Itchy Skin after Burn Injury

Based on Research by Burn Injury Model Systems

Wooden back scratcher

Introduction

As skin heals from a burn injury, it may get itchy. Almost everyone recovering from major burns has problems with itching—especially on or around the burn, graft, or donor site. The medical term for long-lasting itchiness is “pruritus” (proo-ri´tus).

Itching is a normal part of healing. It happens because the scar tissue from burns does not have the oil glands found in normal skin. This makes the scar dry and itchy. Itch intensity (how bad it is) and frequency (how often it occurs) are not necessarily related to the size or depth of your burn injury, but itching may cause you to scratch and open up fragile skin that previously had healed.

Itching can also get in the way of doing everyday activities, including:

  • Sleep: Itching tends to worsen at night before falling asleep, making it hard to fall asleep and stay asleep.
  • Work and school: Persistent itching may make it hard to concentrate when performing these activities.
  • Physical activities: Exercise, sports, and play (for children) may increase itching.

Itching can make you anxious, which can make itching worse. Fortunately, itching decreases over time. In the meantime, there are treatments to help reduce itching. To find the best treatment for you, talk with your health care team about how bad your itching is and how it is affecting your life.

Back to top

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).

Itchy Skin Rating Scale

  • 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
      1. Duration (number of hours per day)
      2. Degree (intensity)
      3. Direction (whether it is getting better or worse)
      4. Disability (impact on activities)
      5. 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.

Back to top

Treatment

No treatment stops itching completely, but several may help.

Topical Therapies

  • Creams and lotions
    • Moisturizers help to maintain skin moisture and hydration. They may help reduce itching if your skin is dry, because itching increases with dry skin. Use unscented or fragrance-free moisturizers.
    • Diphenhydramine (pronounced dai-fen-hai-dremine; abbreviated DPH or DHM) cream blocks histamine and is sometimes helpful. It is available over the counter and does not require a prescription.
    • Doxepin cream (e.g., Zonalon or Prudoxin) has been used with some success. It decreases itching by blocking histamine receptors in the skin. Histamine is a naturally occurring compound in our bodies that triggers the inflammatory response. Doxepin creams can be used only in small amounts and must be prescribed.
    • Capsaicin (pronounced cap-SAY-sin) cream (e.g., Capzasin, 0.025%) may provide temporary relief. It is best to test this cream on a small area of your skin first because it may cause a stinging or burning sensation. Avoid getting capsaicin cream in your eyes and other mucous membranes or on broken skin.
  • Baths
    • Bathing may or may not help with itching. Lukewarm water is best and tends to dry out skin the least.
    • Colloidal oatmeal baths can provide temporary relief.
    • Cooling the skin with water provides some temporary relief.

Back to top

Oral Medications

  • Antihistamines are often the first oral (taken by mouth) systemic medication used to treat postburn itching. They work by blocking histamine, which triggers itching. Common antihistamines used include diphenhydramine (e.g., Benadryl), cetirizine, loratadine, and hydroxyzine. They can be purchased over the counter, either as pills for adults or elixirs or liquids for children. Dosages (how much you should take) vary, so talk with your health care provider before taking any over-the-counter medications.
  • Gabapentin (pronounced gab-ah-pen-tin) is an oral medication that must be prescribed. It acts centrally—in your brain—to help decrease itching and has shown promising results in several research studies.
  • Sleep medications are used to treat sleeplessness. If itching makes it difficult for you to sleep, talk with your health care provider about safe sleep medications that can help. /li>

Before taking any medication, talk to your doctor about the side effects.

Back to top

Other tips

  • Custom-fit pressure garments may help during the first months following burn injury.
  • Gentle skin massages and touch with varying pressure can help reduce itching.
  • Distractions such as television, games, and low-impact or mild exercise or activities can help take your mind off the itching.
  • Short fingernails, especially for children who tend to scratch at night while asleep, can reduce or eliminate scratching.
  • Use unscented laundry detergent.
  • Use unscented or fragrance-free lotions (including sunscreens).
  • Protect your skin from the sun by wearing appropriate clothing (e.g., a hat and long sleeves) and using sunscreen.

Back to top

For more information

References

Carrougher GJ, Martinez EM, McMullen KS et al. Pruritus in adult burn survivors: post-burn prevalence and risk factors associated with increased intensity. J Burn Care Res. 2013;34(1):94?101.

Elman S, Hynan LS, Gabriel V, Mayo MJ. The 5-D itch scale: a new measure of pruritus. Br J Dermatol. 2010;162(3):587?93.

Morris V, Murphy LM, Rosenberg M, Rosenberg L, Holzer CE 3rd, Meyer WJ 3rd. Itch assessment scale for the pediatric burn survivor. J Burn Care Res. 2012; 33(3):419?24.

Copyright © 2011

Model Systems Knowledge Translation Center (MSKTC). May be reproduced and distributed freely with appropriate attribution.

Disclaimer

This information is not meant to replace the advice of a medical professional. You should consult your health care provider regarding speci?c medical concerns or treatment. The contents of this fact sheet were developed under a grant from the Department of Education, NIDRR grant number H133A060070. However, those contents do not necessarily represent the policy of the Department of Education, and you should not assume endorsement by the Federal Government.

Authorship

Itchy Skin After Burn Injury was developed by Gretchen J. Carrougher, R.N., M.N., and Walter J. Meyer III, M.D., in collaboration with the Model Systems Knowledge Translation Center.

Back to top