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Stress also can make itch worse. This makes managing stress a particularly important skill for people with psoriasis. Consider the following ways some people with psoriasis and psoriatic arthritis are effectively reducing stress in their lives. Simply treating your psoriasis can help reduce itch. If your psoriasis is moderate or severe, or your itch is particularly bothersome, consider asking your doctor to put you on a more aggressive treatment. Aspirin and noradrenergic and specific serotonergic NaSSA antidepressants also can relieve itch, Yosipovitch says.

Gabapentin, a drug more commonly used to treat neurological pain, can help, too. Relief is possible. Learn the treatment options that are there for you in our fact sheet.

Pal and the Big Itch

The program highlights over-the-counter products that have been created or are intended to be non-irritating and safe for people with psoriais and PsA, as well as individuals living with severe sensitive skin or joint mobility limitations. Visit the full product directory.

How much do you know about your psoriatic disease treatment options? The National Psoriasis Foundation NPF is a non-profit organization with a mission to drive efforts to cure psoriatic disease and improve the lives of those affected. The National Psoriasis Foundation does not endorse or accept any responsibility for the content of external websites.

The National Psoriasis Foundation does not endorse any specific treatments or medications for psoriasis and psoriatic arthritis. Login Become a Member. Have questions about psoriatic disease? Managing itch. Read on for tips on handling the itch of psoriasis. Stress and itch Home remedies Prescription treatments. Stress and itch Stress is a common trigger for a psoriasis flare.

Jon-Kabat Zinn, M. He describes mindfulness as "paying attention in a particular way on purpose, in the present moment and nonjudgmentally. You can give it try yourself: For 15 minutes, sit comfortably on the floor, with eyes closed or barely open, and focus on your breathing. Exercise increases production of endorphins, chemicals that improve mood and energy.

Exercise also has been shown to improve sleep and decrease anxiety. A large U. Get outside help. Consider taking a course in stress management or finding a therapist in your area who specializes in stress management. Connecting with others who know what you are going through can help, too. Connect with someone who's been through what you're going through with Psoriasis One to One. You can also connect with people living with psoriasis and psoriatic arthritis on TalkPsoriasis.

Home remedies The following are ways people with psoriasis help relieve itch: Keep skin moisturized. This is the first step in controlling itch because it reduces redness and itching and helps the skin heal. Dermatologists recommend heavy creams and ointments to lock water into the skin. Cooking oils and even shortening can be inexpensive substitutes for commercial moisturizers. Remove scale and flaking. Apply a scale-softening keratolytic product to reduce excess skin and prevent psoriasis plaques from cracking and flaking.

Over-the-counter lotions that contain ingredients like salicylic acid, lactic acid, urea or phenol can help remove scale. Removing scale can reduce itch and make itch-relieving lotions and ointments more effective. Cold showers and cold packs also can offer relief. Avoid hot baths and try to limit showers to 10 minutes or less. Hot water can make skin irritation and dryness worse. Apply lotion after washing to lock in moisture. Store lotions in the refrigerator. The feeling of a cool lotion on itchy skin can help.

Over-the-counter treatments can help. There are several ingredients that have been approved by the U. Although pain is the most common symptom of shingles, Oaklander had noticed during her training that some patients also had itching, occasionally severe, and seeing M. It took a moment to realize why. Oaklander tested the skin near M. It was numb to temperature, touch, and pinprick. Nonetheless, it was itchy, and when it was scratched or rubbed M. Oaklander injected a few drops of local anesthetic into the skin.

It was an imperfect treatment, though. The itch came back when the anesthetic wore off, and, although Oaklander tried having M. Oaklander did not have an explanation for any of this. When she took a biopsy of the itchy skin, it showed that ninety-six per cent of the nerve fibres were gone. So why was the itch so intense? Oaklander came up with two theories. The first was that those few remaining nerve fibres were itch fibres and, with no other fibres around to offer competing signals, they had become constantly active.

The second theory was the opposite. The nerves were dead, but perhaps the itch system in M. The second theory seemed less likely. If the nerves to her scalp were dead, how would you explain the relief she got from scratching, or from the local anesthetic? Indeed, how could you explain the itch in the first place? The neurosurgeons stuck with the first theory; they offered to cut the main sensory nerve to the front of M. Oaklander, however, thought that the second theory was the right one—that this was a brain problem, not a nerve problem—and that cutting the nerve would do more harm than good.

She argued with the neurosurgeons, and she advised M. She let them operate on her, slicing the supraorbital nerve above the right eye. When she woke up, a whole section of her forehead was numb—and the itching was gone. A few weeks later, however, it came back, in an even wider expanse than before. The doctors tried pain medications, more psychiatric medications, more local anesthetic. But the only thing that kept M.

She spent the next two years committed to a locked medical ward in a rehabilitation hospital—because, although she was not mentally ill, she was considered a danger to herself. Eventually, the staff worked out a solution that did not require binding her to the bedrails. Along with the football helmet, she had to wear white mitts that were secured around her wrists by surgical tape.


