If you itch, read this

If you haven't noticed, the leaves are changing, there is a nip in the air, and the smells of fall have arrived. Only a quick glance at the calendar betrays the obvious conclusion that Autumn has begun. Not to brag, but I told many of my patients in July that fall would come a month early this year. I knew it because my allergy patients were suffering and my eczema patients were scratching. These diseases are known as the atopic diathesis and they include eczema, hay fever, and asthma. Eczema and asthma are not allergic diseases though they can be made worse with allergic stimulants and hay fever is mostly a reaction to ragweed and mold. So the question is: why is fall early and why are our body reactions so predictable? In fact our body reactions predict the onset of each new season.
Well, I don't know why our bodies have a diurnal rhythm or why they have a lunar rhythm (don't believe me? Work a night in an emergency room when there is a full moon.) Fevers rise at night, itching and pain worsen at night, many diseases worsen with the seasons. More specific to these ailments, what is going on and what shall we do about it?
What is going on: The body releases mediators, chemicals which cause metabolic reactions in the body, on a relatively fixed schedule. And that is usually spring and fall. We make this worse by polluting the air and more specifically by turning on dry heat in our homes. Dry heat not only causes more water loss from the skin which in itself itches, it also probably causes more release of those annoying mediators. (These mediators also have a good side protecting us from infection, disease, cancer, and so on.) Our reaction is to feel an itching sensation and to scratch. Scratching injures the skin and causes more itch and eczema and so the vicious cycle is perpetuated.
What to do about it is another thing. Preventing water loss is very important. Moisturizers are the buzz words in cosmeceuticals, but in fact the primary problem is water loss and not dry skin per say. Moisturizers work by reducing water loss and in some cases by adding moisture to the skin. Once fall hits, and especially after the furnace is turned on, moisturizers are essential every day. There is a new study in children that indicates that moisturizers do not have to be applied after a shower or a bath but I prefer it because of convenience and the added water the shower brings.
The second remedy is antihistamines. Unfortunately, while there are many over the counter antihistamines for hay fever, the are none that work well in the skin that are sold without a prescription. For this, my recommendation is to see a dermatologist well versed in antihistamine treatment of eczema.
One last point: stronger is not better. More salt in a salty dish does not taste better. Stronger steroid creams may damage skin and the adrenal gland and may not make you better. Treating eczema with one thing, like a cream, is like making a quiche with one ingredient.
This year, with an early fall and probably early winter, prevention is 90% of the cure. Use a portable humidifier in the bedroom and topical moisturizers daily.

Lastly, in the spirit of the demagoguery of Sara Palin let me give a few explanations the conservative right may offer for the onset of itch: the health care debate makes you itch and then the death panels will finish you off; immigration to this country is ruining our schools and must be stopped retroactively; lastly, the godless culture in the world is making everyone itch. Reasons from the fanatical left may include: Sara and the NRA are contaminating our water supply with chemicals that make us itch; insisting that Americans work for a living makes people anxious; and lastly,the possibility of giving up the right to frivolous lawsuits and limiting punitive damages makes Americans even more anxious and itchy.