Is Itching An Emergency?

It is discouraging when a parent checks their child into the Emergency Department for a rash.  Rashes are rarely an emergency and should be seen by the child's regular doctor.  I often go into these patient's rooms feeling grumpy:  I feel like this parent is misusing the system, coming to the Emergency Department for convenience rather than being patient and waiting to see their doctor.  However, when I see the child covered with rash and scratching away, I get more sympathetic.  I too have sensitive skin, and itching drives me absolutely nuts.  I imagine this little 2 year old guy trying to sleep at night, but his skin is on fire and he is tearing himself up with scratching.  Rashes are rarely emergencies, but on the other hand itching is quite miserable.  Itching is particularly bad at night, when the air is dry, and there are no day-time distractions to take the kid's mind off his itch.  The child is trying to sleep, but the itch won't let him.  And this is the purpose of this blog: to give parents tools to take care of these problems at home and avoid a time-consuming and expensive Emergency Department visit.   The most common reason for kids coming to see me for itching is eczema.  Eczema is a condition where skin is extra-sensitive.  Extra sensitive skin easily itches when irritated.  When it itches, kids scratch.  When they scratch, they make a rash.  Eczema if often called the itch that rashes, rather than the rash that itches.  Eczema is partly genetic.  These kids are born with skin that is extra sensitive, and breaks down more easily.  Then that sensitive skin gets irritated.  Many things irritate eczema skin, like dry winter air or air-conditioned air.  Dusty conditions are drying and irritating too.  Some soaps are hard on eczema skin, like Zest, Ivory, Irish Spring, and Dial.  These soaps are so strong that they wash away the natural oils that skin makes to protect itself.  Finally, skin can be irritated by abrasive things like washcloths, synthetic clothes, and things that chafe like jewelry or wet and tight clothing.  These things that cause eczema to flare do two things: they dry, or they rub.  And these are the clues to eczema treatment: moisturize, and protect.  The first step in moisturizing is to use a moisturizing soap rather than a drying soap.  Good soaps are Dove, Caress, and Lever.  The next step is using a moisturizing lotion.  This should be smeared all over the child's itchy dry skin three times daily.  It is especially important that one of those times to put it on is right after the kid takes a bath and dries off.  This "locks in" the moisture the child's skin gets from the tub or shower.  To avoid rubbing injury to eczematous skin, have your kid wear only loose fitting, 100% cotton clothes.  That way the clothes don't collect sweat and stay wet, and don't rub too much.  Washcloths often irritate skin too.  They scrub at the skin, which damages sensitive skin.  Kids with eczema should soap up with their hands or a very soft sponge.  Toweling scrubs skin too.  Kids with sensitive skin should be patted dry with the towel, not scrubbed.    Eczema is often helped by medicines like steroid creams.  Steroids are anti-inflammation medicines, and can calm down inflamed, itchy skin.  Steroid creams come in many strengths.  The mildest is over-the-counter hydrocortisone.  Hydrocortisone will calm down most minor, itchy patches.  Medium and high-strength steroids can only be had by a doctor's prescription.  I prescribe medium-strength steroids, which are pretty strong but do not have the potential to damage skin.  High strength steroids should only be prescribed by dermatologists, since they can harm skin if used improperly. Other good medicines for itching are medicines like tylenol, ibuprofen, and benadryl.  Tylenol and ibuprofen take away pain, and itching is actually a minor type of pain.  Since eczema is an allergy-related sensitivity, benadryl can help with that itch too. So when your child with itchy skin starts scratching and whining at night, try these things to calm and protect the skin.  It that does not work, call your doctor.  Eczema is a chronic condition, and chronic conditions should be seen by the same doctor who knows what has worked and what has not.  Don't go to the Emergency Department or a walk-in clinic, because you might see different doctors every time, who won't know your child's condition.  It is your doctor who will go the extra mile to help your kid with his emergency itching.