Itching

[akrasia]

http://www.nytimes.com/2014/02/18/health/itching-more-than-skin-deep.html?ref=health?src=dayp&_r=0


Dr. Yosipovitch said many patients found their way to him only after seeing multiple doctors who could not help and who sometimes misdiagnosed their problems as mental rather than physical.

“They’re not crazy,” he said.

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Joshua Riegel, 18, has a rare disease that was misdiagnosed as a mental issue and for which he was given antidepressants. Jeremy M. Lange for The New York Times
One of the patients was a boy who had scratched his arms and legs raw. Unable to find a cause or a treatment that worked, doctors had referred him and his family to a psychiatrist.

In an interview, the patient, Joshua Riegel, now 18, said, “They said I was doing it to manipulate my parents.” Thus began what he calls “that weird part of my life where they thought I was mentally ill.”

He was 12 or 13 when the psychiatrist prescribedantidepressants, which he dutifully took for two or three years. But they brought on terrible side effects: At one point he was hospitalized with suicidal thoughts.

As a last resort, his parents took him from their home in Hillsville, Va., to see Dr. Yosipovitch, who was then at Wake Forest.

“He had a hunch on what it was,” Mr. Riegel said.

Tests found a rare form of a genetic disease,epidermolysis bullosa, that was causing a particularly destructive set of symptoms: intense itching and skin so fragile that scratching ripped it to shreds.

“Dr. Yosipovitch was quite angry I was being told I was mentally ill when I wasn’t,” Mr. Riegel recalled.

Getting off the antidepressants lifted his spirits and let him be normal again. Since then, other drugs have been prescribed for the itching, with mixed results. It never really goes away, but Mr. Riegel uses video games or his cellphone to take his mind off it and keep from scratching.

For people with other types of chronic itching, Dr. Yosipovitch said: “This is just the beginning of a big era. In the next five years I predict there will be drugs targeted specifically for itch. We’re in the middle of the tip of an iceberg.”