Relieving That Post-Burn Itch
Itching, also known as pruritus, is unfortunately quite common among individuals who had burn injuries. As many as 90 percent of burn patients report itching after their injuries, according to data cited by the Phoenix Society for Burn Survivors. Pruritus is Latin for “itch,” a sensation that causes a desire or reflex to scratch.
Several factors that are associated with post-burn itching have been identified. These include a high percentage of total body surface area (TBSA) burns and a high percent of TBSA grafted. Certain characteristics of the wound itself, such as dry skin and raised or thick scars, are more associated with itching as well. Furthermore, certain external factors, such as heat and sweating, have been shown to worsen itching.
Some itching after a burn is a normal part of the healing process. But itchiness at burn scars isn’t caused by histamine, as with allergies. In this form of itching, nerves misreport an itch on the skin at the burn site, but the irritation actually is coming from the central nervous system. This is a condition known as central itch — basically, an internal itch that can’t be scratched. A bigger or more serious burn doesn’t necessarily lead to worse itching at the scar.
Ways to Describe Your Itching
Your health care team may ask you to describe the intensity and impact of your itch:
- To describe intensity, or how strong the itch is, adults are usually asked to rate the itching on a scale of 0 to 10, where 0 is “no itch” and 10 is “worst itch imaginable.” Children are often asked to use the Burn Man Itch Scale to describe their itch (see below).
- To describe how itching may be affecting your life, your health care team may use the 5-D Itch Scale. This is a set of questions that asks you about the:
- Duration (number of hours per day)
- Degree (intensity)
- Direction (whether it is getting better or worse)
- Disability (impact on activities)
- Distribution (location on your body)
You can also use the questions in the 5-D Itch Scale to initiate conversations with your health care providers.
What treatments provide relief for burn scar itching?
The usual treatment for itchiness is antihistamine. But because central itch isn’t caused by histamine, antihistamine won’t always help. Also, it may be tempting to scratch an itchy burn wound or scar, but that’s not a good long-term solution. In fact, scratching can damage fragile, healing skin, which is a particular concern for patients who have had skin grafts to treat burns. Some of my patients find relief with lidocaine ointment, which can temporarily numb the area of skin where it’s applied. Other patients look to alternative treatments such as acupuncture, hypnosis, massage, and Reiki therapy, a Japanese technique for relaxation and stress relief. These treatments help patients focus on something besides the itching. The sensation is not completely eliminated, but some patients report that the itch is not as persistent or top-of-the-mind as it was before the therapy.