Selects: How Itching Works

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Speaker 2 Hi, everybody. Chuck here.
It's May 9th, 2017, and podcast time. I know it's really 2025, but we're going all the way back.

Speaker 2 to May of 2017 to talk about itching. Oh boy, just seeing that title probably makes you itch.
And that's one of the deals with itching, if I remember correctly.

Speaker 2 So I hope you dig it and I hope you're not too itchy right now.

Speaker 1 Welcome to Stuff You Should Know, a production of iHeartRadio.

Speaker 1 Hey, and welcome to the podcast. I'm Josh Clark.
There's Charles W. Chuck Bryant and there's Jerry Rowland.
So this is Stuff You Should Know, Scratching Edition. Yeah, this is one of many.

Speaker 1 You remember when we did yawning? Yeah.

Speaker 1 Well, that's the only one I can think of. Where just researching something makes you do the thing you're researching.
This definitely happened with this one.

Speaker 2 Yeah, well, we ran across that and Poison Ivy and Scabies for sure.

Speaker 1 Oh, yeah.

Speaker 2 And talked about some of this stuff, but I think itch. We had an itch we needed to scratch

Speaker 2 with this particular topic.

Speaker 1 Well, I'm glad I've been wanting to do this one for a while.

Speaker 2 Yeah, you did a video about this, right?

Speaker 1 Yes.

Speaker 3 A short video.

Speaker 1 No, it was three, four hours long.

Speaker 1 Okay. If I remember correctly.
Does that mean we have to do this?

Speaker 2 Do I have to be here for the next four hours?

Speaker 1 Yeah, we have to just play the whole thing and then we'll talk about it for an hour. That sounds good.
Okay. I think it was a brain stuff video, wasn't it? Yeah, I watched it.

Speaker 1 Did it scratch your itch?

Speaker 2 Yeah, I watched it yesterday.

Speaker 1 Oh, okay.

Speaker 1 Nice work. Thank you very much.
You're just like now we finally arrive at what I was after.

Speaker 2 What? Compliment? Yeah.

Speaker 1 No, it was great. Thanks, man.

Speaker 1 So I guess the point of all that is to say you guys are going, you're going,

Speaker 1 my videos are the best.

Speaker 1 That you're going to scratch. You're going to feel an itch, which is one of the great mysteries of itches.
It turns out. We only very, very recently have started to get a handle on what itches are.

Speaker 1 Yeah.

Speaker 1 And there's still plenty of mysteries left to it.

Speaker 1 Like, for example, it's bizarre, and there's really no evolutionary reason, as far as anyone can tell, of why just hearing about itches or seeing someone else scratch can make you itch. Right.

Speaker 1 That's odd. That's that's weird.

Speaker 2 Or seeing a video of an ant crawling up an arm will make you itch.

Speaker 1 It will. But I mean, think about it.
If somebody is sitting there, you see a video of some Shmo who's got his hand like near an oven and he pulls it away really quick. It doesn't hurt your hand.

Speaker 1 It doesn't make you feel like your hand is burned.

Speaker 1 That doesn't happen.

Speaker 2 I don't even think that would excite mirror neurons like a leg break would. No.

Speaker 1 You're just like, what a stupid idiot. That's what it excites.
Yeah. I hope that guy's hand just burns clean off.
That's what I think, right? Right. Yeah.

Speaker 2 You sourced a couple of, well, we had our own article. on HowStuffWorks.com.
Yeah. But you also sent this great New Yorker article

Speaker 2 written by Dr. Atul Gawande.

Speaker 1 One of the best names in writing today.

Speaker 2 Yeah, that may be my new hotel name.

Speaker 1 Well, you may be thronged by

Speaker 1 science fans, because that guy's pretty well known.

Speaker 2 Actually, I've never used to alias at a hotel that's dumb. And I don't even know if you can, can you? I guess if you're a big shot, you can.

Speaker 1 Yeah, but you have to be like, I'm not Brad Pitt. I'm Atul Gawande.
Right.

Speaker 2 But we'll get to some of the more interesting aspects of that article later, specifically a very specific patient that's quite distressing.

Speaker 1 So calm down for now, a tool's mom.

Speaker 2 We'll get to it eventually. He did include a couple of neat historical tidbits.

Speaker 2 Like in 1660,

Speaker 2 and Germans are all over this thing for some reason.

Speaker 1 Yeah.

Speaker 2 You know, researchers that they're all German.

Speaker 1 They had the itch to explain the itch. I guess so.

Speaker 2 Yeah. The itch.
Right.

Speaker 2 But there was a physician in 1660 named Samuel Hoffenreffer.

Speaker 2 Actually, that's my new hotel name. Yeah, it is.

Speaker 1 That's a good one.

Speaker 2 He kind of, well, he defined it by saying an itch is an unpleasant sensation that provokes the desire to scratch.

