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How to stop itching from adderall


Does Adderall Cause Skin Problems?

This medication is helpful for those with ADHD but it can come with certain side effects. Here’s what you need to know.

by Tracy Davenport, Ph.D. Health Writer

Medical Reviewer

Merihan Raouf, PharmD

Getty Images/Doucefleur

Medical Reviewer

Merihan Raouf, PharmD

If you’re taking Adderall, there’s a good chance your doctor has diagnosed you with attention-deficit/hyperactivity disorder (ADHD). Adderall is a brand name for a drug that contains four active ingredients: Dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate. It is most often prescribed to treat ADHD, but it can also be prescribed for narcolepsy, according to Adam Kaye, Pharm. D., a clinical professor of pharmacy at the University of the Pacific in Stockton, CA. You might have heard that Adderall can cause some unwanted symptoms such as restlessness and a rapid heart rate, but there are also skin issues related to taking this medication. We asked the experts what to watch for if you are taking Adderall and when you should notify your doctor.

What Is Adderall?

More than 25 million people rely on Adderall and other similar drugs, according to the American Chemical Society. Adderall works by stimulating your central nervous system. In doing so, it may improve a person’s ability to focus and think clearly—a benefit for those with ADHD, a disorder that’s on the rise in the 21st century. But using stimulants to enhance cognitive performance is nothing new, says Kaye. “Benzedrine, a brand-name amphetamine, was used to motivate soldiers during World War II,” he points out.

In some ways, treating ADHD with a stimulant may not seem logical when the condition already results in seemingly over-stimulated behavior. Here's why it helps: People with ADHD tend to have less sensitivity at the dopamine receptors, which is a key part of the brain’s reward center. That means people with ADHD are constantly chasing stimulation, causing them to get caught up in small distractions. Adderall helps ADHD by increasing the release of dopamine in the brain, so those minor distractions can then be ignored.

Adderall Misuse

The difficulty with Adderall is that it is often misused, taken at higher doses than recommended, or used for non-medical purposes (to perform better in school or feel high), especially by high school and college students. Studies have found anywhere between 5% and 35% of college students take Adderall without a doctor’s prescription, according to the journal Addictive Behaviors. And prescription stimulant misuse is prevalent among medical students worldwide, another report in the journal Psychiatry International found.

All of that is important information, because when it comes to Adderall side effects, including skin issues, the severity and prevalence of those side effects varies greatly depending on how much someone is taking, and whether they have a doctor-approved prescription.

Skin Side Effects for Normal Adderall Dose

Even when taken as prescribed, Adderall can contribute to skin problems. “Because Adderall is a stimulant, it constricts blood vessels which may result in an increase in blood pressure and less waste removed at a cellular level,” Kaye explains. The constricted blood flow can also lead to Raynaud’s disease, which causes some areas of your body, such as your fingers and toes, to feel numb and cold in response to changing temperatures or stress. According to the U.S. Food and Drug Administration, serious skin rashes, including Stevens-Johnson syndrome (a rare and painful skin disorder), skin peeling and blistering, and hair loss have also been reported with Adderall.

What’s more, all amphetamines have the potential, though rare, to increase risk of serotonin syndrome or serotonin toxicity, especially if combined with serotonergic agents such as selective serotonin reuptake inhibitors (SSRI) or tricyclic antidepressants (TCAs). Some of the symptoms of serotonin syndrome may include increase in body temperature known as hyperthermia, Kaye says. “Hyperthermia, especially with exercise, increases heat production while simultaneously decreasing heat dissipation.” In turn, this can lead to an itchy skin sensation. “At the end of the day, Adderall is an amphetamine and amphetamines are known to influence a variety of nervous system activities including repetitive scratching activity and possibly more itch,” Kaye says.

