Itchy scar question

October 11, 2023 12:48 PM

On June 15 I had a revision surgery to implant a new CRT-D lead and generator. The new scar is ITCHY AF. It feels like it's itchy on the inside too. It was not like this with my first surgery 6 years ago, and I need suggestions for stopping the itch. Pics and more info inside.

I was using bio oil but then switched to mederma. I hadn't had problems with it before, but I think it was making things itchier so I stopped using it and went back to bio oil. But the itch is still there all around the scar, the scar itself, and it feels like inside the pocket where the generator sits. And the whole area is still tender, which again I don't remember from last time. The old scar (which I'd had no problems with) is now ultra sensitive too.

I have tried the anti itch benadryl spray, which helps but does nothing for the inside itch. I am continuing the bio oil nightly.

I want to point out I don't care about the fact of the scar, or the appearance of the scar (much), it's really the itch/tenderness that is driving me batty.

Suggestions for how to help this go away?

Pic 1
Pic 2
Pic 3

Oh, I was at my dermatologist for another reason a few weeks ago and asked her to look at it. She said it looked "fine" and offered cortisone shots to make the hypertrophic scar shrink, which I declined for now.

posted by misanthropicsarah to Health & Fitness (12 answers total)

Best answer: Wouldn't the cortisone help with the itching too??
posted by Elysum at 1:08 PM on October 11, 2023 [3 favorites]

Best answer: The application of corticosteroids for pathological scar prevention and treatment: current review and update" (2023) has pros and cons of topical and injected cortisone; "Corticosteroids are the mainstay drugs in clinical scar prevention and treatment as they effectively induce scar regression and improve scar pruritus and pain. [...] Intralesional injections deliver corticosteroids directly into scar tissues, resulting in a high local drug concentration. Numerous randomized controlled trials (RCTs) and meta-analyses have demonstrated their effectiveness in improving the congestion, texture and height of pathological scars, as well as local symptoms such as pain and itching".
posted by Iris Gambol at 1:28 PM on October 11, 2023 [1 favorite]

The tenderness especially makes it sound to me as if you might have a minor infection:

From the Danish Pacemaker (PM) and implantable cardioverter-defibrillator (ICD) Register, we included consecutive Danish patients undergoing CIED implantation or reoperation from January 1982 to April 2018, resulting in 97 750 patients, 128 045 operations and follow-up of in total 566 275 device years (DY). We identified 1827 DRI causing device removals. Device-related infection incidence during device lifetime was 1.19% (1.12–1.26) for PM, 1.91% (1.71–2.13) for ICD, 2.18% (1.78–2.64) for cardiac resynchronization therapy (CRT)-pacemakers (CRT-P), and 3.35% (2.92–3.83) for CRT-defibrillators (CRT-D).

posted by jamjam at 2:07 PM on October 11, 2023 [2 favorites]

I would most definitely call the surgeon who did your revision in June and ask them for guidance. If you have access to a patient portal that would let you upload those photos, even better. The way it looks and the symptoms you describe are concerning for infection.
posted by little mouth at 3:26 PM on October 11, 2023 [6 favorites]

This may or may not be appropriate to your situation, but... I have had recurrent skin condition for years that exhibits much itching flare ups that can last a month or so, usually at a fairly localized area. I've found a weird and reasonable solution to combat itchiness is to use a topical capsaicin medication that's intended as topical pain relief. It seems to just replace the itching sensation with a burning sensation, which I find far more tolerable than the itching. I also find I feel much less impulse to scratch the burning area. The stuff I buy is from the local 99 Cent Only store, an alcohol based substance in a small bottle with a pad applicator. I've seen what I think is a comparable product at a CVS, but it was much more expensive, so I stick with the cheap stuff.
posted by 2N2222 at 4:10 PM on October 11, 2023 [1 favorite]

In addition to resolving the not significant annoyance of being itchy, I'd be concerned about a bacterial or fungal infection that could be causing the itching. Resolving the symptom of being itchy would just mask a potential underlying infection.
posted by RoadScholar at 4:25 PM on October 11, 2023 [1 favorite]

I have had some relief from using IPL Laser Handset. But check for infection or possibly an allergy reaction - depending on the coating an allergy/sensitivity might be happening
posted by Barbara Spitzer at 5:56 PM on October 11, 2023

This advice is assuming there is not any infection or other serious issues. Definitely rule those out.

I had a couple of surgeries on my chest. I found the weird itch and nerve pain to be irritating. My doctor recommended using a small massager like those bug shaped ones on the area to relieve the itch/burn. Basically using the nerve overloading/gate control theory to give a break from the unpleasant sensations.
posted by CleverClover at 8:07 PM on October 11, 2023

This sounds like when I used biooil a schooch too early and got infected.. urgent care provider stat!
posted by eastboundanddown at 12:33 AM on October 12, 2023

As described above, if all is good medically infection wise and such, and hoping these won't be an issue for the implant (so checking with your Doc), I've found the cheap piezoelectric mosquito bite relief things really good to get relief from a variety of itchy healing scars (not just bites).
posted by many-things at 3:11 AM on October 12, 2023

I find that pressing firmly on my surgical scars makes the itch under the tissue abate. I just press it firmly for about half a minute and them move to another location. Finger tips work, or something hard and smooth, like a small round rock. Massaging that way may also help, but just pressing definitely does for me.
posted by Jane the Brown at 2:55 PM on October 12, 2023

Best answer: As others have said, first definitely rule out infection.

If it is not an infection, then it is possible you might be allergic/sensitive to one of the ingredients in the oil/topicals you have used. I would stop using everything and see if things clear up, or stop everything and try a bit of hydrocortisone cream topically to see if that helps. Your dermatologist may have some further suggestions on what to use if it does turn out to be some kind of allergy.
posted by gudrun at 1:30 PM on October 14, 2023