Speaker 2 Pretty simple. Yeah.

Speaker 2 But right on the money.

Speaker 1 It is. And actually,

Speaker 1 it's so on the money that anywhere you look in the medical literature, whenever they define itch, word for word, that's the definition they use. The Hoffenreffer? Yeah.

Speaker 1 Although poor Hoffenreffer doesn't get credit for it all the time, but that's the one. The only expansion of that that I've seen is that can occur anywhere on the body, which apparently is true.

Speaker 2 I think Hoffenreffer

Speaker 2 felt that was implied. Right.

Speaker 1 And he's like, it goes without saying. Yeah.

Speaker 1 I'm scratching right now, by the way.

Speaker 2 Yeah, it started. I don't know if I

Speaker 2 just noticed more because as I was doing it, I was thinking, well, now I'm scratching. But I thought, thought, do I always scratch this much or itch this much?

Speaker 1 Oh, I hadn't thought about that. I'm pretty sure that I was, I don't think I scratch as much as, I don't know.
You raise a really good question.

Speaker 2 Maybe we can get an intern to follow us around and just record our scratching.

Speaker 1 Right. I'm surprised that that's not already a TV show, frankly.

Speaker 2 Josh and Chuck scratch?

Speaker 1 Just being followed around. Yeah.
Oh. You know?

Speaker 2 No one wants to see that.

Speaker 1 Well, that's probably why it's not.

Speaker 2 You're scratching.

Speaker 1 See, that's what I'm saying. I don't think I scratch this much.

Speaker 2 I don't notice it.

Speaker 2 All right. Moving on.

Speaker 2 To Dante's Inferno.

Speaker 2 It was in Dante's Inferno, the burning rage, a fierce itching that nothing could relieve, is how falsifiers were punished.

Speaker 1 Yeah, do you know what a falsifier is?

Speaker 1 Us?

Speaker 1 I...

Speaker 1 No, really. Like, isn't that

Speaker 1 somebody who bears false witness or somebody who falsifies a document?

Speaker 2 I don't know. Is it just a fancy name for liar?

Speaker 1 Maybe.

Speaker 2 Oh, I thought you were going to tell me. You were just wondering.

Speaker 1 Yeah, I don't know. All right.

Speaker 2 Well, I don't know what Dante meant, but they're bad people.

Speaker 1 Sure, apparently. There's a special place in hell for him, literally.
Well, I guess actually not literally.

Speaker 3 Figuratively.

Speaker 1 Sure.

Speaker 1 Literarily.

Speaker 2 Oh, very nice.

Speaker 2 So itching scientifically is known as puritis. P-R-U-R-I-T-I-S.
Yeah. it's one of those tough to pronounce things for me at least um

Speaker 2 and for

Speaker 2 well actually they still believe that the evolution of the itch was to help humans um survive basically because so many things that can kill you uh and and nature

Speaker 2 are things like mosquitoes or flies or spiders or fleas yeah that can have like malaria or the plague or any number of diseases attached to their tiny little insect bodies. Right.

Speaker 2 So, hey, human, you've got a mosquito on your neck that could kill you. You might want to slap it or scratch.

Speaker 1 Yeah. And that's still, as far as I know, the evolutionary hypothesis for why we experience itching.
Yeah. And it's not just us either.

Speaker 2 Well, you're scratching like crazy now.

Speaker 1 It's found throughout the animal kingdom.

Speaker 1 From us to apparently fish have shown scratching behavior. Yeah, that's crazy.
Fruit flies.

Speaker 2 How does a fish scratch, you might ask?

Speaker 1 It rubs up against rocks. Yeah.
It's kind of cute. It is a little cute.

Speaker 2 It's like, I remember my dad did like the

Speaker 2 who was the Baron Jungle book?

Speaker 1 Was that Baloo?

Speaker 2 Yes. He would do the Baloo where he would get up against a tree or a wall.

Speaker 2 And then I did it

Speaker 2 probably because of that. I'm sure that's where I got it and realized that it works.
And I still do it every now and then.

Speaker 1 Oh, yeah.

Speaker 2 Yeah, I look kind of silly, but do you sing while you do it?

Speaker 1 Yeah. The bare necessities.

Speaker 2 That's still my favorite.

Speaker 1 What else are you going to sing

Speaker 1 like mambo number five

Speaker 2 i'm gonna start doing that actually you'd be like i think something's wrong with chuck yeah so like you said though it was up until

Speaker 2 almost what was it 1987 the mid to late 80s yeah that another german ho handwerke

Speaker 1 uh

Speaker 1 and his gang of toughs,

Speaker 2 they started to do actual research about it. They were puzzled and wanted to solve it.

Speaker 1 Right, because up to this point, up to actually 1987, everyone thought that an itch was just a low-grade pain stimulus. Yeah, I guess it was a pain sensation.

