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PRURITIS: or itching, is the most common skin complaint. It can be caused by insect bites and stings, poison ivy or oak, sunburn, or dry skin. Itching can also signal something more serious, including diabetes mellitus, hypothyroidism, gout, leukemia, lymphoma (cancer of the lymph nodes), infection by parasites, kidney failure, or liver disease. In an estimated 10% to 50% of cases, generalized itching over a large area of the body that lasts more than a week is a symptom of systemic disease requiring a doctor's attention.
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DRUG TREATMENT: Corticosteroids are the most effective option for relieving itching from simple rashes, hives, bug bites, and poison ivy, but not the safest. They are potent drugs that normally aren't sold without a prescription. However the FDA has allowed two of them, hydrocortisone and hydrocortisone acetate, to be sold in low dosages over-the-counter. These steroid creams are effective because they inhibit the body's elimination of irritants and prevent the release of histamine. One problem is that if the irritant is not removed, the rash is liable to come back in full force when the drug is stopped. A worse problem is that when inflammation is reduced by suppressing the immune system, resistance to infection is lowered at the same time. The result can be secondary infection, including boils and thrush. If the cream doesn't work after a week, or if the rash returns after you stop using it, you should see a doctor. Other potential adverse effects of topical steroids include allergic reactions, irreversible marks on the skin, unwanted hair growth, and acne. If used on children's skin or in large amounts by adults, the drugs can also enter the general circulation and reach the pituitary, where they can have systemic effects such as those seen with systemic steroids. Other over-the-counter itch remedies are local anesthetics -- drugs with active ingredients ending in "-caine." Their main drawback is that they can cause sensitivity reactions in susceptible people. Those who react most severely to poison ivy and poison oak are most likely to have an allergic reaction to local anesthetics. The effects can be skin rash, hives, and eruptions. When large amounts of some of these drugs, including lidocaine, dibucaine, and tetracaine, are applied to large areas of damaged skin, much of the drug is absorbed. Life-threatening toxic reactions can result. This reaction is rare and does not happen with benzocaine, which is insoluble in body fluids.
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