Skin Side Effects for Non-Prescription Use

When Adderall is misused or taken in greater quantity than the recommended dose, a whole new set of skin problems is possible, according to Gil Yosipovitch, M.D., director of the Miami Itch Center at the University of Miami’s Miller School of Medicine in Florida. “Adderall can cause itch and in high doses, can cause delusional infestation,” he says. Delusional infestation is as bad as you might be guessing—the feeling of bugs crawling on your skin.

In the scientific journal Acta Dermato-Venereologica, Dr. Yosipovitch published a case study of a man taking three times the recommended maximum dosage of Adderall. The man described scabies “burrowing into his scalp and moving” and seeing scabies’ eggs “raining” from his scalp. Upon examination, no evidence of bugs was found. After reducing the man to a much lower dose of Adderall, one month later the feelings of delusional infestation were gone. Other research supports the notion that patients who experience delusional infestation while taking stimulants like Adderall are typically misusing or abusing the medication.

Bottom Line on Skin Issues With Adderall

Just because a medication is relatively easy to access doesn’t mean it’s any safer or less potent to take. In the case of Adderall, even at prescription doses it can impact your skin. Abusing Adderall or other stimulants can lead to serious psychotic episodes, including the feeling of creepy-crawly sensations on and underneath the skin.

If you are taking Adderall and experience skin problems, you should reach out to your doctor. “If there are any new rashes, especially if there are changes of skin circulation like whitening and then red purple changes (a high index of suspicion of abnormal skin circulation), then I would recommend you see your dermatologist as soon as possible,” says Dr. Yosipovitch. And remember, while Adderall may help control your ADHD, the most effective medication works in tandem with healthy lifestyle changes like eating right, sleeping well, and exercising regularly. Good luck!

Adderall Use: American Chemical Society. (2015.) “How Does Adderall Work?” https://www.brainfacts.org/diseases-and-disorders/mental-health/2015/how-does-adderall-work

Adderall Side Effects: FDA. (2017.) “Adderall® CII.” https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/011522s043lbl.pdf

Adderall Misuse (1): Addictive Behaviors. (2018. ) “Perceived Academic Benefit Is Associated With Nonmedical Prescription Stimulant Use Among College Students.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5614826/

Adderall Misuse (2): Psychiatry International. (2022.) “Prescription Stimulants in College and Medical Students: A Narrative Review of Misuse, Cognitive Impact, and Adverse Effects.” https://www.mdpi.com/2673-5318/3/3/18/htm

Reynaud’s Disease: Mayo Clinic. (2022.) “Raynaud’s Disease.” https://www.mayoclinic.org/diseases-conditions/raynauds-disease/symptoms-causes/syc-20363571#:~:text=Raynaud's%20(ray%2DNOSE)%20disease,to%20affected%20areas%20(vasospasm)

Delusional Infestation (1): Acta Dermato-Venereologica. (2019.) “Treatment-induced Delusions of Infestation Associated with Increased Brain Dopamine Levels.” https://pubmed.ncbi.nlm.nih.gov/30460371/

Delusional Infestation (2): Journal of the German Society of Dermatology. (2022.) “Adverse Psychocutaneous Effects of Prescription Stimulant Use and Abuse: A Systematic Review.” https://onlinelibrary.wiley.com/doi/abs/10.1111/ddg.14669

Meet Our Writer

Tracy Davenport, Ph.D.

Tracy Davenport is a regular health writer for HealthCentral. She is the founder of Tracyshealthyliving.com. Using the latest scientific research, she helps people live their healthiest lives via one-on-one coaching, corporate

Adderall Side Effects - Serenity Lane

Over the last few decades, Adderall has emerged as one of the most popular treatment options for many different disorders that can affect a person’s ability to focus, including attention-deficit/hyperactivity disorder (ADHD) and narcolepsy (sudden bouts of uncontrollable sleep). As with most powerful prescription drugs, the positive and desired effects of Adderall come with a number of possible, and potentially serious, side effects.

The ’90s and the Rise of Adderall

Table of Contents

We saw the rise in popularity of Adderall start when the drug was introduced to the market in 1996. While Adderall is commonly prescribed for people of all ages with various disorders, the initial popularity of the drug started with its prescriptions for children.