Speaker 2 I was happy with that.

Speaker 1 That's just what they thought it was.

Speaker 1 And Han Verker said, you know what? Let's find out if this is actually true. I'm tired of sitting around just assuming this is fine.
I'm a Han Verker. And he got to Verk

Speaker 1 with his hands uh testing this right so what he I know it was like Jonathan Strickland level yeah

Speaker 1 um what he did was

Speaker 1 this is just awful yeah he introduced using like electrical stimulation I guess he introduced histamine to skin cells right and histamine is a natural I don't know if it's a protein, but it's a natural compound, natural chemical, right?

Speaker 1 Yeah. That the body releases in response to certain stimuli, say, for example, like a mosquito bite or something, and it triggers the inflammation and immune response in that area, right?

Speaker 1 So, histamine is associated with itch, and it had been for a very long time.

Speaker 1 So, this guy was using electrical stimulation to introduce histamine in increasing amounts in these poor study participants. And it went from barely noticeable to,

Speaker 1 this is a quote, the maximum imaginable itch.

Speaker 1 and they never felt pain.

Speaker 2 Yeah, like even though they ramped it up to 11, no one ever said, like, holy crap, that hurts.

Speaker 1 They said, please, please, for the love of God, stop, let me out of this. And Han Verker just cackled and cackled.

Speaker 1 Right. And these men with like black leather gloves were holding the participants down.

Speaker 2 Yeah, they said, this is not worth the five Deutsch Marks that I'm getting for this lousy study.

Speaker 1 Yeah, that's nice, man. This would have been pre-Euro, I think.
Oh, yeah. Even though the EU EU was around, I don't think the Euro was around in 87, right?

Speaker 2 No, no. Was it the 90s?

Speaker 2 I traveled to Europe in 1997, and I was still on all that weird money.

Speaker 1 Oh, okay.

Speaker 2 Yeah, so it was a while after that. So now scientists,

Speaker 2 I think this sort of

Speaker 2 introduced an itch to the scientific community because after hundreds and hundreds of years, Hanvucke sort of disrupted the thought process of the itch and the scratch. Right.

Speaker 2 And all of a sudden, scientists were like, oh, well, maybe we should start looking into this. Maybe we can actually isolate the nerve and figure this thing out.

Speaker 1 Yeah, because I mean,

Speaker 1 if it's not just...

Speaker 1 a low-level pain sensation, then that means it's its own thing. And if it's its own thing, it probably has its own system and we need to know more about it.
So they got to studying it.

Speaker 2 Yeah, I wonder if all of this was under the notion that they were trying to cure itching.

Speaker 1 I don't know because from what I was reading, and all this was pretty recent stuff,

Speaker 1 there is a real unmet medical need in dealing and addressing like chronic itch. Sure.
Because, you know, most people who go through life just experiencing itch under normal circumstances, right?

Speaker 1 Like say you or me, we're like an itch. Yeah, they suck for a second and then it goes away.

Speaker 1 Imagine it not going away ever, whether you're asleep or awake or swimming or in outer space or doing whatever. You're itching constantly.
Supposedly,

Speaker 1 it has as much of a pronounced effect on a patient's life as chronic pain does. It's constant, persistent, and agonizing.
And

Speaker 1 it's not being met or treated because it's not understood. So they're just now starting to get into pain re or itch research.

Speaker 1 I saw that somebody put it where pain research was about 20 years ago. So it's starting to really heat up, but we're still just starting to understand it.

Speaker 1 So I would think that they weren't looking to cure it. I think it was just pointed out that there was this whole branch of neuroscience that was totally not understood.
So get to work, neurologists.

Speaker 1 I wonder.

Speaker 2 I never really thought about it until just now, but I wonder what happens when

Speaker 2 a performer or somebody like that is in the public eye or on TV or on stage or like

Speaker 2 the president giving a

Speaker 2 address, like what, what, what do they do if they have poison ivy or some other kind of contact dermatitis? Like, have you ever thought about that?

Speaker 2 Like, what if Lynn Manuel Miranda has like a really bad case of poison? I guess they can get an understudy in that case. Sure.
But you can't have an understudy as president. No.
Which is too bad.

Speaker 1 You just go out there with your hands bandaged up, just holding them up.

Speaker 2 Like, how do you fight that?

Speaker 1 Poison ivy. On camera?

Speaker 2 Or like a news anchor when they're just like, oh my God, I'm dying.

Speaker 1 I don't know.

Speaker 2 I guess a news anchor can tape things, but I'm talking about live. What does Tom Petty do? For God's sakes?

Speaker 1 Tom Petty grins and bears it. He had a hard Scrabble childhood.
He sure did. Prepared him for that.

Speaker 2 I'm going to see him tomorrow night.

