357: Got Itchy Skin Without Rash? The Surprising Neuropathic Itch Trigger No One Talks About w/ Dr. Shawn Kwatra

The Healthy Skin Show

“Why am I so itchy?” If you have itchy skin without rash, including issues like eczema, psoriasis, or chronic hives, you might have neuropathic itch.
Though itch is caused primarily by inflammation, neuropathic itch is actually caused by dysfunction of your nervous system!
Put simply, this type of itch has no primary skin rash, so you won’t see inflamed dry patches or welts. You’ll only feel itchy.
It is often localized to certain areas of the body. For example, you could have an itchy scalp, back, or arms. The itchy skin can sometimes be mild, but is unfortunately usually quite intense, leading to scratching, which can damage the skin.
And because there’s no treatment for neuropathic itch, despite it being very common, you might start to feel like there’s no hope. Yes, what’s causing this is not yet well understood, but it sounds like experts are digging into this.
Joining me to discuss neuropathic itch is returning guest Dr. Shawn Kwatra. He is the Chair of Dermatology at the University of Maryland School of Medicine. He specializes in medical dermatology areas of clinical expertise, including atopic dermatitis, psoriasis, chronic itch of unknown origin and dermatology for ethnic skin. Dr. Kwatra also runs a basic science laboratory and clinical trials unit and is funded by the National Institutes of Health and multiple foundations.
He currently serves as the National Secretary/Treasurer of the Skin of Color Society. He is a member of the National Eczema Association’s Scientific and Medical Advisory Council.
Dr. Kwatra has been an author or co-author on over 200 publications and author of the book Living with Itch.
In This Episode:

• What is neuropathic itch (aka. itchy skin without rash)?
• How could your brain cause itchy skin without rash?
• Itch intensity of different examples of neuropathic itch
• Treatment options for neuropathic itch
• Which inflammatory cytokines are involved?
• Could Low Dose Naltrexone help itchy skin without rash?
• Alternative therapies for neuropathic itch

Quotes
“[Neuropathic itch is] initiated or caused by dysfunction of the nervous system…so it actually is caused by the nerves. And the core symptoms here are that you have normal skin, or skin only with some secondary skin changes or signs of scratching, excoriation, and it oftentimes favors a localized distribution. And so the scalp is actually a very common site where folks itch.”
“Unfortunately, a lot of the medications we use to treat this condition are very sedating. They're drugs that are focusing on the transmission of itch in the central nervous system and spinal cord like gabapentin or anticonvulsants. So those are the type of drugs that we're giving for this condition.”
Links
Find Dr. Shawn Kwatra online here and here | Twitter
Healthy Skin Show ep. 275: Why You're So Itchy (HINT: It's Probably Not Histamine) w/ Dr. Shawn Kwatra

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1. Introduction (00:00:00)

2. What causes itchy skin without rash? (00:04:32)

3. Brain connection to itchy skin (00:09:45)

4. Examples of neuropathic itch (skin itching without rash) (00:13:30)

5. Treatment options for neuropathic itch (00:17:35)

6. Which inflammatory cytokines are involved? (00:21:35)

7. Could Low Dose Naltrexone help? (00:24:15)

8. Alternative therapies for neuropathic itch (00:28:10)

9. Final thoughts (00:31:55)