Winter Itch

Many people attribute poor sleep, depression, agitation, difficulty concentrating, and reduced sexual desire and function to itch. We are talking about winter itch, or its real name Xerotic Eczema. This condition gets worse as winter drags on – weeks of air that is cold and heat that is too dry take their toll. The vulnerable develop itchy arms, thighs, knees, elbows and trunk. It gets worse in bed at night and after a hot shower – for most it is just an annoyance but for some the itch can be so severe that it can drive them mad. It can even get to the point where the continuous rubbing and scratching can create an “itch-scratch-itch” cycle that makes things worse. Some people gouge and scratch until they bleed. Infections and chronic eczema can follow.

Perhaps 25% of the population get winter itch. Every winter doctors see patients with itch but often there is not a lot to see on the skin.

This condition is caused by excessive water loss from the top layers of the skin causing dehydration and drying of the upper layer skin cells called corneocytes. The outer top layers of the epidermis need 10-20% of water concentration to maintain their integrity. Normally there are fats in the top layers of the skin that act as water balances and skin loss of these lipids can cause an increased loss of water up to 75 times that of healthy skin. When water is lost, skin cells shrink, elasticity reduces and splits and the can form.

Other symptoms of winter itch can include the skin feeling tight after bathing or swimming, the skin feeling and looking rough, and the skin looking sunken and dehydrated.

The situations that cause an increased risk of this condition are:

• Inherited tendency.
• Age, especially older women after menopause who have a reduction in their oil glands. Men seem to do better until they get into their 80s.
• Cold, dry air in winter.
• Heated houses – especially air conditioners and wood burners.
• Excessive swimming in chlorinated pools.
• Soaps/detergents/solvents especially if they are alkaline.
• Metabolic and endocrine conditions like underactive thyroid gland.
• Dehydration – you can tell by pulling up the skin on the back of your hand. If it does not snap back quickly you are dehydrated.
• Alcohol and drugs including caffeine can dehydrate you. Diuretics, antihistamines and acne drugs can dry you up too.
• Pre-existing skin conditions can get worse during the winter, e.g. eczema and psoriasis.

An important point here is that this dry skin condition is actually caused by a lack of oil in the skin, not water.

Apart from treating any medical problems like thyroid disease and chemical exposure, etc., it is important to do the following:

• Avoid drying soaps – especially those that contain deodorants and are perfumed.
• Do not lather yourself all over with soap. This is unnecessary because water on its own has a cleaning effect.
• Bathe less, you do not have to wash a lot.
• Use cooler water and avoid hot water because the hotter the shower the more moisture is removed from the’skin.
• Don’t rub your skin dry – pat gently until slightly damp.
• Follow each bath or shower with a moisturiser – this holds the water in the skin. It is important to note that putting moisturiser onto the skin straight after a wash makes it work better – this is called the “soak and smear method”.
• Your family doctor can prescribe emulsifying ointment for you to use in the shower instead of soap. This is an easy way of using a soap substitute and moisturising the skin at the same time.

The prognosis of this condition is that it will improve in most people in less than two weeks. In severe cases, you may even have to place a humidifier in your house or bedroom.

More tips that can help include the following:

• Keep your house a bit cooler – it has an anaesthetic effect on the skin. If your house is too hot your blood vessels dilate and your itch becomes worse. There is a similar effect if you are very hot in bed or have a hot shower.
• Diet – avoid alcohol, caffeine and hot spicy foods.
• In bed, keep it cooler and sleep with mittens on.
• Clothes – no wool against the skin and use natural fibres that breathe.
• Use soap substitutes like cold cream, cocoa butter, coconut oil soap, tar liquids or non soap cleansers.
• You can get hydrocortisone 0.5% a mild anti itch steroid over the counter and this will help.
• Steroid ointments are better than creams, after applying the ointment, cover skin with cling wrap at night and football socks over the top for legs.

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