One New York Times article reports that in 1990, about 600,000 children were on stimulants for various reasons, including for the treatment of ADHD. At that time, Ritalin was the treatment of choice. Ritalin is an older stimulant drug that often has to be taken multiple times a day.

Adderall was introduced in 1996 and immediately gained popularity as the new, upgraded, and more effective treatment for ADHD. It became the go-to medicinal treatment for ADHD, often improving symptoms with one extended-release tablet per day. By 2013, a staggering 3.5 million children were prescribed stimulant drugs, mostly Adderall.

With the drug’s incredibly quick rise in popularity for treating children with attention disorders, it made sense that Adderall prescriptions for adults would soon follow this trend. By the mid-2000s, adults ages 20 to 39 were the fastest-growing group receiving prescriptions for the drug. In 2012, roughly 16 million Adderall prescriptions were written for young adults in the United States.

One reason Adderall became so widely prescribed is because the drug is effective in improving the symptoms of ADHD. According to the Cleveland Clinic, stimulant drugs such as Adderall are proven to be effective in 70% to 80% of children with ADHD, and 70% of adults living with the condition.

The widespread prescribing of Adderall eventually led to drug sharing, illegal drug sales, and misuse by people who have no legitimate need for the drug. Not only does Adderall improve focus and concentration for people living with ADHD, but it is also believed to improve focus and concentration for people without a medical need. This has led to widespread misuse of Adderall among people who are seeking improvement in physical or academic performance.

Adderall Is a Powerful Drug, Not a “Magic Pill”

Despite what the massive prescription numbers would suggest, Adderall is not a “magic pill” that increases focus and concentration without consequences. There are certain side effects, both common and uncommon, that result from taking Adderall.

This is not only true for people who take the drug without a prescription, but even those who are prescribed Adderall for legitimate medical reasons can expect to experience some or all of these side effects.

Many of these side effects are a result of the ways the drug affects the people who take it. Adderall is a brand name for the combination of dextroamphetamine and amphetamine, two powerful stimulants. The medication works by altering certain naturally occurring chemicals in the brain.

Adderall affects chemicals known as neurotransmitters, which act as chemical messengers that tell the brain to feel certain emotions. By boosting the neurotransmitters dopamine and norepinephrine, the drug increases concentration, focus, motivation, and even feelings of happiness or contentment.

Because of the way the drug works in the brain, Adderall can have some powerful side effects on many different systems of the body.

Adderall’s Side Effects on the Central Nervous System (CNS)

The desirable effects of Adderall are a result of the drug’s interaction with the body’s central nervous system (CNS). For people who suffer from narcolepsy, the medication can help keep them awake and alert during the daytime hours. For people with ADHD, it can help them feel more calm and able to focus.

Along with these positive effects, there are also some potential unwanted CNS side effects that may include:

  • Restlessness
  • Headaches
  • Nervousness
  • Difficulty getting to sleep or staying asleep
  • Dry mouth and hoarse voice
  • Dizziness
  • Slowed speech
  • Changes or blurring of vision

While these are relatively common and mild side effects, there are some potentially dangerous CNS side effects that include:

  • Fever, sweating, and weakness
  • An allergic reaction to Adderall that can cause swelling of the tongue, throat, or face.
  • Uncontrollable shaking, movements (also called tics), or seizures
  • Visual or auditory hallucinations (seeing or hearing things that aren’t actually there)
  • Intense paranoia (fear people want to hurt you) and intrusive thoughts
  • Worsening of other mental health conditions such as depression or anxiety

If you experience any of these side effects, which could be potentially dangerous and even deadly, it is very important to contact your healthcare provider immediately.

Adderall’s Side Effects on the Circulatory and Respiratory Systems

As is the case with all stimulant drugs, Adderall can make the blood vessels contract, leading to an increase in blood pressure and heart rate. For people with pre-existing heart conditions, taking Adderall can be extremely dangerous.

