Itchy Skin after Burn Injury
Click the triangle below to listen to the podcast brief and access the transcript by clicking here.
Introduction
As skin heals from a burn injury, it may get itchy. Almost everyone recovering from major burns experiences itchy skin—especially on or around the burn, graft, or donor site. The medical term for itchiness is “pruritus” (proo-ri´tus).
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 fragile skin that was previously healed. Itching can also make you anxious, which can make itching worse.
Itching can also get in the way of doing everyday activities, including:
- Sleep. Itching tends to worsen at night, making it hard to fall asleep and stay asleep.
- Work or school. Persistent itching may make it hard to concentrate when performing these activities.
- Physical activities. Exercise, sports, and play (for children) may increase itching.
- Social activities. The continuous need to scratch an itch may make it uncomfortable to be in social settings.
For many people, itching improves 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.
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.” Providers may also ask about how often (hours per day) you itch, the location of the itch, and the impact of the itch on your daily activities.
Children who are unable to describe the details of their itch symptoms in words are often asked to use the Itch Man Scale to describe their itch (see the figure below)
Treatments
Creams and lotions
- Itching increases with dry skin. If your skin is dry, applying moisturizer may help reduce itching and hydrate the skin. Lotions generally come in a bottle, have a higher water content than creams, and generally soak into the skin faster than creams, but you will need to apply them more often. Creams come in a tube or jar and are generally thicker, so you can apply them less frequently. Apply your moisturizer of choice as often as needed or as instructed by your health care provider.
You should choose the moisturizer that feels best on your skin. Look for unscented or “fragrance-free” moisturizers, as well as moisturizers that do not include alcohol. Products that include alcohol as an ingredient can make your skin dry. (Note: the ingredient “cetyl alcohol” is OK and will not dry out your skin.) For quick and easy tips on selecting a moisturizer, see: How to Select a Moisturizer for Itchy Skin After Burn Injury.
- There are also creams and lotions that have medications in them to help control itching. Some medicated moisturizers may be found over the counter (such as Capsaicin), while others need to be prescribed by your health care provider. Speak with your health care team to see what options may work best for you and your needs.
Bathing
- Bathing may or may not help with itching. Lukewarm water is best and tends to dry out skin the least.
- Bath additives such as oatmeal, powdered milk, or baby oil can be helpful.
- Cooling the skin with water provides some temporary relief.
Oral Medications
- Gabapentin, pregabalin, and tricyclic antidepressants are commonly used oral medications that must be prescribed. They act centrally—in your brain—to help decrease itching.
- Antihistamines work by blocking histamine, which triggers itching. Common antihistamines that can be purchased over the counter include diphenhydramine (e.g., Benadryl), cetirizine, loratadine, and hydroxyzine. The correct dosage (how much you should take) varies, so talk with your health care provider before taking any over-the-counter medications.
- Sleep medications are used to treat sleeplessness (insomnia). If itching makes it difficult for you to sleep, talk with your health care provider about safe sleep medications that can be helpful to get to sleep and stay asleep.
- Before taking any medication, talk to your health care provider about your options and potential side effects. In addition, ask your doctor or health care provider to review all your medications as some medicines can cause itching.
Other Tips
- Pressure garments and other supportive dressings (such as Tubigrip® elasticated tubular bandage, Elastinet®) or tight-fitting sport clothing may help during the first months and up to the first year following a burn injury.
- Skin massage with lotion and/or touching with firm pressure on healed areas can help reduce itching. Strongly patting on the itchy spot rather than scratching is preferable. Make sure you check with your health care provider if your itching remains bothersome.
- Laser therapy is a newer form of treatment that may help with itchy skin. This method provides gradual relief and may require three to six sessions of therapy to get the most benefit. Learn more from our Laser Therapy for Burn Scars factsheet: https://msktc.org/burn/factsheets/laser-therapy-burn-scars.
- Distractions such as television, games, and low-impact or mild exercise or activities can help take your mind off the itching.
- Short fingernails or sleeping with cotton gloves on, especially for children who tend to scratch at night while asleep, can reduce injuries to fragile skin.
