I'm on, she asked if I was still seeing my therapist for my anxiety and I said yes. She suggested that maybe my scalp issue was related to that.

Anyway, it took a couple of months but with the help of my therapist I figured my scalp thing out. When I was getting really anxious, like on the verge of an anxiety attack I would start to pick my sclap. The more anxious I got the more I picked so I had this crusty scabs on my scalp from all the picking.
posted by OsoMeaty at 1:28 PM on May 3, 2012

I have a close friend who had a severe itchy skin problem that doctors and dermatologists couldn't fix. It was absolutely helped by reducing stress, seeing a therapist, and using anti-anxiety medication.
posted by thejanna at 1:47 PM on May 3, 2012

I've never read about anyone else experiencing this (nor have I ever googled it actually so it may be a thing that dermatologists see often), but I used to use scratching as an unconscious form of self-harm. So, maybe that's a possibly in their minds, as well as the usual stress-itching connection?

I had nasty eczema as a kid, and it itched like crazy all the time. Later that receded, leaving me with dry skin. But I kept feeling really itchy, more itchy than my remaining skin issues warranted, and would regularly scratch until bloody. It wasn't a shrink but a very psychiatrically knowledgeable boyfriend who pointed out that the itching was probably decoupled from skin problems at that point. I scratched most when I was stressed and he could see me using it as a self-punishing thing. Once I was aware of the weird comfort/punishment dynamic that I felt when I scratched, the itching miraculously mostly disappeared. Now I only itch very slightly if my skin is particularly dry.
posted by pickingupsticks at 1:50 PM on May 3, 2012

Similar story to lovableiago. A decade ago I was going crazy with an itching that would spread all over my body at night. This went on for a year or two. I went through rounds of allergy testing, took all kinds of antihistamines and other drugs with no results, got a HEPA filter to suck suspected allergens from the air, and had a service come and do a deep clean of my apartment and so forth.

Toward the end either my dermatologist or allergist tactfully suggested a shrink, but I found that approach absurd since the symptoms were real and physical. How could they possibly be caused by anything but something in the environment?

Then I got divorced. And a couple of weeks later, temporarily living in a moldy little rental house in the woods, I realized the itching was completely gone. It never came back, either.

So yes, it can be completely psychological.

p.s. I'd forgotten about this part, but lovableiago's experience with a good amount of wine reducing the itching was exactly the same as mine! Which should have rung some kind of warning bell at the time, because red wine is full of histamines and logically should have exacerbated any itching rather than reducing it.
posted by bassomatic at 2:52 PM on May 3, 2012 [1 favorite]

I ask this question because dermatologists sometimes tell their itchy patients to see a shrink. Does it ever work? Especially if there is an actual chronic dermatological condition (not just "itchy skin, dunno why")?

I think it does-- by virtue of what we call the placebo effect, although the meaning of that term is shifting as underlying mechanisms come into view.

A recent study in Nature has shown that the placebo effect for non-opiate pain relievers works because of the action of endocannabinoids (endogenous cannabinoids).

There are a number of studies showing that cannabinoids can be effective in controlling otherwise intractable itching:

Most recently, researchers at Wroclaw, Poland's University of Medicine, Department of Dermatology, reported that application of an endocannabinoid-based topical cream reduced uremic pruritus and xerosis (abnormal dryness of the skin) in hemodialysis patients.[4] Three weeks of twice-daily application of the cream "completely eliminated" pruritus in 38 percent of trial subjects and "significantly reduced" itching in others. Eighty-one percent of patients reported a "complete reduction" in xerosis following cannabinoid therapy.

This doesn't contradict what others have said about reducing anxiety and stress, it merely proposes a physiological mechanism for how that reduction could do the trick.
posted by jamjam at 4:59 PM on May 3, 2012 [1 favorite]

I went through an extreme itchy spell this winter that had me seeing a dermatologist and an allergist. After ruling out a lot of things (beyond one allergy), the allergist prescribed me, among other things, an antipruritic that also has soporific and mild antidepressant effects. Also, anecdotally, my itching did seem to get better after a certain out-of-my-control work situation was resolved (though that also coincided with the end of winter, so who knows?). So it does make sense to me that there could be some use in investigating psychiatric methods of dealing with the itch, if you've exhausted other modes of treatment.
posted by limeonaire at 6:10 PM on May 3, 2012

I have dyshidrotic eczema that flares up like clockwork when I'm stressed. Reducing my general anxiety level does wonders. I used to be as big a skeptic as anyone about the mind-body connection in circumstances like these but it is very, very real.
posted by dixiecupdrinking at 7:06 PM on May 3, 2012

The skin is the largest organ, and is sensitive to stress of any kind---physical or psychological.

All my life my skin has reflected my emotions---including sometimes breaking out in hives from physical stress (sleep deprivation, for example), or emotional intensity of various kinds. I haven't seen a shrink, or even made a dermatology appointment about it; I've just accepted it as part of life...I get a yearly skin scan, and usually there is an area somewhere that's a bit red and itchy; the dermatologist just remarks that itchy skin is fairly common, especially for fair-skinned people.

I've found that taking brewer's yeast, which is high in B vitamins, helps. Wearing only natural fabrics--cotton, wool, silk---and absolutely NO polyesters or acrylics---helps considerably. I use only cotton sheets and pillowcases. I use natural skin care products, like Trader Joe's or Burt's Bees, and body soaps like Ivory.
posted by ragtimepiano at 10:16 PM on May 3, 2012

PS: For an itch that is so severe that it keeps you awake all night, calamine lotion will soothe it.
posted by ragtimepiano at 10:18 PM on May 3, 2012

i had really bad itchy eczema on my hands and wrists for several months, for the first time in my life - which i attributed to a very stressful job and extremely dry ambient air in my office - i went to the gp and the specialists, they gave me essentially palliative creams & whatnot, some stronger than others, none of which made it go away, but when i got hooked up with some sleep medication by yet another doctor to deal with my insomnia - boom - a couple of days later the eczema was gone, and it hasn't come back in the year subsequent. for me the cause and effect couldn't have been clearer - it wasn't that the environmental stressors were independently causing the eczema, it was that shitty useless sleep wasn't letting my system heal itself. all catabolic, no anabolic.
posted by facetious at 11:22 PM on May 3, 2012