In some cases, Adderall can impact the way blood circulates throughout the body. Poor blood circulation can lead to pain or numbness in the fingers or toes. It can also make it so injuries to the hands or feet take a much longer time to heal due to lack of oxygenated blood flow. The hands or feet may even turn blue or red, signaling that the drug is interfering with the flow of blood.

By affecting the way blood flows throughout the body, Adderall can also cause diminished sexual performance and even impotence.

The most serious side effects of Adderall include heart attack and stroke. If you start to experience chest pain, shortness of breath, difficulty breathing, or fainting, contact your healthcare provider immediately.

The Negative Effects of Adderall and Alcohol

The potential heart complications of taking Adderall are compounded when a person drinks alcohol at the same time. The chances of a heart attack or stroke are greatly increased, so the two drugs should never be consumed together.

Along with further heart complications, stimulant drugs can also lower the intoxicating effects of alcohol, causing a person to drink more in order to get drunk. This can quickly lead to alcohol poisoning and other alcohol-related consequences.

Adderall’s Side Effects on the Digestive System

Adderall affects the digestive system, including the stomach and intestines, by causing the body to release an increased amount of glucose (sugar) into your system, causing irritation. Some other various side effects on the digestive system include:

  • Stomach pain and cramping
  • Constipation
  • Vomiting
  • Nausea
  • Diarrhea

Adderall also causes the muscles in the digestive tract to slow, which can cause both stomach pain and constipation.

In a less enlightened time in the mid-20th century, stimulant drugs were often prescribed as weight-loss supplements because they suppress the appetite. This leads to a wide range of undesired effects that can include the stunting of growth in children who take Adderall.

Stimulants can also cause extreme weight loss and even unintentional anorexia. While loss of appetite is an initial side effect of responsible Adderall treatment, this effect gradually wears off as the body adjusts to the drug’s presence.

Adderall’s Side Effects on the Skin

As mentioned above, a small percentage of people who take Adderall experience an allergic reaction that can cause swelling and itching. A moderate amount of itching is to be expected for a person who is prescribed Adderall, but if these effects become too severe, or develop into blisters or rashes, it’s very important to contact your healthcare provider immediately.

Long-term Side Effects of Adderall

Most of the long-term side effects of Adderall have already been mentioned and don’t go away even as the body adjusts to the presence of the drug. The most serious of these include stunted growth in children, weight loss, and possible complications stemming from increased blood pressure. In most cases, these side effects stop once Adderall treatment stops, and the body is able to return to normal function.

Some studies also suggest long-term Adderall treatment may cause negative psychological effects and changes in the brain.

In one article for The New York Times, Dr. Leonard Sax reports there is substantial evidence that stimulant medications, such as Adderall, may damage an area of the brain known as the nucleus accumbens. This area of the brain is crucial to personal motivation and drive. The nucleus accumbens is not involved in cognitive functions (thinking, understanding, etc.), so if it is damaged, there will be no impairment to cognitive function, but the drive to achieve will be diminished.

The Effects and Symptoms of Adderall Addiction

Because of the way Adderall affects the brain, it is very possible to develop an addiction or physical dependence on the substance. Adderall dependence is marked by an increasing reliance on the next dose of Adderall to improve mood, get work done, or bolster focus. Without that next dose, those with a dependence can experience a kind of crashing sensation.

People who have become dependent on Adderall may feel more depressed and gloomy. Those with more severe cases of dependency can even experience suicidal thoughts or thoughts of self-harm.

Without a follow-up dose, people who take the drug can feel sluggish. Even forming basic plans or trying to communicate ideas with others can be difficult. The ability to work or finish a project seems impossible without a dose of Adderall.

In order to address cases of Adderall dependence, it is necessary to identify common symptoms.

