Why Your Body Itches

Itch is not exclusively limited to skin conditions like atopic dermatitis. Various causes can induce itching. We often see discussions identifying impaired blood circulation as a primary cause of itching. Therefore, prescriptions that aid in dispelling wind and moving blood (消風行血) and similar remedies are frequently utilized.

According to Traditional Korean Medicine (TKM) pathophysiology, itch is classified under 'external wind,' and it is stated that "herbal medicines like *Seontae* (蟬蛻 Cicada Slough), *Ubangea* (牛蒡子 Burdock Fruit), and *Baekseonpi* (白鮮皮 Dictamnus Root Bark), which dispel wind and relieve itch (消風止痒), are primarily utilized."

There are also treatments, such as *Gua Sha* (刮痧) therapy, that improve blood circulation to the peripheral skin by means of scraping. However, in skin diseases, scratching can irritate the skin and worsen the condition, so scratching should be minimized.

Neurological Understanding of Itch

Itch stimuli travel from the peripheral skin to the central nervous system via nerves. Besides histamine, various other pruritogens exist.

Similar to pain, there's a component where the central nervous system reinterprets the signals. Thus, in cases of chronic pruritus, it's necessary to consider central nervous system changes, much like in chronic pain.

Data Source: Kamata, Y., Tominaga, M., & Takamori, K. (2016). Itch in Atopic Dermatitis Management. Current Problems in Dermatology, 86–93. doi:10.1159/000446048

Treatment Options for Pruritus

The table above summarizes treatment options and their mechanisms that are beneficial for itch symptoms. It also introduces Korean herbal medicine and acupuncture. Research shows quite effective itch-relieving effects of acupuncture treatment on acupoints such as *Gokji* (LI11) and *Pungji* (GB20).

In my personal opinion, if itch control is difficult during the treatment process, a limited combination of antihistamines is not a bad option. In very severe cases, resembling peripheral neuropathy, it's referred to as neuropathic itch, and medications like gabapentin and pregabalin may be used.

Additional Treatment Methods

Mohammad Ali, B. M., Hegab, D. S., & El Saadany, H. M. (2015). Use of transcutaneous electrical nerve stimulation for chronic pruritus. Dermatologic Therapy, 28(4), 210–215. doi:10.1111/dth.12242

There are also studies suggesting that Transcutaneous Electrical Nerve Stimulation (TENS) can help alleviate itching in various chronic pruritic conditions such as atopic dermatitis (AD), lichen simplex, and hepatic itch. What's interesting about this study is that it examined how effectively itching could be controlled with TENS alone after discontinuing antihistamines or steroids.

The Relationship Between Atopy and Itch

In atopic dermatitis, NEF becomes dominant over NRF, leading to c-fiber nerve endings extending further into the epidermis. Consequently, the skin becomes more sensitive. Not only are there more pruritogens that can induce itching, but the response to them is also more sensitive, so it's understandable that the itch can be maddening.

Summary

• Chronic itching is more difficult to treat than expected.
• All available methods must be utilized to control itching to achieve a successful treatment response for atopic dermatitis.
• *Gokji* (LI11), bloodletting, dermal needle therapy, TENS, moisturizers, nail clipping, Tubifast, etc.