Speaker 1 Oh, yeah. Mm-hmm.
Nice. Tell him I said bye.
I'm waiting for coffee.

Speaker 2 He's not performing.

Speaker 2 Anyway, I was just curious about that.

Speaker 2 Well, it's a good question.

Speaker 1 Thanks. Do you remember when Costas had Red Eye at the Olympics? He was so dedicated to

Speaker 1 being the commentator, the anchor for the Olympics, they finally were like, you have to stop. No one can look at you.
People are writing in.

Speaker 2 You're disgusting them. It was gross.

Speaker 2 One thing that made me think of that is I had recently, you can still kind of see it on my forearm, the scars, but I did a cement job. I was building this fence, putting in a gate at my house.

Speaker 2 And Scotty, you know, Scotty. Sure.
He and I built, huh?

Speaker 1 Pippin. Not Scotty Pippin.

Speaker 2 He and I built this

Speaker 2 thing together, and we sank these huge posts for this gate. And I didn't know that cement could cause contact dermatitis or even burns.
Never knew this. Yeah.
And we were,

Speaker 2 it was kind of a tight spot, and we couldn't get shovels in there in the hole. So we were literally mixing the stuff like up to our elbows with our arms.
And I was like, this kind of feels good.

Speaker 2 I even said, like, you know, like oatmeal or something. And then two days later, my right arm was just covered in the nastiest dermatitis I've ever seen.
Wow.

Speaker 1 And then he got it.

Speaker 2 Yeah. It's still like kind of hanging around.
So I went and got a prescription for steroids, which made me a little crazy for a week and a half. Okay.

Speaker 1 Did you trash the gate and have to start over? No.

Speaker 2 I think I was probably not the best husband, though. I see.
Over that time period. Yeah.

Speaker 1 Judging from Emily saying hey you're a real a-hole get off the steroids gotcha um get off the juice i was like shut up watch this watch me hit this homer

Speaker 2 so long story short i experienced this recently and it was awful and i can't imagine like shooting a tv show or something or like doing anything on or performing live yeah like i would have to address it Because I would scratch and smack it was what I usually do.

Speaker 1 That's how you're supposed to do, not scratch. I guess we'll just cut to the chicks here.
This is why everyone's listening. How do you scratch a niche correctly? You rub it.

Speaker 2 Yeah, I didn't do. I did, you know what really did it was the

Speaker 2 we have a handheld implement in the shower along with a regular shower head. Okay, yeah.
And put that sucker on the tightest, hardest, most penetrating flow. Right.

Speaker 2 And just put that hot water on it, man. And that was like, I think I spent half my days in the shower over that week and a half.

Speaker 1 Were you biting down like a broomstick while you were doing that?

Speaker 2 No, it felt so good, man. I was just like, I couldn't get enough of it.

Speaker 2 And then the cortisone and all that junk, too.

Speaker 1 So

Speaker 1 we'll talk about this because you're raising some great points here.

Speaker 2 Well, I just kind of

Speaker 2 ruined the spoiler.

Speaker 1 No, no, this is good stuff. We're going to analyze what was going on with your arm after this break.
How about that? Sounds good.

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Speaker 1 So Chuck, you had contact dermatitis, right?

Speaker 2 I thought it was poison ivy because that area has some poison ivy.

Speaker 2 But each of us, Scotty and I, had it just on the arm that we sunk in cement.

Speaker 2 And then we researched and found out that could happen.

Speaker 1 Yeah. So lesson learned on that.
Yeah.

Speaker 1 So what happened was you, something in the cement, and I'm not sure what it was, reacted chemically with the mast cells in your skin. Yeah.
And histamine was released, right?

Speaker 2 Apparently.

Speaker 1 And so the histamine

Speaker 1 sent a signal through specialized nerve nerve cells called C fibers.

Speaker 2 Yeah, which C fibers aren't just limited to itching. I think only about 5% handle that, and most of the rest are for pain.

Speaker 1 Right, right. So they use the same type of neural pathway as pain, but for itch, it's

Speaker 1 basically it's just like, no, these are just for itches only. Yeah.
And it sent a signal through your spinal column. And in your spinal column, it released a neurotransmitter called

Speaker 1 gastrin-releasing peptide receptor. And so, at the skin, the histamine would have released a neurotransmitter called what?

Speaker 2 Naturauretic polypeptide B.

Speaker 1 Okay. So that says itch signal coming your way along those C fibers.
Yes. Okay.

Speaker 1 It makes it to the spinal column. And I guess in about 2007, they found that there's another neurotransmitter in the spine that I guess accepts the

Speaker 1 NPPB.

Speaker 2 The invitation.