Common symptoms of Adderall dependence can include:

  • Continuously taking larger doses of the drug to achieve the same feelings
  • Attempting to cut back or stop taking Adderall without much success
  • Finding it difficult to start or complete work and other tasks without Adderall
  • Feeling low on energy or very tired before taking Adderall
  • Devoting more time to taking and acquiring Adderall by cutting out interests, hobbies, relationships, and other responsibilities
  • Experiencing withdrawal symptoms when trying to quit or lower the dose
  • Continuing to take Adderall even though its negative consequences are evident
  • Allocating more time toward stocking up on the drug or taking it

Addiction to Adderall and other substances can happen unexpectedly and take a person by surprise. After all, students looking for that extra energy and motivation during finals week don’t start taking Adderall expecting to develop an addiction.

Unfortunately, taking Adderall continuously can cause a person to build up a tolerance and develop an increasing reliance on the drug. While the initial intentions of taking Adderall often begin innocently, the need to continue taking the drug can grow. Some people may even need to fake or exaggerate ADHD or narcolepsy symptoms to secure fraudulent prescriptions.

Treatment for Adderall Addiction Is Effective and Available at Serenity Lane

At Serenity Lane, we understand addiction isn’t something people plan for. Especially with a drug like Adderall, the “study drug,” people who may be relying on that next dose might be surprised to find themselves addicted.

Treatment for Adderall addiction is available and effective. We’ve been helping people in the Oregon community overcome their issues with addiction since 1973. Our compassionate, licensed substance use disorder counselors are waiting for your call.

Contact us today at (800) 543-9905 to get started.

FAQs:

What are the most common side effects of Adderall?

The most common side effects of Adderall include loss of appetite, weight loss, dry mouth, stomach upset/pain, nausea/vomiting, dizziness, headache, diarrhea, fever, nervousness, and trouble sleeping. If any of these effects persist or worsen, contact your healthcare provider immediately.

What does Adderall do to you?

For people who suffer from attention-deficit/hyperactivity disorder (ADHD), it calms them and often improves their ability to focus. In people who don't have ADHD, because Adderall produces an excessive amount of dopamine, they may experience feelings of euphoria (extreme happiness) and increased energy levels, as well as possibly dangerous physical and emotional side effects.

Why shouldn't you take Adderall?

Adderall can be an effective tool in the treatment of attention-deficit/hyperactivity disorder (ADHD) and narcolepsy (sudden bouts of uncontrollable sleep). For someone who doesn’t suffer from these conditions, Adderall can have negative effects on the central nervous system, digestive system, heart, and even cause damage to parts of the brain responsible for motivation.

Is Adderall bad for anxiety?

Because it is a stimulant drug, Adderall can cause or worsen negative psychological issues such as depression and anxiety. If a person takes Adderall without a prescription or medical supervision, the likelihood of increased anxiety is much higher.

Itching due to skin allergy1

Back

Itching in skin allergies is an unpleasant sensation that occurs in the surface layer of the skin, causing a desire to scratch. This symptom can significantly reduce the patient's quality of life.

When itchy skin may occur

2

With urticaria, which is characterized by the appearance of blisters. Acute urticaria usually occurs as a result of an allergic reaction to food and medicine. Itchy blisters on the skin pass within a day without the formation of secondary elements.

Mechanism of pruritus development

3

With allergies, itching of the face or body is caused by stimulation of special histamine-sensitive nerve fibers. In this case, a reflex motor response arises: the desire to rub, knead or scratch the problem area of ​​the body. Such a mechanical effect gives only short-term relief, and in the future can lead to skin damage. Prolonged itching leads to the formation of a focus of pathological excitation in the brain, and scratching leads to an increase in the sensitivity of nerve receptors. As a result, the threshold for perception of itching becomes lower, and it worries the patient more and more often.

Treatment of allergic pruritus in urticaria

2

Medical treatment

To relieve the symptoms of chronic urticaria, modern antihistamines are used. To determine how to relieve itchy skin with allergies, you should consult with your doctor. The specialist will select the appropriate drug, taking into account the indications and contraindications.

