Act Like a Doctor, Think Like a Patient

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The Itch That Ate Brooklyn

The Meaning of Itch

If I asked what bothers people about itch and you said, “Because it’s itchy!” you would just be partly right.

Itch means many things.  Itch is annoying, of course, but it’s also embarrassing.  “My co-workers look the other way because I sit at meetings scratching like a monkey,” people say.  Scratching inflames the skin and may leave extra pigmentation, which also embarrasses people.  The other day I saw a teenager with terrible, lifelong eczema that she hadn’t even bothered to treat for a long time.

“How come you decided to do something about this now?” I asked her. 

She pointed to her collarbone.  “These brown spots,” she said.  Seems she could deal with the itch fine, just not the extra color the itch left behind.  Other people can see it, and nobody likes to be stared at.

Many times what bothers people is not the itch itself but what the itch might mean.  Cancer, for instance.

If you scan the internet, you’ll get the idea that a mole that itches can be trouble.  Well maybe it can, but I don’t remember the last time I saw an itchy mole that actually was trouble.  I spend a lot of my days reassuring people that the itchy spot they’re worried about just got irritated or rubbed and doesn’t need to be taken off.

Patients troop in all the time complaining, “My back itches.”  (They often seem somewhat amazed by this, as though it’s a very rare symptom.)  Especially when we’re older, our bodies develop all kinds of spots: freckles from ancient sunburns, brown “liver spots”, keratoses, those nasty barnacles we collect as we age.  New spots worry people anyway, just because they weren’t there before.  If new spots start to itch—and they’re on the back where you can’t see if they’ve changed—that makes people even more anxious.  Everybody knows that could be trouble.

In other words, when people say, “My back itches,” what they’re really wondering is, “What the devil is going on back there??!!”  For most of them my answer is, “Not much.  Forget about it.”

My profession is good at asking certain questions about itch: Which diseases cause it, what caliber of nerve fibers carry itch impulses, what treatments blunt it.  These are good questions, but often they’re not the most important ones—to the patient who itches.

If what bothers someone is not so much the itch but the resulting pigmentation, that’s what needs to be addressed.  And if—you’ll have to take my word for how often this happens—the real issue is not the itch but what scary things it could mean, then the best thing the doctor can do is say it’s OK to ignore it.

Reassurance is better than Benadryl.  Doesn’t make you groggy either.

Dr. Alan Rockoff has practiced Dermatology since 1979. He is Clinical Assistant Professor of Dermatology at the Tufts University School of Medicine.

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