Sickle cell Living with sickle cell disease means living with chronic anaemia, which is a common feature due to the destruction of red blood cells and the decreased lifespan of these cells. Anaemia we know can lead to various symptoms, including fatigue and weakness however, itchy skin can also be associated with anaemia in individuals with sickle cell.
One of the reasons for itchy skin in anaemic individuals, including those living with sickle cell disease, is related to the decreased oxygen carrying capacity of the blood. When the blood lacks sufficient oxygen, it can lead to poor circulation and skin dryness which may result in itching. Additionally, anaemia can lead to the release of certain substances in the body that can irritate nerve endings in the skin, contributing to itchiness.
Furthermore, individuals living with sickle cell disease may experience complications such as jaundice, where the skin and whites of the eyes appear yellow due to the breakdown of red blood cells and the release of bilirubin. Jaundice can also cause itchiness in some cases.
Nerve damage can be associated with itchy skin through several mechanisms. Itching, also known as pruritus, can be a symptom of nerve damage or neuropathy in various medical conditions, such as Sickle cell, including those affecting the peripheral nerves or central nervous system.
It is important to note that itching related to nerve damage can also vary in intensity and distribution depending on the underlying causes and individual factors. Management typically involves addressing the underlying condition causing the nerve damage, along with treatments aimed at relieving itchiness, such as using topical creams, antihistamines, or medications targeting the nerve related symptoms.
Causes of Itchiness
Central nervous system disorder – conditions affecting the central nervous system such as stroke, which individuals living with sickle cell are susceptible to, as a result of blocked blood flow due to sickled cells can damage the blood vessel walls and also in the brain. This damage can weaken the vessels, making them more prone to rupture and causing haemorrhagic stroke where bleeding occurs in and around the brain. This can disrupt the normal processing of sensory signals, including those related to itch sensation. This disruption can lead to abnormal sensations of itching in various parts of the body.
Medication side effect – some medications used to manage nerve related conditions, such as opioids or anticonvulsants, can cause side effects including itching. This itching may be related to their effects on nerve functions or other mechanisms.
Inflammation and immune response – nerve damage can trigger inflammatory responses in the body, which may contribute to itching. In conditions like ulcer, the immune system mistakenly attacks the nerves, leading to inflammation and nerve pain, which can manifest as itching among other symptoms.
In sickle cell disease, individuals are prone to developing chronic ulcers, particularly, on the lower legs and feet. These ulcers can be extremely painful and slow to heal due to poor circulation, tissue damage, and impaired immune function. Nerve damage, known as peripheral neuropathy, can also be a complication of sickle cell, especially in individuals with recurrent vessel occlusive crisis or chronic anaemia.
When nerve damage occurs in conjunction with an ulcer in individuals living with sickle cell, it can contribute to various sensations, including itching. Below, we will read how nerve damage with an ulcer wound can affect itchy skin in sickle cell disease.
Peripheral neuropathy: is nerve damage associated with sickle cell disease and this involves dysfunction or damage to the nerves outside of the brain and spinal cord. Neuropathy can cause abnormal sensations, including itchy skin in the affected areas.
Nerve regeneration and healing in individuals with sickle cell: means that the nerve damage may interfere with the normal process of wound healing. Nerves play a crucial role in wound healing by signalling pain, inflammation, and other responses necessary for tissue repair. Disruption of nerve function can impair these processes and contribute to prolonged inflammation and itching around the ulcer wound.
Inflammation response: nerve damage and chronic ulcers in sickle cell can trigger an inflammation response in the surrounding tissues. Inflammation can stimulate nerve endings and increase sensitivity to various stimuli, including itching.
Poor circulation: chronic ulcers in Sickle cell are often associated with impaired blood flow to the affected area. Poor circulation can exacerbate nerve damage and contribute to abnormal sensations, including itching, due to inadequate oxygen and nutrient supply to the tissues.
Secondary infection: itching around an ulcer wound may also be a response to secondary infections or microbial colonization of the wound. Nerve damage can impair the body’s ability to detect and respond to infections, leading to delayed recognition and treatment, which can further exacerbate itching and inflammation.
It is important for individuals living with Sickle cell experiencing itch skin to consult their healthcare provider for proper evaluation and management. Management of itching associated with nerve damage ulcer wound in Sickle cell typically involves a multidisciplinary approach. This may include addressing the underlying factors contributing to nerve damage and poor wound healing, such as blood transfusion or blood exchange, medications to boost red blood cell production, as well as strategies to alleviate itching, such as topical treatment by moisturizing the skin, using medications targeting neuropathic symptoms and addressing any underlining causes. All these may be recommended to improve the individual’s comfort and quality of life.
Until next time.
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