ZYRTEK® for relief of itching in urticaria

ZIRTEK® is a modern antihistamine drug available in two dosage forms (drops and tablets). The active ingredient of the drug is cetirizine, which helps relieve itching in urticaria 4.5 . ZYRTEK® does not affect memory, attention and thinking 6 . ZIRTEC® drops are approved for use in children older than 6 months 4 ,*, tablets - in adults and children older than 6 years 5 . Before using the product, you must read the instructions and consult with a specialist.

* Use in children from 6 to 12 months is possible only on prescription and under strict medical supervision.

Advice for patients

The treatment is based on the exclusion of factors that provoke itching in allergies. The substance causing the hypersensitivity reaction should be identified and avoided if possible. 2 . If there is a symptom such as itching, it is important to pay great attention to personal hygiene 3 , as profuse sweating can increase the feeling of itching.

  1. Cheburkin A. A. Itching: differential diagnosis and therapy. Therapeutic archive. 2014. V.86, No. 4, S. 85-90.

  2. Goryachkina L.A., Nenasheva N.M., Borzova E. Yu. Urticaria. Attending physician, 2003, No. 9 S.10-15.

  3. Vyalov S.S. Skin itching: differential diagnosis, principles of rational pharmacotherapy. breast cancer. 2015, №19, S. 1142

  4. Instructions for medical use of the drug Zyrtec®, P N011930/01, http://grls.rosminzdrav.ru/, accessed: 11/17/2021

  5. Instructions for medical use of the drug Zyrtec® P N014186/01, http://grls.rosminzdrav.ru/, accessed: 11/17/2021

  6. Curran M. P., Scott L.J., Parry K.M. Cetirizine. Review of application in allergic diseases. Medicines. 2004, V.64, No. 5, S. 523-651

things to think about uMEDp

The article deals with the pathogenesis of pruritus, possible psycho-emotional problems and somatic triggers of pruritus. The advantages of second-generation antihistamines, in particular cetirizine, are described: in addition to blockade of h2-histamine receptors, the drug inhibits the migration of eosinophils in the focus of inflammation, suppresses the skin response to platelet-activating factor. The results of our own studies showing the effectiveness of cetirizine in dermatological diseases are presented. Namely: the maximum reduction in the intensity of itching already three hours after application during the first five days of therapy.

Fig. 1. Algorithm for diagnosing pruritus

Fig. 2. Distribution of patients by nosology

Fig. 3. The average subjective assessment of the intensity of itching after the use of the drug

Fig. 4. Dynamics of clinical manifestations

The skin makes up about 15% of the total human body weight and is the largest organ. Its most important function is protective.

The condition of the skin has a significant impact on a person's self-esteem and the formation of interpersonal relationships.

Skin itching is an unpleasant subjective sensation that causes a desire to scratch. This symptom in the vast majority of cases causes discomfort, psycho-emotional stress and exhaustion. In addition, as a result of combing, the integrity of the skin is violated.

It should be noted that, despite the high prevalence of the symptom, it has not been sufficiently studied due to the difficulties of its adequate assessment and the lack of models for research.

Somatic triggers of pruritus

Generalized itching that occurs without concomitant manifestations on the skin can be due to various reasons - from skin xerosis to endocrinological pathologies or carcinoma. That is why in clinical practice one should not neglect the assessment of this important prognostic symptom.

Relatively benign etiological factors include drug allergic reactions, dry skin, scabies, and primary dermatological diseases. Most often, pruritus is observed with dry skin. In older patients, it occurs in 10–50% of cases [1]. Generalized pruritus occurs in 13% of patients with chronic renal failure and in 70–90% on hemodialysis [2]. Liver diseases accompanied by cholestasis (primary biliary cirrhosis of the liver, cholestasis caused by oral contraceptives, intrahepatic cholestasis during pregnancy, etc.) also often cause pruritus [2].

Among the hematological diseases that cause itching are polycythemia, iron deficiency anemia, endocrine diseases - thyrotoxicosis and diabetes mellitus [3].

