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Feeling itchy? Scientists are working to unravel the mysteries behind chronic itch

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This story is part of CBC Health’s Second Opinion, a weekly analysis of health and medical science news emailed to subscribers on Saturday mornings. If you haven’t subscribed yet, you can do that by clicking here.


Candice Coghlan spent much of her time in high school missing class after scratching large areas of her legs, back and scalp, without knowing the itching was due to a silent disease.

When Coghlan returned home to Waterloo during her second year of university, she’d lost weight on top of the skin issues. Hours after blood was drawn, the lab called telling her to go to the emergency department immediately.

Coghlan, now 38, was told she was in end-stage kidney failure.

Looking back, the itching she thought was from ordinary psoriasis was actually a clue.

“With my failed kidneys, it was actually the toxins trying to escape through my skin because my kidneys could no longer process the toxins, causing extreme itchiness,” Coghlan said.

She was on dialysis for more than a year. In September 2009, her mother donated a kidney to her.

“It was by day two, I would say, of having my kidney transplant that I realized I was no longer itchy,” she recalled.

For kidney recipient Candice Coghlan, relief from itching during dialysis treatment came after her mother donated the organ to her. (CBC)

Chronic itching can be a sign of a deep, underlying problem like liver or kidney disease, as it was for Coghlan.

But even when the cause is more benign, which is more common, the itching itself can have a major impact on someone’s quality of life, say dermatologists, and it’s not well understood.

Why is itching contagious? Why do we keep scratching ourselves, beyond when it helps? Scientists are still unravelling the head-scratcher of itching — from how hard we scratch the skin to neurons in the brain that could explain what’s going on.

Common ailments: eczema and dry skin

Dr. Rachel Asiniwasis, a dermatologist based in Regina, said atopic dermatitis — more commonly called eczema — tops the list of what she treats in her office.

The itching can be as harmful to patients as chronic pain on a mental health level, she said.

“I feel like it’s a condition that’s often misunderstood or dismissed as just a skin problem,” Asiniwasis said.

A female dermatologist on Zoom.
Dr. Rachel Asiniwasis, a dermatologist in Regina, says atopic dermatitis or eczema is often misunderstood. (Origins Dermatology Centre)

Many with chronic itch have hallmark scratches on a large surface of the skin, she said. The flesh can also ooze and swell with open sores, increasing the risk for infection.

“I spend a lot of my time counselling about moisturizing and lifestyle,” Asiniwasis said. “I call it the diabetes of dermatology because it’s common.”

During winter when indoor heating tends to dry out the air, people often scratch their skin more.

In severe eczema, the skin may respond to scratching by thickening up, like leathery, elephant skin, Asiniwasis tells her patients.

Asiniwasis has received funding from pharmaceutical makers in the field of atopic dermatitis.

How hard are you scratching?

Akhil Padmanabha, a PhD student at Carnegie Mellon University in Pittsburgh, faced itching from eczema since birth. While it made him uncomfortable, the skin condition also inspired his life’s work.

In high school, Padmanabha said he went through several health challenges, including being hospitalized twice due to the eczema and side-effects from topical steroids, which can include thinning of the skin.

A diagram showing the parts of Akhil Padmanabha's wearable device to measure the intensity of scratching intensity shows a hand on the right wearing a ring with its components shown on the left.
A diagram showing the parts of a wearable invention to measure the intensity of scratching. (Carnegie Mellon University)

When Padmanabha started his doctoral work on sensors in robotics, he stumbled on a paper about tracking scratch behaviours, leading him to search for a way to measure it.

Padmanabha said the intensity of stratching is an important metric for how much an itch is disrupting someone’s life, but researchers haven’t looked at it much.

For instance, two individuals can spend the same amount of time scratching with different degrees of damage to the skin. Having an objective measure of scratching intensity could inform doctors on whether a treatment is working or not, he said.

“What we did is we used this pressure-sensitive tablet to basically measure the force and intensity of someone’s scratch on it,” he said.

As you scratch, Padmanabha said, the friction between your nail and skin causes vibrations that travel through your fingers. In his 2023 prototype, a ring device consisting of two sensors is placed on one of the scratching fingers to measure high-frequency vibrations and accelerations of the finger and arm during the scratching motion.

