Antidepressants for Itchy Skin Rash?

Q: I have been suffering from a skin rash for about 10 years. A large patch of my skin constantly itches, and the skin is thick and feels like leather. I have gone through almost every ointment on the market, and none works. I went to a new doctor and he said that my rash was neurodermatitis, and the best treatment would be an antidepressant to stop the scratching. I am a little skeptical. Have you ever heard of using a mood-altering medication to treat a skin rash?

A: Neurodermatitis, or lichen simplex chronicus, is a chronic skin condition characterized by intense itching. Scratching the itch irritates nerve endings in the skin, resulting in more itching and more scratching.  An “itch-scratch-itch cycle” sets in, and it is tough to break.

Anything that causes itching can start this cycle—an insect bite, an itchy scar, or a reaction to a skin product.  Stress or habit can also start the cycle—unconsciously scratching your leg while studying, scratching your arm when you’re nervous, or scratching as a chronic habit.  But whatever the precipitating cause, continued scratching results in itchy, thickened, discolored skin.

Neurodermatitis is frequently seen on the arms or legs, but can occur on any area that can be reached. Once the skin is irritated and thickened, itching is intense. Scratching feels good and is hard to resist. It is usually worse at bedtime, when there are few distractions. The constant itching can result in anxiety, and scratching can result in skin erosion and infection.

To treat neurodermatitis, it is necessary to break the itch-scratch-itch cycle. Here are some tips:

• Use a mild, unscented soap for bathing
• Avoid any perfumed products
• Try soothing lotions and ice packs to relieve itching.

If itching persists, your doctor may want to evaluate you for underlying factors or conditions that may be contributing to the itching. Sometimes a skin biopsy is needed to confirm the condition. Also, allergy testing may be recommended.

Topical steroid creams and ointments prescribed by your physician can reduce itching and redness. But these alone will not be sufficient if scratching continues. Oral medications that can be helpful include:

• Antihistamines
• Certain low-dose antidepressant medications, such as doxepin
• A sedative to assist sleeping
• A mild tranquilizer to reduce anxiety associated with itching

Constant scratching can allow bacteria or other germs to get into the skin, causing a skin infection. If this occurs, your doctor will prescribe a topical or oral antibiotic.

Neurodermatitis is not a simple skin condition. It may have started with an itch, but scratching becomes a necessity, and causes stress and anxiety. Because of these associated factors, medications with anti-anxiety, anti-depressant, and mood-altering qualities may be very helpful in relieving itching and in breaking the itch-scratch-itch cycle.

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Rebecca Campen, M.D., J.D. is an Assistant Professor of Dermatology at Harvard Medical School and former Deputy Director of the Harvard/Massachusetts General Hospital Cutaneous Biology Research Center (CBRC). She currently serves as Senior Advisor to the CBRC and divides her time between clinical practice of dermatology at the Massachusetts General Hospital and private practice in Savannah, Georgia. Dr. Campen is the author of two books for medical students and residents, Going Into Medical Practice and Blueprints in Dermatology.

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