Pruritus is a common clinical manifestation of AIDS and associated Kaposi's sarcoma, opportunistic infections. Thus, itching with or without skin rashes is observed in 84% of AIDS patients, in 35. 5% of patients with Kaposi's sarcoma, which developed against the background of AIDS. AIDS-associated opportunistic infections are accompanied by itching in 100% of cases [4].

It has been established that pruritus can appear in malignant diseases. For example, with Hodgkin's lymphoma, itching occurs in 10-25% of patients, is characterized by high intensity and limited localization, more often in the lower part of the legs. In some cases, this symptom precedes the diagnosis of lymphoma and may serve as an indicator of a less favorable disease prognosis than fever or weight loss [4]. Adenocarcinomas and squamous cell carcinoma of various organs (stomach, pancreas, lungs, colon, brain, breast, prostate) are accompanied by itching on larger areas of the skin: on the legs, upper body and extensor surfaces of the arms. At the same time, there is a direct relationship between the presence of itching and the activity/recurrence of cancer [4].

Secondary skin itching is usually associated with taking drugs such as opium derivatives (cocaine, morphine, butorphanol), phenothiazines, tolbutamide, erythromycin, anabolic hormones, estrogens, progestins, testosterone, aspirin, quinidine and other antimalarial drugs, biologics ( monoclonal antibodies), vitamin B. In addition, it is known that itching can be a subclinical manifestation of hypersensitivity to any drug [5].

Since itching is observed not only in dermatological pathologies, it is advisable to conduct a thorough examination of patients (Fig. 1) and treat them taking into account the identified pathology.

Mechanisms of development and relief of pruritus

Hypotheses of the mechanisms of itch development were formulated on the basis of a study of the pathophysiology of pain, since pain and itch combine common molecular and neurophysiological mechanisms.

The sensation of itching and pain is the result of the activation of a network of free nerve endings in the dermal-epidermal zone. The trigger mechanism is the influence of internal or external thermal, mechanical, chemical stimuli or electrical stimulation. Skin nerve irritation can be mediated by several biological agents, including histamine, vasoactive peptides, enkephalins, substance P, prostaglandins.

It is believed that other, non-anatomical factors, such as psycho-emotional stress, individual subjective perception, the presence and intensity of other sensations and / or distractions, have a significant impact on the degree of itch sensitivity in different areas of the skin.

The nerve impulse that causes the sensation of itching, which has arisen under the influence of any of the listed factors, is transmitted along the same neural connection as pain impulses: from peripheral nerve endings to the dorsal horns of the spinal cord, through the anterior commissure, along the spinothalamic tract to the contralateral laminar nucleus of the thalamus. It is suggested that the thalamocortical tract of tertiary neurons acts as a "relay" for impulse transmission through the integration of the reticular activating system of the thalamus in several areas of the brain. In response, there is a desire to comb the skin, which is formed in the corticothalamic center and is realized in the form of a spinal reflex. After scratching, itching reappears after 15–25 minutes. However, in some cases, especially in patients with chronic dermatoses, the sensation of itching after scratching does not stop, which leads to excoriation.

Despite the fact that many etiological and pathogenetic factors contributing to the occurrence of itching are currently known, their study continues and new mechanisms are being discovered.

The mechanism by which itching is relieved by scratching has not been reliably established. Perhaps, during scratching, sensory impulses are formed that interrupt the neural arc responsible for the occurrence of sensation.

In addition to scratching, vibrations, injections into the itchy area, exposure to heat, cold, and ultraviolet radiation help to reduce itching [3].

Treatment

Therapeutic methods should be aimed primarily at eliminating pathogenetic factors.

Patients are shown sedatives (especially for intense chronic itching), emollients (to reduce dry skin, which is both a cause and a consequence of itching), topical distractions (cold lotions, menthol-containing products, etc. ), antihistamines, which in the vast majority of cases are first-line drugs.