Speaker 1 And says I'm gonna transfer this along up to the brain that's gastrin releasing peptide receptor that shoots up to the brain and it starts this cascade of activity right yeah because when they like after handwerker said hey you know itching is its own thing uh-huh these other researchers went to town and traced and figured out there that there were specific um specific types of itch receptors that were dedicated just to itches right more germans more germans and swedes and a a couple of Swedes, but mostly Germans.

Speaker 2 Just for good measure.

Speaker 1 Yeah. Yeah.
And what they found eventually from tracing this pathway, they were able to follow it into the wonder machine. And apparently they made some people itch and would not let them scratch it.

Speaker 1 And then they had them lay down in an MRI and they took a brain scan and they found that there's this whole galaxy of stuff going on in your brain that combined is the itch sensation.

Speaker 2 Yeah, it was pretty interesting, too. There's a signature pattern in the brain when you get an itch and a few specific areas light up.
One is a cortex, and it all makes sense when you put it together.

Speaker 2 The cortex,

Speaker 2 in this case, just sort of geolocates where on your body you're getting that sensation. Right.
So that helps.

Speaker 1 It's like left elbow.

Speaker 2 Yeah, or in my case, from right elbow to wrist.

Speaker 1 Right.

Speaker 2 And then a little bit in other places, but not too bad.

Speaker 2 That was the main area.

Speaker 1 Is this your cortex still saying this? Yeah.

Speaker 2 Very complex conversation going on.

Speaker 2 And then the region, I thought this was interesting. The region that

Speaker 2 governments, that governs emotional response.

Speaker 2 So basically, this is your brain saying, like, I don't like this. This makes me feel bad.

Speaker 1 Yeah, it's the worst thing ever. Do something.

Speaker 2 And then finally, the limbic and motor areas. And I thought this was the most interesting.

Speaker 2 Those areas process irresistible urges. The same ones that say, I want to smoke crack or I want to eat too much cake

Speaker 2 say

Speaker 2 you have an itch that is unbearable and you need to scratch it.

Speaker 1 Right. And maybe go smoke some crack and eat some cake while you're at it.
Because that'll help. Right.

Speaker 2 So I just, I don't know. I thought that was all very super interesting when you combine that pattern.

Speaker 1 Yeah, that's the, that's an itch and then it's followed by the irresistible urge to scratch it, which apparently research has shown those two do not happen in independently.

Speaker 1 They're they're part of a cycle. Yes.
There's something called the itch-scratch cycle, right? And so you have an irresistible urge to scratch the itch. It's weird if you think about it.
Like,

Speaker 1 on the one hand, it makes sense where

Speaker 1 you sense that there's a really hot heat source that your hand is really close to.

Speaker 1 So you have an irresistible urge to pull it back, but it doesn't feel like an urge. It almost feels like an involuntary reflex.
Yeah, I think it's actually. A scratch is almost like

Speaker 1 i'm gonna kill this itch i can't wait to scratch it like you're almost exacting revenge on the itch for itching you right so a scratch is it's an irresistible urge whereas like pulling your hand back from a a hot hot source or something is like an involuntary reflex it just feels different like a scratch is its own thing well it is you know they kind of found that out and and gawande dr gawande um pointed out something interesting too that i never thought about is that you can have like that short collar rubs against your neck all day, and you might never notice it.

Speaker 2 But if there's like one little string that's just poking one little area, that might trigger an itch.

Speaker 1 Right. And so, you would think that you know, itch receptors are super finely tuned and they cover just this one tiny, like

Speaker 1 a micron of skin. As a matter of fact, no, apparently, an itch receptor can sense itch stimuli like three inches away from it on the screen.
That's crazy. Yeah, So they're really sensitive.

Speaker 2 Yeah, whereas pain receptors are that specific

Speaker 2 down to like, you know, millimeters. Yeah.

Speaker 2 And the other thing they found out too is that not only can they sense it from a few inches away, but it's a very slow acting thing. Right.
Which

Speaker 2 as opposed to like heat on the hand, like a candle on your hand. I almost said candle in the wind.

Speaker 2 That's super fast, but that that explains why an itch like is kind of slow to come come and then slow to resolve by scratching. Yeah.

Speaker 2 It's not like you scratch it and you're like, oh, it's all better now. Yeah.

Speaker 1 It helps a little bit. So the itching is a good strategy if you think about,

Speaker 1 say,

Speaker 1 there's a mosquito on you and that's what's making you itch. When you go to scratch it, you're getting rid of the mosquito, maybe even smushed it or something like that.

Speaker 1 The problem's taken care of. The issue is that that itch-scratch cycle eventually becomes a vicious cycle because when you scratch, this is what they think is going on.

Speaker 1 This is another mystery with itches. We don't understand how scratching alleviates an itch or why we scratch, really, right?

Speaker 1 What they think, the current hypothesis, is that when you scratch an itch,

Speaker 1 you're stimulating other receptors in the area that aren't itch receptors.

