Itching in the healed burn patient is considered to be one of the most problematic and distressing issues that the patient experiences. The staff in any burn center can attest to both the magnitude of the problem as well as the fact that no effective treatment is currently being used.^1-10

The itch experienced by the burn survivor can be described by three criteria incidence, severity and duration.¹³

The incidence of significant itching in burn survivors is approximately 50% for adults and close to 100% for children.^1-5

The severity has always been difficult to evaluate. However, studies using a 10 point linear visual analog scale (10 being the worse itch), have demonstrated that the itch ranges from 5 to 7 in patients already on standard antihistamine therapy. This degree of itch interferes with sleeping, eating, working, therapy and overall quality of life.

The characteristics may vary from patient to patient, but all have the following:^1-14

First of all, the itching begins during the re-epithelialization process but does not peak for several weeks after the burn wound has healed.

Secondly, itching is more prominent in a partial thickness burn taking about 3 weeks to heal. There is a reformation of an epidermal-dermal junction where the itch appears to start.  Also a persistent tissue inflammatory process is present. There is usually less itching in a deep burn with scar or a grafted burn. Often, there is more pain in these burns with motion as there is less flexibility in the wound.

Third, the itching is accentuated by heat and activity, anything that increases body temperature. Erythema, a marker of increased skin blood flow is usually present and correspons to the degree of itching. Since histamine release can lead to itch and also increased blood flow, there may be a relationship. However, it remains unclear how heat releases histamine.

Fourth, the itching tends to be worse at night. Given the relationship of itch and pain, it is possible that with less pain of movement present at night, more itch can evolve.

Finally, the itching usually lasts several months but can last much longer, especially in the large body burn patient where healed skin and donor sites are very thin and very red.