How to prevent pruritus associated with anxiety?

From the Guidelines

To prevent pruritus associated with anxiety, it is essential to address both the physical symptoms and the underlying anxiety through a combination of stress reduction techniques, proper skin care, and potentially, medication. When considering the management of pruritus associated with anxiety, it's crucial to understand the interplay between psychological factors and skin symptoms, as highlighted in the British Association of Dermatologists' guidelines 1. The guidelines emphasize the importance of psychological and emotional factors in triggering or worsening pruritus, including stress, emotional excitation, and cognitive factors.

Key Recommendations for Management

• Practice stress reduction techniques such as deep breathing exercises, meditation, progressive muscle relaxation, or mindfulness for 10-15 minutes daily to help manage anxiety and reduce pruritus.
• Keep the skin well-moisturized with fragrance-free lotions applied immediately after bathing to maintain the skin barrier.
• Avoid hot showers or baths, limiting water temperature to lukewarm and bathing time to under 10 minutes to reduce skin irritation.
• For immediate relief, consider over-the-counter antihistamines like cetirizine (10mg daily) or diphenhydramine (25-50mg before bedtime), as suggested by the guidelines 1.
• Topical treatments containing 1% hydrocortisone cream, menthol, or calamine lotion can be applied to itchy areas up to four times daily for temporary relief.
• Wear loose-fitting, cotton clothing to minimize skin irritation and stay hydrated by drinking 8-10 glasses of water daily.

Addressing Underlying Anxiety

If anxiety is severe, consulting a healthcare provider about cognitive behavioral therapy or medications like selective serotonin reuptake inhibitors (SSRIs) is recommended. These approaches can help regulate the nervous system's response to anxiety, thereby reducing the triggers for pruritus. The British Association of Dermatologists' guidelines 1 support the consideration of input from clinical psychology and/or psychiatry in the management of chronic generalized pruritus, acknowledging the significant psychosocial morbidity associated with the condition.

By following these recommendations and addressing both the physical and psychological aspects of pruritus associated with anxiety, individuals can better manage their symptoms and improve their quality of life.

From the FDA Drug Label

More ELIDEL patients (57%) had mild or no pruritus at 6 weeks compared to vehicle patients (34%) The improvement in pruritus occurred in conjunction with the improvement of the patients’ atopic dermatitis.

To prevent pruritus associated with anxiety, using a cream like pimecrolimus (ELIDEL) may help, as it has been shown to reduce pruritus in patients with atopic dermatitis 2.

• Pimecrolimus cream can be applied twice daily to affected areas.
• It is essential to note that pimecrolimus is used to treat atopic dermatitis, and its effectiveness in preventing pruritus associated with anxiety may not be directly addressed.
• However, if the pruritus is related to atopic dermatitis, using pimecrolimus cream may help alleviate the symptom.

From the Research

Preventing Skin Itching with Anxiety

To prevent pruritus associated with anxiety, several strategies can be employed:

• Habit reversal training and arousal reduction have been shown to have positive effects on itch relief 3
• Reducing anxiety through pharmacological and nonpharmacological treatments can help alleviate itch 4
• Addressing anxiety sensitivity social concerns can help break the vicious cycle of stress and skin disease symptoms 5
• Stress-relieving holistic approaches such as cognitive-behavioral therapies, yoga, and acupuncture can also be beneficial 6

Psychological Factors

Psychological factors such as stress, anxiety, and depression play a significant role in exacerbating itch:

• Stress can induce the sensation of itching and exacerbate existing itch conditions 3, 4, 6
• Anxiety and depression are commonly associated with itch, and addressing these conditions can help alleviate itch 4, 7
• Perceived stigmatization can also contribute to the severity of itch and should be addressed in treatment plans 7

Treatment Approaches

Treatment approaches for preventing skin itching with anxiety should encompass both physical and psychological factors:

• Drug treatments targeting brain structures associated with emotion, such as γ-aminobutyric acid-ergic drugs, serotonin and norepinephrine reuptake inhibitors, may help modulate itch 6
• Nonpharmacologic treatments such as cognitive-behavioral therapies and stress-relieving holistic approaches can also be effective 6
• Directing individuals towards suitable healthcare resources for further psychological assessment and treatment is crucial in addressing the interconnected psychological factors associated with itch 7