- Avoid the use of fragrances on your skin. Choose unscented laundry detergent and body and bath products (e.g., soaps, lotions, sunscreens).
- Protect your skin from the sun by wearing appropriate clothing (e.g., a hat and long sleeves) and using sunscreen.
For More Information
- Infographic: How to Select a Moisturizer for Itchy Skin After Burn Injury (https://bit.ly/Moisturizer_Infographic)
- Infocomic: Itchy Skin After Burn Injury (https://bit.ly/Itchy_Skin_Infocomic)
- The Phoenix Society for Burn Survivors (http://www.phoenix-society.org/)
- American Burn Association (http://www.ameriburn.org/)
- In addition, you can contact your health care providers about local support groups and other resources.
References
Carrougher, G. J., Martinez, E. M., McMullen, K. S., Fauerbach, J. A., Holavanahalli, R. K., Herndon, D. N., Wiechman, S. A., Engrav, L. H., & Gibran, N. S. (2013). Pruritus in adult burn survivors: Post-burn prevalence and risk factors associated with increased intensity. Journal of Burn Care & Research, 34(1), 94−101.
Elman, S., Hynan, L. S., Gabriel, V., & Mayo, M. J. (2010). The 5-D itch scale: A new measure of pruritus. British Journal of Dermatology, 162(3), 587−593.
Morris, V., Murphy, L. M., Rosenberg, M., Rosenberg, L., Holzer, C. E. 3rd, & Meyer, W. J. 3rd. (2012). Itch assessment scale for the pediatric burn survivor. Journal of Burn Care & Research, 33(3), 419−424.
Schneider, J. C., Nadler, D. L., Herndon, D. N., Kowalske, K., Matthews, K., Wiechman, S. A., Carrougher, G. J., Gibran, N. S., Meyer, W. J., Sheridan, R. L., & Ryan, C. M. (2015). Pruritus in pediatric burn survivors: Defining the clinical course. Journal of Burn Care & Research, 36(1), 151–158.
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(MSKTC). This factsheet was reviewed and updated in 2016 by Gretchen Carrougher, MN, RN, Northwest Regional Burn Model System; Karen Kowalske, MD, University of Texas Southwestern; Jeffrey C. Schneider, MD; Colleen M. Ryan, MD; and Barbara A. Gilchrest, MD, Boston-Harvard Burn Injury Model System in collaboration with the MSKTC. This factsheet was reviewed and updated in 2024 by Lauren Shepler, MPH; Anupama Mehta, MD; Colleen M. Ryan, MD; and Jeffrey C. Schneider, MD, Boston-Harvard Burn Injury Model System in collaboration with the MSKTC.
Source: The content in this factsheet is based on research and/or professional consensus. This content has been reviewed and approved by experts from the Burn Model System (BMS) centers, funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). The content of the factsheet has also been reviewed by individuals with burn injury and/or their family members.
Disclaimer: This information is not meant to replace the advice of a medical professional. You should consult your health care provider about specific medical concerns or treatment. The contents of this factsheet were developed under a grant (number H133A110004) from the U.S. Department of Education (ED), National Institute on Disability and Rehabilitation Research (NIDRR). It was updated under grants (numbers 90DP0012 and 90DPKT0009) from the NIDILRR. NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this factsheet do not necessarily represent the policy of NIDILRR, ACL, HHS, or ED, and you should not assume endorsement by the federal government.
Recommended citation: Shepler, L., Mehta, A., Ryan, C. M., & Schneider, J. C. (2024). Itchy skin after burn injury. Model Systems Knowledge Translation Center. https://msktc.org/burn/factsheets/itchy-skin-after-burn-injury.
Copyright © 2024 Model Systems Knowledge Translation Center (MSKTC). May be reproduced and distributed freely with appropriate attribution. Prior permission must be obtained for inclusion in fee-based materials.
Other Languages
The Itchy Skin After Burn Injury factsheet is also available in Amheric, Arabic, Russian, Somali, Tigrinya, and Vietnamese.