Dr. Amy Wechsler Gets The Itch Out-------
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I have particularly reactive skin and sometimes it gets itchy when I get nervous. It can erupt into hives—or my cheeks will flush. I’ve been treated with prednisone in the past, but I’m wondering if there is another way to relieve these symptoms going forward.
When people get anxious, the adrenaline surge brings more blood to the surface of the skin, and you get a flush—the blood vessels just dilate and you turn red. For some people, this is also accompanied with a histamine release, and that causes itching and hives. For that, we usually just prescribe an antihistamine and if there’s a particularly stressful period of time, you can take those daily. They’re over-the-counter now—something like Allegra, Zyrtec, Claritin. The nervousness—and there’s usually palpitations that go along with it—often comes around public speaking or a social phobia, and if it happens a lot, we prescribe beta-blockers. You still feel anxious, but you won’t vasodilate and bring more blood to the skin. I always have patients try that at home first, though, because even though I prescribe a very low dose, you can get tired and feel a little dizzy.
Some people need to be on an SSRI (selective serotonin re-uptake inhibitor) like a Lexipro or a Prozac or Zoloft if it’s a daily thing. Wellbutrin is another antidepressant that’s also a good antianxiety medication. Rarely, patients take a benzodiazepine like a Xanax or Ativan or Klonopin.
I’ve also sent patients for biofeedback, where you go into a little lab and you’re set up with electrodes and it really shows you how you can decrease your own heart rate and your breathing rate by doing relaxation techniques—like rhythmic breathing and imagery and all sorts of neat things. It’s really interesting to learn about your body and different ways to control it.
One of only two physicians in the U.S. board-certified in both dermatology and psychiatry, Dr. Amy Wechsler understands not only patients’ emotional states, but also the impact they can have on the outer surface. A specialist in the fundamental connection between the mind and body, Dr. Wechsler literally wrote the book on the subject. A frequent contributor to nationally recognized television programs and magazines, she has a private practice in New York.