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He had had shingles on his neck, she explained, and also developed a persistent itch. I met M. She is forty-eight now. She lives in a three-room apartment, with a crucifix and a bust of Jesus on the wall and the low yellow light of table lamps strung with beads over their shades. Together, they summed up her struggles, for she is still fighting the meaninglessness, the isolation, and the physiology of her predicament.

She met me at the door in a wheelchair; the injury to her brain had left her partially paralyzed on the left side of her body. She remains estranged from her children. She has not, however, relapsed into drinking or drugs. Her H. Although the itch on her scalp and forehead persists, she has gradually learned to protect herself. She trims her nails short. She finds ways to distract herself. If she must scratch, she tries to rub gently instead.

The two years that she spent bound up in the hospital seemed to have broken the nighttime scratching. Still, the itching remains a daily torment. Some of her doctors have not been willing to let go of the idea that this has been a nerve problem all along.

When to Get Emergency Help

A local neurosurgeon told her that the original operation to cut the sensory nerve to her scalp must not have gone deep enough. A new scientific understanding of perception has emerged in the past few decades, and it has overturned classical, centuries-long beliefs about how our brains work—though it has apparently not penetrated the medical world yet.

We believe that the hardness of a rock, the coldness of an ice cube, the itchiness of a sweater are picked up by our nerve endings, transmitted through the spinal cord like a message through a wire, and decoded by the brain. We do not know the world of objects, he argued; we know only our mental ideas of objects. Still, Berkeley had recognized some serious flaws in the direct-perception theory—in the notion that when we see, hear, or feel we are just taking in the sights, sounds, and textures of the world. And, the more we examine the actual nerve transmissions we receive from the world outside, the more inadequate they seem.

Our assumption had been that the sensory data we receive from our eyes, ears, nose, fingers, and so on contain all the information that we need for perception, and that perception must work something like a radio. But it is. Yet, as scientists set about analyzing the signals, they found them to be radically impoverished.

Suppose someone is viewing a tree in a clearing.

Neuropathic Itch

Given simply the transmissions along the optic nerve from the light entering the eye, one would not be able to reconstruct the three-dimensionality, or the distance, or the detail of the bark—attributes that we perceive instantly. Yet somehow you perceive the mutt to be whole, an intact entity travelling through space. Your mind now configures the slices as two independent creatures. The images in our mind are extraordinarily rich. We can tell if something is liquid or solid, heavy or light, dead or alive.

But the information we work from is poor—a distorted, two-dimensional transmission with entire spots missing. So the mind fills in most of the picture. You can get a sense of this from brain-anatomy studies. Instead, scientists have found that only twenty per cent do; eighty per cent come downward from regions of the brain governing functions like memory. Richard Gregory, a prominent British neuropsychologist, estimates that visual perception is more than ninety per cent memory and less than ten per cent sensory nerve signals.


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When Oaklander theorized that M. The fallacy of reducing perception to reception is especially clear when it comes to phantom limbs. Doctors have often explained such sensations as a matter of inflamed or frayed nerve endings in the stump sending aberrant signals to the brain. But this explanation should long ago have been suspect. Efforts by surgeons to cut back on the nerve typically produce the same results that M. Moreover, the feelings people experience in their phantom limbs are far too varied and rich to be explained by the random firings of a bruised nerve.

People report not just pain but also sensations of sweatiness, heat, texture, and movement in a missing limb. There is no experience people have with real limbs that they do not experience with phantom limbs.

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They feel their phantom leg swinging, water trickling down a phantom arm, a phantom ring becoming too tight for a phantom digit. Children have used phantom fingers to count and solve arithmetic problems. Ramachandran, an eminent neuroscientist at the University of California, San Diego, has written up the case of a woman who was born with only stumps at her shoulders, and yet, as far back as she could remember, felt herself to have arms and hands; she even feels herself gesticulating when she speaks.

And phantoms do not occur just in limbs. Around half of women who have undergone a mastectomy experience a phantom breast, with the nipple being the most vivid part. When the dentist gives you a local anesthetic, and your lip goes numb, the nerves go dead. The mind integrates scattered, weak, rudimentary signals from a variety of sensory channels, information from past experiences, and hard-wired processes, and produces a sensory experience full of brain-provided color, sound, texture, and meaning. We see a friendly yellow Labrador bounding behind a picket fence not because that is the transmission we receive but because this is the perception our weaver-brain assembles as its best hypothesis of what is out there from the slivers of information we get.

Perception is inference. The theory—and a theory is all it is right now—has begun to make sense of some bewildering phenomena. Among them is an experiment that Ramachandran performed with volunteers who had phantom pain in an amputated arm. They put their surviving arm through a hole in the side of a box with a mirror inside, so that, peering through the open top, they would see their arm and its mirror image, as if they had two arms.

