While most of you were out enjoying barbecues, picnics, or sunny days at the beach, I was sitting indoors trying really, really hard not to scratch myself silly. The bumps came on Saturday and reached an unabated crescendo in the wee hours of Tuesday morning — just in time to render me sleepless and senseless enough to have to cancel my morning appointments in favor of a visit to the dermatologist.
As I suffered, distracting myself with cool showers and warm soaks interspersed with some guilty pleasure reading (Game of Thrones, I’ll confess), I couldn’t help wondering … at what point does itching become worthy of an ER visit? Luckily, I’ve not been forced to find out. But I came damn close.
Creams, lotions, gels, tonics, tinctures, shampoos and powders … they all made it onto my skin over the weekend. Even my huge gnarled heads of backyard aloe took one for the team, as I sacrificed a few of its dreads for my plight. Poor, poor me.
So it was that my firework phobics hardly figured into this Fourth of July. Instead, I ruminated relentlessly on all my chronically-itchy patients in all their Sisyphean misery. Poor things! Was I truly doing enough to alleviate their collective itch?
Because it’s true, you know. Nothing makes you want to solve a problem all the more than a personal taste of its poisonous wrath. And nowhere is this more evident than when it has to do with a symptom so perfectly plain, despite the species divide. After all, itchiness is itchiness, whether you’re furred, feathered, scaled or otherwise overlaid.
Which is probably why I took notice of an e-mail I’d recently squirreled away for a slow, post-less day. "Topical therapies for skin disease," it read, offering this tempting tidbit as lure:
Topical medication, either as a primary or adjunct therapy, plays an important role in treating dermatologic diseases, particularly when systemic therapy is not available or desirable.
For allergic patients, topicals help remove allergens and may help manage pruritus (itchiness) and secondary bacterial or yeast infections. In these patients, topical therapy is also currently focused on repairing the skin barrier, although this area of topical therapy is in its infancy and its benefits have not been well-established.
Now, that may not sound seductive to you, but to me, in all my pruritic glory, it was like manna from heaven. Feed me more, I begged, clicking hungrily at my Mac’s track pad.
Technology being what it is, my machine complied, leading me to a perfectly accessible dermatology article that any of you with an inclination to could easily digest. But let me break it down for you anyway:
Topical therapy for skin disease is a growing field of study in veterinary medicine. Because owners are willing to put more time into (and shoulder greater expenses for) their pets these days, time-consuming and wallet-shrinking options once considered feasible only for the human medical marketplace are being increasingly evaluated for their potential efficacy in pets.
According to the article, these are the indications for which they’re most likely to be employed:
- Pruritus (itchiness)
- Skin infections
- Skin barrier protection
- Seborrhea (flaky skin)
And these are the specific cases in which topical therapeutics might be best suited:
- When antibiotics have been ineffective
- When the efficacy of oral therapy is incomplete
- When the resolution of infection is too slow
- When recurrent infection might be better prevented
To which I might add another bullet point:
- When bringing itch relief to my suffering patient, faster, more reliable, and more long-lasting is of utmost importance. (God, could I get jiggy with the faster thing after this past miserable weekend.)
This raises a bunch of itch-relieving tips designed specifically for the dermatologically challenged:
- Colloidal oatmeal soaks or poultices, though limited in their efficacy, will almost always help soothe skin that’s inflamed for any reason.
- Topical anesthetic ingredients, such as pramoxine or lidocaine, are undeniably effective, at least for short stints.
- Topical antihistamines don’t seem to work so well, while topical glucocorticoids (cortisone-like drugs, like triamcinolone) are rarely ineffective.
- Lime-sulfur dips are all-organic, but way gross and truly smelly. Still, once applied, they reliably offer significant itch relief.
- Phytosphingosine is the new kid on the block, but it bears watching to see whether it’ll pan out as the topical powerhouse it’s currently billed as.
- As the article notes, "Shampoo therapy also provides the benefit of washing away allergens that may be directly absorbed through the skin and trigger skin inflammation and pruritus."
- Shampoos undeniably serve to limit the bacterial and yeast component inherent to any inflammatory skin disease. Bathing itchy pets every one to seven days is considered a mainstay of most itch therapy, regardless of your other approaches.
Yeah, so that’s all I’ve got on the animal front. Which brings me back to my own personal disease:
Technically it’s called a morbilliform (measles-like) eruption, almost certainly secondary to a viral infection. (That cough and malaise and crappy Sunday morning run? Not a fluke.)
It will go away, they said, sometime between today and a month from now. That is, unless I take some prednisone to make it go away sooner.
And guess what? This woman who swore she’d never-ever take corticosteroids for naught? She broke down and swallowed her first forty milligrams of pred just today … almost happily … because nothing screams "treat me!" like an itch.
Dr. Patty Khuly