Adaptive Techniques for Applying Lotion and Other Anti-itch Products

  

Pruritus, or itchiness, can be a very significant annoyance. For some patients it can be so severe that it interferes with therapy participation. Addressing this issue productively can reduce anxiety and improve patient participation. Patients with limited range of motion or flexibility may not be able to reach affected areas to scratch or apply lotion or powder. In this post I will share popular anti-itch remedies as well as methods to aid application of lotion and other anti-itch products to hard-to-reach areas.

Hydrating the skin is often the most effective solution for itch relief. For serious pruritus, a medicated lotion may be needed instead of typical lotion. Popular over the counter (OTC) anti-itch lotions include those with 1% pramoxine hydrochloride (Sarna, CeraVe), or 1% hydrocortizone (Cortizone-10). These are appropriate for most areas of the body. If not sufficient, an oral anti-itch medication may be useful. Dyphenhydramine (Benadryl) and cetirizine (Zyrtec) are popular OTC medications. Of course a patient should discuss any new medications with their doctor before taking. 

Some areas benefit from different solutions. For example, pruritus ani or itchy anus, is often best treated with a thicker lotion like Calmoseptine. Pruritus otis and pruritus auris, itchy ear, or ocular pruritus, itchy eyes, are each treated with medicated drops. Anti-itch ear drops and eye drops can be purchased OTC. Note that these should only be used at the location intended and never interchanged.  

Itchiness inside the nostrils, nasal pruritus, can also be caused by dryness although it is commonly caused by inflammation. The patient should discuss the issue with a doctor to find the cause. If dryness is known to be the issue, such as is common in winter, a moisturizer may be beneficial. A small amount of moisturizer can be applied just inside the entrance of the nostrils. Petroleum jelly, unscented lotion, or Aquaphor can all be used. The patient should begin by using as small amount as possible to avoid clogging the nostril and add more as needed. A small amount on the tip of the pinky finger is often the easiest method of application. For easier application, NeilMed NasoGel comes with an applicator tip. 

Another common location for dryness and itchiness is the scalp, known as pruritus capitis. The use of conditioner and hydrating shampoos can help along with anti-dandruff shampoos if dandruff is an issue. If these are insufficient, a scalp lotion (also called leave in conditioner) may be required. TeaTree brand Hair and Body Moisturizer is a popular option that does not leave an oily residue in the hair as traditional lotion would. There are numerous similar products available. Also, 1% hydrocortisone scalp anti-itch liquids can be purchased OTC. A discussion with the pharmacist at a local drugstore may help the patient find a suitable product. If this is a persistent problem, the patient should talk to their PCP or a dermatologist. 

Additionally, some people find that regular lotions are inadequate. People with extra-dry skin may find a thicker topical cream more helpful. Examples include coconut oil, Aquaphor, petroleum jelly (Vaseline), and cocoa butter. Petroleum jelly with aloe vera added can be especially helpful. These products are common among people with dark skin but not exclusively. It is always important to discuss with the patient what they have found helpful in the past before recommending other products.

Sometimes excess moisture is the issue rather than dryness. In such cases, a medicated powder may be more effective. Areas prone to sweating and chafing, like between the thighs, under the breasts, or in the groin area are places where a powder is more appropriate. Additionally, an itchy back can be caused by excess moister when a patient has been bedbound for extended periods, especially if they have difficulty repositioning themselves. Gold Bond is a popular medicated powder option.

These are all great solutions that a therapist can educate a patient or family about. If these issues are present during a stay in an overnight facility, the patient should discuss their issues with the provider to find the underlying cause. 

Adaptive Application

Next, let's discuss adaptive methods for applying these products. A long-handled back scratcher and lotion applicator are great tools to have on hand. One brand, Rounds, makes an all-in-one back scratcher and lotion applicator. Other lotion applicators have a closed cell foam on the end of their handle. One drawback of lotion applicators is that they can leave too much lotion on the skin surface. To address this, apply the lotion and leave on for 1-2 minutes to allow absorption. Then gently wipe the area with a towel to remove most of the excess. A long bath towel can be used to wipe the legs, feet, or back even if the patient cannot reach them with the hand. 

Alternatively, a moisturizing body spray (Aquaphor, Vaseline, etc.) may be more convenient as it can simply be sprayed over the hard-to-reach area.

A long-handled foam lotion applicator may be most useful to self apply creams to the buttocks and anal region. The cream can be applied along the narrow (side) edge of the sponge to more conveniently access the intergluteal cleft. 

It can also be difficult to apply lotion to the arm if only one arm is functional. The hemi-technique for applying lotion is the same as for washing in the shower. Apply a small amount of lotion to the top of the thigh, then rub the hand, forearm, and elbow through the lotion. A dry cloth can be used to wipe off excess by draping it over the thigh and then rubbing the arm across it. Granted this method may seem crude and tend to result in inconsistent application. Practice will help. A lightweight lotion such as face lotion may also reduce the feeling of excess greasiness. 

For eye drop application, an eye drop guide can be purchased to ease use. The Owen Mumford AutoDrop is one affordable option. An internet search for an eye drop guide may be helpful.

For ear anti-itch, Eosera Ear Itch MD offers an easy application bottle for patients with limited shoulder range of motion. The nozzle is angled at 90 degrees.

To apply powder, a long-handled powder puff may be the appropriate accessory. It can help to minimize mess. 

In order to make shampoo and conditioner easier to apply, a long-handle hair washer is a good option. Avoid options with bristles and opt for silicone tips instead. The Etoc hair washer (model 6630) is a good choice. 

Lastly, the patient should be educated that long showers and hot water often contribute to increased skin dryness. Shortening the shower or lowering the temperature of the water slightly can help ease symptoms. 

Hopefully this post will enable you to help your patients find the relief they need. The more barriers we can help remove the better they can participate in therapy and the sooner they can return to their most meaningful occupations.