COLLECTIONS

Ramachandran then asked them to move both their intact arm and, in their mind, their phantom arm—to pretend that they were conducting an orchestra, say. The patients had the sense that they had two arms again. Even though they knew it was an illusion, it provided immediate relief. People who for years had been unable to unclench their phantom fist suddenly felt their hand open; phantom arms in painfully contorted positions could relax. With daily use of the mirror box over weeks, patients sensed their phantom limbs actually shrink into their stumps and, in several instances, completely vanish.

Researchers at Walter Reed Army Medical Center recently published the results of a randomized trial of mirror therapy for soldiers with phantom-limb pain, showing dramatic success. Things can stay like this for years. The mirror box, however, provides the brain with new visual input—however illusory—suggesting motion in the absent arm. Therefore, it guesses again, and the pain goes away. The new theory may also explain what was going on with M.

The shingles destroyed most of the nerves in her scalp. And, for whatever reason, her brain surmised from what little input it had that something horribly itchy was going on—that perhaps a whole army of ants were crawling back and forth over just that patch of skin.

So she itches. Not long ago, I met a man who made me wonder whether such phantom sensations are more common than we realize.

Behind Every Great One by Deconstructeam

An MRI revealed a cavernous hemangioma, a pea-size mass of dilated blood vessels, pressing into the spinal cord in his neck. A week later, while the doctors were still contemplating what to do, it ruptured. Once the swelling subsided, a neurosurgeon performed a tricky operation to remove the tumor from the spinal cord. The operation was successful, but afterward H. His left hand felt cartoonishly large—at least twice its actual size. He developed a constant burning pain along an inch-wide ribbon extending from the left side of his neck all the way down his arm.

And an itch crept up and down along the same band, which no amount of scratching would relieve. Although the burning is often tolerable during the day, the slightest thing can trigger an excruciating flareup—a cool breeze across the skin, the brush of a shirtsleeve or a bedsheet. For all that, the itch has been harder to endure. He has tried all sorts of treatments—medications, acupuncture, herbal remedies, lidocaine injections, electrical-stimulation therapy.

Why Do We Itch?

But nothing really worked, and the condition forced him to retire in He now avoids leaving the house. He gives himself projects. Last year, he built a three-foot stone wall around his yard, slowly placing the stones by hand. But he spends much of his day, after his wife has left for work, alone in the house with their three cats, his shirt off and the heat turned up, trying to prevent a flareup.

His neurologist introduced him to me, with his permission, as an example of someone with severe itching from a central rather than a peripheral cause. So one morning we sat in his living room trying to puzzle out what was going on. The sun streamed in through a big bay window. One of his cats, a scraggly brown tabby, curled up beside me on the couch. But I told him about the increasing evidence that our sensory experiences are not sent to the brain but originate in it.

When I got to the example of phantom-limb sensations, he perked up. The experiences of phantom-limb patients sounded familiar to him. When I mentioned that he might want to try the mirror-box treatment, he agreed. He brought a cheval glass down to the living room, and I had him stand with his chest against the side of it, so that his troublesome left arm was behind it and his normal right arm was in front.

He tipped his head so that when he looked into the mirror the image of his right arm seemed to occupy the same position as his left arm. Then I had him wave his arms, his actual arms, as if he were conducting an orchestra. The first thing he expressed was disappointment. But then suddenly it was. After a moment or two, I noticed that he had stopped moving his left arm. Yet he reported that he still felt as if it were moving. He felt the burning pain in his arm diminish. And the itch, too, was dulled.

He still felt the pain and the itch in his neck and shoulder, where the image in the mirror cut off. And, when he came away from the mirror, the aberrant sensations in his left arm returned. He began using the mirror a few times a day, for fifteen minutes or so at a stretch, and I checked in with him periodically. After a couple of weeks, his hand returned to feeling normal in size all day long.

The mirror also provided the first effective treatment he has had for the flares of itch and pain that sporadically seize him. Where once he could do nothing but sit and wait for the torment to subside—it sometimes took an hour or more—he now just pulls out the mirror. There have been other, isolated successes with mirror treatment. In Bath, England, several patients suffering from what is called complex regional pain syndrome—severe, disabling limb sensations of unknown cause—were reported to have experienced complete resolution after six weeks of mirror therapy.

In California, mirror therapy helped stroke patients recover from a condition known as hemineglect, which produces something like the opposite of a phantom limb—these patients have a part of the body they no longer realize is theirs. Such findings open up a fascinating prospect: perhaps many patients whom doctors treat as having a nerve injury or a disease have, instead, what might be called sensor syndromes. This is no less true for human beings. Our sensations of pain, itch, nausea, and fatigue are normally protective. Unmoored from physical reality, however, they can become a nightmare: M.

Doctors have persisted in treating these conditions as nerve or tissue problems—engine failures, as it were. We get under the hood and remove this, replace that, snip some wires.