Speaker 2 Yeah, so I got that, but what does that do to sort of like

Speaker 2 say, hey, body, don't worry about that for a a minute? I think so. A pain receptor is now active.

Speaker 1 Right, exactly. It's sending feedback to the brain saying it's being taken care of.
You can settle down with the itch. Gotcha.
Right? I think.

Speaker 1 The problem is that neurologically or neurochemically, when you scratch an itch, you're activating those pain receptors in the area, pain, pressure, that kind of thing, you're causing...

Speaker 1 serotonin to be released,

Speaker 1 natural pain reliever, right? Yeah. Or at least mood enhancer.
And what they found is that serotonin, among other neurochemicals, actually exacerbates the itch sensation.

Speaker 1 So your itch not only comes back, it gets worse.

Speaker 1 So you go to scratch it again, and then the same thing happens over and over again. That's the itch-scratch cycle, which

Speaker 1 is not the best cycle around. No.
You can make up better cycles.

Speaker 2 Not a bad band name.

Speaker 1 Yeah.

Speaker 3 It's okay. A little too cute.

Speaker 1 Maybe Prague.

Speaker 1 Folk Prague.

Speaker 2 Well, they'd have to be German, probably.

Speaker 1 German folk prog. Okay.

Speaker 2 Another interesting thing they learned, too, was that

Speaker 2 I guess we're kind of jumping around, but who cares, right?

Speaker 2 If you scratch, you don't even have to scratch the point of the itch to relieve it, apparently. Right.

Speaker 2 Like, if you have, I had that itch on my right forearm, and I could scratch maybe, it doesn't even have to be the left forearm, so it's not like you have to mirror it.

Speaker 2 But I could scratch, like, my neck, and apparently that might help relieve it.

Speaker 1 Yeah, I tried it. It didn't work for me.
No. No.

Speaker 1 But I think the reason why there's that's it's possible that it could have that effect is supposedly scratching also

Speaker 1 activates like your pleasure center. Yeah, you bet it does.
But there's different different places where you're scratching on your body have different amounts of pleasure associated with them.

Speaker 1 Did you know that? I mean,

Speaker 1 I guess so, but.

Speaker 2 Yeah, interesting.

Speaker 1 Yeah, but I mean, think about it. It's like if you scratch your,

Speaker 1 like, your clavicle, who cares? It's nothing, right? But then you scratch like your head right above and behind your ear. It's great.

Speaker 2 Well, and they, I think they did find that like your back and your ankles, supposedly, are some of the most rewarding places to scratch. Exactly.
And I, I,

Speaker 2 I don't know, I've never really thought about the ankles, but um,

Speaker 2 my mom would give me back scratches when I was a kid. That's nice.
And And it was always like one of my favorite things ever. Sure.

Speaker 2 And so I don't get those anymore now that I'm a grown-up because that's gross.

Speaker 1 Mom, scratch my back. I'm 46 years old.
Lay down.

Speaker 2 But yeah, it was like, I think I preferred a back scratch to a back rub even.

Speaker 2 Oh, yeah. When I was younger.
But now, you know, a massage is probably way better. Sure.
But if they, if a masseuse could include a little back scratch in there,

Speaker 1 get ready for a huge tip for me. Yeah, I guess so.
Or is that what? Is that sexual? I think it crosses a line once they're potentially clawing away skin cells.

Speaker 1 I think that's no longer in the masseuse range or masseur range. Yeah, I get that.

Speaker 2 Once skin cells are involved

Speaker 2 under the nails, then you're a murder suspect.

Speaker 1 Right, exactly.

Speaker 2 All right. Well, should we take another break? Yeah.
And talk a little bit about one of the most distressing

Speaker 2 articles I've ever read.

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Speaker 2 All right, so we've referenced this article from the New Yorker from Dr. Atul Gawande.

Speaker 2 And

Speaker 2 he talked a lot about itching and just had good information on the science of it all.

Speaker 1 Well, that's what he does.

Speaker 2 But most of the article was focused on a patient, a woman in Massachusetts,

Speaker 2 that they named M for the article.

Speaker 1 Just M.

Speaker 2 The letter M. Right.
In other words, you know, she's anonymous.

Speaker 2 And I think she was anonymous because she kind of had a rough go after her divorce.

Speaker 2 She ended up getting HIV from

Speaker 2 getting on heroin. Kind of spun out, it seems like, but then got her life back

Speaker 2 by all accounts, but ended up getting shingles as a result of HIV complications. Right.

Speaker 2 And

Speaker 2 the shingles went away, but the itching did not. to say the least.