Man with black hair and beard wearing a purple shirt on a blurred outdoor background.
Akhil Padmanabha is a PhD student inspired by his personal struggle with chronic itch to invent a sensor to objectively measure scratching intensity. (Submitted by Akhil Padmanabha)

Padmanabha hopes one day the device will help patients and doctors to better inform treatment plans.

Until then, Padmanabha is trying to subjectively figure out why his own symptoms fluctuate as the weather, diet and other factors change.

What’s behind contagious itching?

Medical researchers are finding clues to other key mysteries of itch, like contagiousness. Just seeing someone scratching can be enough to trigger the same behaviour in people.

Researcher Alexandru Papoiu worked with dermatologist Gil Yosipovitch at Wake Forest University Winston-Salem, N.C., on a contagiousness experiment.

Itch “is physiologically wired in our neurons, from the skin to the spinal cord to the brain,” Papoiu said.

But what’s happening in the brain to transmit itch remains an enigma, he said.

Histamine can trigger nerve endings in skin for an itch sensation. But in the clinic, most patients with itch don’t respond to antihistamine.

Back in 2011, Papoiu and his team used histamine to compare 14 healthy subjects, who received histamine or a saline control on their forearm, to 11 patients who had eczema. All study participants were monitored as they watched short video clips of people scratching or just relaxing.

Those with the skin condition had a higher itch intensity and scratched more frequently while watching the videos of other subjects scratching. What’s more, they scratched widely all over their own body after watching the clip, instead of just where the person in the video targeted.

Papoiu said they tried to coin a term, pruricebo, similar to placebo or sugar pill, for this unique effect that can be triggered by seeing someone else scratch.

An image of the outline of a person scratching in white superimposed over colourful circles on a black background.
An image of the outline of a person scratching superimposed over fluorescently labelled neurons that are responsible for itch. (Xinzhong Dong/Johns Hopkins Medicine)

It even seems to happen with images suggesting itch — like parasites or insects crawling on skin.

“It’s not necessarily that you see somebody scratching or itching,” Papoiu said“It is more subtle because the brain actually has to interpret that image to suggest something to you.”

Scientists have a few lines of thinking about what might be behind contagious itch.

The starting point is that both itch and pain seem to be conducted to the brain through the same pathways.

Papoiu suggested that while both sensations are sent by the same nerve fibres and activate the same parts of the brain, the signals may be coded differently. He compared it to the varying signals of FM and AM radio. The brain also pinpoints subtle differences in the frequency of signals and interprets each as pain or itch.

Scientists say our brains might distinguish the nuisance of itch from the seriousness of pain that warns something is wrong.

Understanding more about how could help explain the engima of cases like a woman, M, whose scalp remained itchy even after neurosurgeons cut the main nerve to the area.

 

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What’s the greatest holiday gift: lips, hair, skin? Give the gift of great skin this holiday season

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Give the gift of great skin this holiday season

Skinstitut Holiday Gift Kits take the stress out of gifting

Toronto, October 31, 2024 – Beauty gifts are at the top of holiday wish lists this year, and Laser Clinics Canada, a leader in advanced beauty treatments and skincare, is taking the pressure out of seasonal shopping. Today, Laser Clincs Canada announces the arrival of its 2024 Holiday Gift Kits, courtesy of Skinstitut, the exclusive skincare line of Laser Clinics Group.

In time for the busy shopping season, the limited-edition Holiday Gifts Kits are available in Laser Clinics locations in the GTA and Ottawa. Clinics are conveniently located in popular shopping centers, including Hillcrest Mall, Square One, CF Sherway Gardens, Scarborough Town Centre, Rideau Centre, Union Station and CF Markville. These limited-edition Kits are available on a first come, first served basis.

“These kits combine our best-selling products, bundled to address the most relevant skin concerns we’re seeing among our clients,” says Christina Ho, Senior Brand & LAM Manager at Laser Clinics Canada. “With several price points available, the kits offer excellent value and suit a variety of gift-giving needs, from those new to cosmeceuticals to those looking to level up their skincare routine. What’s more, these kits are priced with a savings of up to 33 per cent so gift givers can save during the holiday season.

There are two kits to select from, each designed to address key skin concerns and each with a unique theme — Brightening Basics and Hydration Heroes.

