Don’t scratch that itch
IT seems that every summer I write about skin. It’s because every summer emergency departments are full of patients with skin-related complaints. As we circumnavigate New Zealand on our boat, a few crew members, including myself, are having a few skin issues.
Stewart Island was one of the only places on Christmas Day to bathe in sunshine. Apart from a pair of nesting oystercatchers and their super cute chicks, my children and I were the only ones on a long, pristine Rakiura Beach soaking up the sun. Wide hats, plenty of sun protection and the intermittent relief of the rainforest meant no major damage was done to our skin in our southern sojourn.
As a few hours of rain approached a few days later, another crew member neglected to spray herself with the best insect repellent I have ever come across, Parakito. The very few sandflies around (comparatively speaking) placed a few strategic bites on the top of her feet. As the histamine flowed to react to the bites, red lumps appeared with the associated itch.
Years of personal and clinical experience has taught me that scratching these bites may feel good for a few seconds, but is not a good idea. The scratching damages more cells and attracts more histamine-generating ones, which then intensifies the itch and creates bigger lumps and a greater inflammatory mess.
Taking antihistamines helps alleviate the effects of histamine, such as swelling and itching, but reducing histamine load by not scratching is equally, if not more, important. ‘‘But scratching feels SOOO good,’’ my crew member replied. By this stage the cycle has started and soon one just wants to scratch the offending histaminedrenched bites and skin off, which is exactly what can happen.
The lumps are replaced by little skin ulcers and often bacteria under the nails find refuge in the little self-inflicted craters and do what they do best, multiply.
The bacterial and occasional fungal overlay summer party kicks in, resulting in more redness, more inflammation, swelling and pain. Antibiotics and antifungal medications are added to the antihistamine load and time is taken waiting in busy hospital or GP waiting rooms when you could be doing something else on yourwelldeserved holiday.
A diagnosis of cellulitis is made as the rampant infection starts spreading between the skin layers and the redness increases dramatically. Vivid markers are often used to determine if the oral medicine is working. Depending on the location and spread of the infection – such as over a joint or on the face – a hospital admission and intravenous antibiotics may be warranted.
Some bacteria such as Staphylococcus (which are present on our skin) are prone to forming abscesses, leading to pockets of pus forming which have no blood supply so antibiotics, oral or intravenous, can’t penetrate and are ineffective. Surgical drainage is then required, often with a general anaesthetic. As a former surgical registrar, incising and draining abscesses, whatever the cause was one of my most common procedures.
So, the point is, protect your skin this summer as it is designed to protect you. Moisturise those cracked heels and skin parched by sun surf and tide, block that sun and prevent things biting, piercing your sensitive armour.
Avoid making things worse by itching, scratching and excoriating and avoid complications such as doctors’ visits or an operation. It started out with an itch, how did it end up like this…? Dr Tom Mulholland is a GP with 30 years’ experience in New Zealand. He’s currently on a mission, tackling health issues around New Zealand.