Speaker 1 Yeah, I think the itching came after the shingles even. And at first her her physicians were like well i mean you must have you damaged some nerves in there so

Speaker 1 t s for you i guess yeah um

Speaker 1 and then eventually after treating it like all these different ways and it's still being scratching they said

Speaker 1 okay you're crazy how about that right

Speaker 1 and she said well whatever i still have this itch do whatever you need to to treat it because i'm literally scratching this itch in my sleep it was on her scalp, wasn't it?

Speaker 2 Yeah, it was on her head and she

Speaker 2 kind of managed to control it during the day, but like you said, at night, she couldn't control it to the point where I think she was like restrained in her sleep.

Speaker 1 That came after. Oh, okay.

Speaker 2 After they realize it's a problem because your brain is oozing out of your head. Yeah.

Speaker 1 Can you believe that? She scratched her scalp so much that she scratched through her skull. And she went into her doctor one day and said, they've got like this green fluid coming down.

Speaker 1 And And then apparently,

Speaker 1 the doctor didn't even say anything. He was just, she or she was like, Excuse me, went and called an ambulance and came back and said, Please lay down and don't talk or move or do anything else.

Speaker 1 And they finally told her after she was at the ER, you scratched through to your brain. Like, that's your brain you're touching right now.

Speaker 2 The doctor's like, Very interesting.

Speaker 2 Just give me a second here.

Speaker 1 Or I

Speaker 1 please. Oh, my God.

Speaker 2 Well, they gathered up all the other doctors and nurses

Speaker 1 sure yeah you got to come see this she said also in this article um she said that she had a uh

Speaker 1 a what do they call him a roommate at a

Speaker 1 okay a roommate yeah so um

Speaker 1 she had a roommate while she was like they treated it gave her a skin graft and then she she itched she scratched away the skin graft oh man

Speaker 1 and then um they finally were like okay you're going to an asylum. And she's like, do they even call it that anymore? And they're like, just shut up.
Yeah.

Speaker 1 And they put her in this asylum and restrained her, like you said, while she was sleeping. And she had a roommate in there.
She said in the article,

Speaker 1 she heard didn't survive. He had scratched through his carotid artery and died blood death.
Yeah.

Speaker 1 So

Speaker 1 they never really got to the bottom of this. She finally got a doctor.
Like the doctors were like, it's something that had to do with the shingles. This is what we think happens at her doctors.

Speaker 1 That

Speaker 1 the nerve endings around the area where she had shingles were so devastated by the shingles that there were just a couple of nerve endings left. And it just so happened that they were itch receptors.

Speaker 1 Yeah, itch receptors.

Speaker 2 Bad luck.

Speaker 1 And that those were like really exacerbated by the fact that there was no other competing sensations.

Speaker 1 Ipso facto, there's your problem, right?

Speaker 1 So they said, well, we'll just cut the main nerve to your face and that should solve the problem. They cut the main nerve to her face.
And she said, thanks a lot.

Speaker 1 Yeah. And then the itch came back.
And she's like, you have to be kidding me. So finally, she met a doctor who said, I don't think it's

Speaker 1 your receptors or the nerve transmission. I think it's your brain.
Yeah. Not psychologically.
I don't think it's a psychosis.

Speaker 1 I think there's that the actual itch signal in your brain is being set off without any stimulation or transmission going on.

Speaker 1 And apparently she was right.

Speaker 1 But then they were like, good luck treating that. Right.

Speaker 2 You know, I didn't see much follow-up on this. I did read one article that,

Speaker 2 a follow-up with Dr. Gawande, because there were a lot of skeptics after that article came out that said, it's impossible with your fingernail.
Because she said she didn't use an implement.

Speaker 2 It's not like she got out of metal file to scratch through your skull. Right.
And he said that his theory was that bacteria, it became infected, had eaten it away such that the skull became soft.

Speaker 1 Turned it to mush. Yeah.

Speaker 2 Yick.

Speaker 2 And then people also said, you know, you don't have men and women in the same room in hospitals or asylums. That's that's false.
And he said that it was like the room next door

Speaker 1 and quit being pedantic. Yeah, really?

Speaker 2 Man. I think people just didn't believe it.
So all these folks wrote into the New Yorker. So those coastal elites said, no way.

Speaker 1 They said, Atul, Atul. Come on.

Speaker 1 So the idea, though, that even if this woman was hypothetical, I think Atul Gwande is pretty upstanding cat and didn't make this up. But even if, say she was hypothetical, her problem,

Speaker 1 what the doctors initially thought it was, was that she had a neuropathic itch, type of chronic itch.

Speaker 1 But then the doctor who apparently figured it all out said, no, no, no, it's a neurogenic itch, another type of chronic itch.

Speaker 1 And it has to do with whether it's the brain going off or the nerve transmissions going off. Either way, you don't actually have an itch, although you're experiencing the itch sensation.

Speaker 2 Well, and they also then said at some point she had a psychogenic itch. Right.
So they basically covered three out of the four kinds of itches.