Brightening Basics is a mix of everyday essentials for glowing skin for all skin types. The bundle comes in a sleek pink, reusable case and includes three full-sized products: 200ml gentle cleanser, 50ml Moisture Defence (normal skin) and 30ml1% Hyaluronic Complex Serum. The Brightening Basics kit is available at $129, a saving of 33 per cent.

Hydration Heroes is a mix of hydration essentials and active heroes that cater to a wide variety of clients. A perfect stocking stuffer, this bundle includes four deluxe products: Moisture 15 15 ml Defence for normal skin, 10 ml 1% Hyaluronic Complex Serum, 10 ml Retinol Serum and 50 ml Expert Squalane Cleansing Oil. The kit retails at $59.

In addition to the 2024 Holiday Gifts Kits, gift givers can easily add a Laser Clinic Canada gift card to the mix. Offering flexibility, recipients can choose from a wide range of treatments offered by Laser Clinics Canada, or they can expand their collection of exclusive Skinstitut products.

 

Brightening Basics 2024 Holiday Gift Kit by Skinstitut, available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

Hydration Heroes 2024 Holiday Gift Kit by Skinstitut – available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

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Here is how to prepare your online accounts for when you die

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LONDON (AP) — Most people have accumulated a pile of data — selfies, emails, videos and more — on their social media and digital accounts over their lifetimes. What happens to it when we die?

It’s wise to draft a will spelling out who inherits your physical assets after you’re gone, but don’t forget to take care of your digital estate too. Friends and family might treasure files and posts you’ve left behind, but they could get lost in digital purgatory after you pass away unless you take some simple steps.

Here’s how you can prepare your digital life for your survivors:

Apple

The iPhone maker lets you nominate a “ legacy contact ” who can access your Apple account’s data after you die. The company says it’s a secure way to give trusted people access to photos, files and messages. To set it up you’ll need an Apple device with a fairly recent operating system — iPhones and iPads need iOS or iPadOS 15.2 and MacBooks needs macOS Monterey 12.1.

For iPhones, go to settings, tap Sign-in & Security and then Legacy Contact. You can name one or more people, and they don’t need an Apple ID or device.

You’ll have to share an access key with your contact. It can be a digital version sent electronically, or you can print a copy or save it as a screenshot or PDF.

Take note that there are some types of files you won’t be able to pass on — including digital rights-protected music, movies and passwords stored in Apple’s password manager. Legacy contacts can only access a deceased user’s account for three years before Apple deletes the account.

Google

Google takes a different approach with its Inactive Account Manager, which allows you to share your data with someone if it notices that you’ve stopped using your account.

When setting it up, you need to decide how long Google should wait — from three to 18 months — before considering your account inactive. Once that time is up, Google can notify up to 10 people.

You can write a message informing them you’ve stopped using the account, and, optionally, include a link to download your data. You can choose what types of data they can access — including emails, photos, calendar entries and YouTube videos.

There’s also an option to automatically delete your account after three months of inactivity, so your contacts will have to download any data before that deadline.

Facebook and Instagram

Some social media platforms can preserve accounts for people who have died so that friends and family can honor their memories.

When users of Facebook or Instagram die, parent company Meta says it can memorialize the account if it gets a “valid request” from a friend or family member. Requests can be submitted through an online form.

The social media company strongly recommends Facebook users add a legacy contact to look after their memorial accounts. Legacy contacts can do things like respond to new friend requests and update pinned posts, but they can’t read private messages or remove or alter previous posts. You can only choose one person, who also has to have a Facebook account.

You can also ask Facebook or Instagram to delete a deceased user’s account if you’re a close family member or an executor. You’ll need to send in documents like a death certificate.

TikTok

The video-sharing platform says that if a user has died, people can submit a request to memorialize the account through the settings menu. Go to the Report a Problem section, then Account and profile, then Manage account, where you can report a deceased user.

Once an account has been memorialized, it will be labeled “Remembering.” No one will be able to log into the account, which prevents anyone from editing the profile or using the account to post new content or send messages.

X

It’s not possible to nominate a legacy contact on Elon Musk’s social media site. But family members or an authorized person can submit a request to deactivate a deceased user’s account.