There are two generations of antihistamines: sedatives (Suprastin, Tavegil, Diazolin, Diphenhydramine, Phencarol, Fenistil) and non-sedative/mildly sedatives (cetirizine, levocetirizine, loratadine, desloratadine, fexofenadine, ebastine, rupatadine).

It is important to note that, despite the need to take sedatives, it is better not to use first-generation antihistamines (which have a sedative effect in addition to the antihistamine). Firstly, sleep during their use is non-physiological (drugs inhibit the phase of REM sleep). Secondly, the multiple side effects characteristic of this group of drugs limit the possibility of their use in patients with comorbidities.

Therefore, it is better to use tranquilizers as sedatives, and when choosing antihistamines, preference should be given to second-generation blockers.

Cetirizine occupies a special place among them.

Cetirizine

Cetirizine inhibits the histamine-mediated early phase of the allergic reaction, prevents various physiological and pathophysiological effects of histamine, such as dilation and increased capillary permeability (development of edema, urticaria, redness), stimulation of sensitive nerve endings (itching, pain) and contraction of the smooth muscles of the respiratory and gastrointestinal tract.

In the late stage of an allergic reaction, cetirizine not only inhibits the release of histamine, but also the migration of eosinophils and other cells, thus attenuating the late allergic reaction. Reduces expression of adhesion molecules such as Intercellular Adhesion Molecule 1 (ICAM-1) and Vascular Cellular Adhesion Molecule 1 (VCAM-1), which are markers of allergic inflammation .

In addition, unlike other drugs used for skin manifestations of allergies, cetirizine not only blocks H 1 -histamine receptors, but also suppresses the skin response to platelet-activating factor [6, 7]. This is confirmed by the results of numerous clinical comparative studies: due to the ability to accumulate in the skin, the drug relieves itching and hyperemia more effectively than such drugs as ebastine, epinastine, terfenadine, fexofenadine and loratadine [8–10].

Compared to other antihistamines, cetirizine has a low volume of distribution of 0.5 l/kg. This provides higher concentrations of the substance in the extracellular space, where H 1 -histamine receptors are located. Thus, their full employment and the highest antihistamine effect are ensured [11]. Another feature of the drug is its high ability to penetrate the skin. 24 hours after taking a single dose of cetirizine, the concentration in the skin is equal to or even slightly higher than the concentration in the blood. The advantage of cetirizine is the steroid-sparing effect: with the simultaneous administration of cetirizine and inhaled glucocorticosteroids in patients with bronchial asthma, the dose of the latter may be reduced or not increased, despite contact with the allergen.

Among cetirizines, Cetrin occupies a special place. In the study of E.E. Nekrasov et al. in patients with chronic urticaria, Cetrin showed the highest efficacy among other cetirizine generics and the best results in terms of pharmacoeconomics [12].

Application experience

We observed 75 patients aged 18 to 76 years (34 men and 41 women) with diagnoses of "atopic dermatitis", "allergic dermatitis", "chronic eczema in the acute stage", "lichen planus", "toxidermia" ( Fig. 2).

All patients received topical and systemic therapy, which included the antihistamine drug Cetrin (cetirizine) at a dose of 10 mg once a day at night. The duration of therapy is from 14 to 21 days, depending on the diagnosis.

Patients assessed the effectiveness of itching relief according to a point system: 0 points - no itching, 1 point - mild itching (present, but does not bother), 2 points - moderate (it bothers, but does not interfere with daily activity and / or sleep), 3 points - severe / intense itching (disturbs and interferes with daily activity and / or sleep).

The maximum decrease in the intensity of itching was observed already three hours after taking the drug in the first five days (Fig. 3).

Subsequently, a decrease in itching or its absence was noted by the tenth day of therapy with a simultaneous decrease in the clinical manifestations of diseases (Fig. 4).

The results obtained demonstrate the high efficiency of Cetrin (cetirizine) in the treatment of chronic and acute dermatoses.

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