5. ◼ “local discomfort or irritation of the skin,
prompting the sufferer to scratch or rub
the affected area. It is the main symptom
of skin disease”
◼ “a peculiar tingling or uneasy irritation of
the skin that causes a desire to scratch
the affected area”
6. “It feels as though every nerve ending in my
body is attacking me intensely at my
ankles, feet, lower legs, neck, under the
breasts (even the nipples tingle). It's
absolutely horrendous! My hands grow red
as a beet and the itching nearly takes the
skin off my hands as I scratch.”
“ It’s like someone tickling you under
the skin”
8. ◼Free nerve endings
fibres most concentrated
in wrists and ankles
Unmyelinated C fibres to
dorsal horn in spinal
cord
◼Scratching is a spinal
reflex response ascends
to cerebral cortex via
spinothalamic tract
◼Skin inflammation
◼Psychological concerns
◼ Chemical mediators
Substance P
Opioid and non-opioid
peptides
Somatostatin
Neurokinin A
Histamine
Serotonin
Prostaglandins
◼ External mediators
Environmental heat or
dryness
9.
10.
11. ◼ History
including onset, duration, pattern, effect
on sleep, previous skin disease, contacts,
other medical problems, drugs, response
to treatment so far.
◼ Skin examination
features of rash, post-inflammatory
changes, signs of scratching
◼ General examination
57. ◼keep looking for a cause
◼avoid aggravating factors
temperature, humidity, bedding,
clothing
◼reduce damage from scratching
clothing, bandaging, cut nails