Passwords

Besides the major online services, you’ll probably have dozens if not hundreds of other digital accounts that your survivors might need to access. You could just write all your login credentials down in a notebook and put it somewhere safe. But making a physical copy presents its own vulnerabilities. What if you lose track of it? What if someone finds it?

Instead, consider a password manager that has an emergency access feature. Password managers are digital vaults that you can use to store all your credentials. Some, like Keeper,Bitwarden and NordPass, allow users to nominate one or more trusted contacts who can access their keys in case of an emergency such as a death.

But there are a few catches: Those contacts also need to use the same password manager and you might have to pay for the service.

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Is there a tech challenge you need help figuring out? Write to us at onetechtip@ap.org with your questions.

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Pediatric group says doctors should regularly screen kids for reading difficulties

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The Canadian Paediatric Society says doctors should regularly screen children for reading difficulties and dyslexia, calling low literacy a “serious public health concern” that can increase the risk of other problems including anxiety, low self-esteem and behavioural issues, with lifelong consequences.

New guidance issued Wednesday says family doctors, nurses, pediatricians and other medical professionals who care for school-aged kids are in a unique position to help struggling readers access educational and specialty supports, noting that identifying problems early couldhelp kids sooner — when it’s more effective — as well as reveal other possible learning or developmental issues.

The 10 recommendations include regular screening for kids aged four to seven, especially if they belong to groups at higher risk of low literacy, including newcomers to Canada, racialized Canadians and Indigenous Peoples. The society says this can be done in a two-to-three-minute office-based assessment.

Other tips encourage doctors to look for conditions often seen among poor readers such as attention-deficit hyperactivity disorder; to advocate for early literacy training for pediatric and family medicine residents; to liaise with schools on behalf of families seeking help; and to push provincial and territorial education ministries to integrate evidence-based phonics instruction into curriculums, starting in kindergarten.

Dr. Scott McLeod, one of the authors and chair of the society’s mental health and developmental disabilities committee, said a key goal is to catch kids who may be falling through the cracks and to better connect families to resources, including quicker targeted help from schools.

“Collaboration in this area is so key because we need to move away from the silos of: everything educational must exist within the educational portfolio,” McLeod said in an interview from Calgary, where he is a developmental pediatrician at Alberta Children’s Hospital.

“Reading, yes, it’s education, but it’s also health because we know that literacy impacts health. So I think that a statement like this opens the window to say: Yes, parents can come to their health-care provider to get advice, get recommendations, hopefully start a collaboration with school teachers.”

McLeod noted that pediatricians already look for signs of low literacy in young children by way of a commonly used tool known as the Rourke Baby Record, which offers a checklist of key topics, such as nutrition and developmental benchmarks, to cover in a well-child appointment.

But he said questions about reading could be “a standing item” in checkups and he hoped the society’s statement to medical professionals who care for children “enhances their confidence in being a strong advocate for the child” while spurring partnerships with others involved in a child’s life such as teachers and psychologists.

The guidance said pediatricians also play a key role in detecting and monitoring conditions that often coexist with difficulty reading such as attention-deficit hyperactivity disorder, but McLeod noted that getting such specific diagnoses typically involves a referral to a specialist, during which time a child continues to struggle.

He also acknowledged that some schools can be slow to act without a specific diagnosis from a specialist, and even then a child may end up on a wait list for school interventions.

“Evidence-based reading instruction shouldn’t have to wait for some of that access to specialized assessments to occur,” he said.

“My hope is that (by) having an existing statement or document written by the Canadian Paediatric Society … we’re able to skip a few steps or have some of the early interventions present,” he said.

McLeod added that obtaining specific assessments from medical specialists is “definitely beneficial and advantageous” to know where a child is at, “but having that sort of clear, thorough assessment shouldn’t be a barrier to intervention starting.”

McLeod said the society was partly spurred to act by 2022’s “Right to Read Inquiry Report” from the Ontario Human Rights Commission, which made 157 recommendations to address inequities related to reading instruction in that province.

He called the new guidelines “a big reminder” to pediatric providers, family doctors, school teachers and psychologists of the importance of literacy.

“Early identification of reading difficulty can truly change the trajectory of a child’s life.”

This report by The Canadian Press was first published Oct. 23, 2024.

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