Speaker 2 The last one being,

Speaker 2 man, I have such a hard time.

Speaker 1 Pr receptive.

Speaker 2 And that's what you get from like a mosquito bite. Yeah.
Or if you have a skin disorder like eczema or something. Sure.

Speaker 2 So they basically ruled out the most common one and at various stages said, no, you've got this other one for the other three.

Speaker 1 Right. Finally.
And then again, they said, we don't, there's really nothing we can do to treat it. The one that they've got down pretty well is perreceptive.

Speaker 1 We've got all sorts of stuff to treat that because that's, that's basically histamine is being released and your, your skin is itching. So you can treat histamines with antihistamines.
Yeah.

Speaker 1 You can reduce that response and then your itch will go away.

Speaker 2 Well, I took Benadryl at night and they also make this Benadryl spray,

Speaker 2 a topical spray that just, it really helps.

Speaker 1 Right.

Speaker 2 So between that and cortisone and then the Benadryl at night, I did okay. Right.
In those awesome showers.

Speaker 1 So the, like, the proreceptive itch, we've got treatment for, basically. Yeah.
The other three,

Speaker 1 you're in trouble, it turns out. As far as it stands right now, maybe five or ten years from now, there'll be something.

Speaker 1 Apparently, there is a lot of movement right now on treating this stuff, but it's like they're having to figure out how to block some really otherwise important chemicals in the body, like that NPPB, right?

Speaker 2 Yeah, that one, what does it help regulate your blood pressure as well?

Speaker 1 Right. So they can just switch that off.
Right. Yeah.
Just turn off the gene that produces that.

Speaker 2 You won't itch, but you might die early.

Speaker 1 Right. Not worth it.
Right.

Speaker 2 The one that really, I mean, they're all sad, but the psychogenic, when you have a mental illness where you feel like you have parasites and bugs on your skin.

Speaker 1 you remember our Morgelons disease? Yeah.

Speaker 1 How did you said it, Morgellons, right? And I said Morgellons.

Speaker 2 I can't remember. I know that I said it the way everyone else says it, though.

Speaker 1 That's all I remember. Morgelons.

Speaker 1 That's right. That's how I said it.

Speaker 2 Man, but all this stuff, I just had so much empathy for Em

Speaker 2 and wanted a follow-up so bad to see how she was doing.

Speaker 1 You know? Yeah.

Speaker 2 And if she kept scratching holes in her skull.

Speaker 1 I don't know.

Speaker 2 Jeez.

Speaker 1 So there's, I read another article called Accidental Therapists.

Speaker 1 It's by a guy named Eric Brudman, and it was published on a website called STAT. And it's all about delusional

Speaker 1 parasitosis, but how it's treated sometimes by

Speaker 1 entomologists. You know, like those extension services at universities.
Yeah. Here in the U.S., like state universities have what are called extension services where like

Speaker 1 a scientist will just basically be there for the public to come talk to about whatever. Usually it's like household stuff or farm stuff, something like that.

Speaker 1 And apparently entomologists frequently are approached with people who are like, I've got these bugs like crawling all over me. Here's a sample of them.

Speaker 1 And it turns out it's like carpet fiber or something like that. And these people just can't stop itching or whatever, but it turns out they have a delusion.
They don't actually have parasites.

Speaker 1 My question question is, is that our understanding of it now?

Speaker 1 And in five or ten years, we're going to know that they had neurogenic itches and we just treated them like they were crazy, even though they weren't? Yeah.

Speaker 1 And it's going to be like a real blemish on the history of neuroscience? Maybe. Or will this idea of psychogenic itches, you know, hold up? Yeah.
I wonder.

Speaker 2 Did you ever see the Todd Haynes movie Safe with Julianne Moore?

Speaker 1 No.

Speaker 2 It was one of his first movies after the Karen Carpenter thing he did

Speaker 2 that wasn't like, I mean, it was a real movie, but it wasn't released.

Speaker 2 But Safe was very disturbing. It was about a woman who kind of slowly drifted into madness from believing that the world was poisoning her.
Wow. And like household chemicals and everything.

Speaker 2 And it kind of started slow. And eventually she ended up at this kind of safe camp for people like her.
Right.

Speaker 2 Very distressing movie. And one of her first movies, too.

Speaker 1 I'll have to check it out. Yeah, it's really good.
Oh, it's old?

Speaker 2 Yeah,

Speaker 2 early 90s, I think.

Speaker 1 I know what you're talking about. No, it's called The Road to Wellville.

Speaker 1 Is that what you mean? No. It's called Safe.
Okay, I'll check it out. Yeah, it's good.

Speaker 2 Very distressing.

Speaker 1 I'm trying to think of anything.

Speaker 2 And that wasn't necessarily itching, but it was just like that psychogenic thing of like, I think everything in my house is killing me.

Speaker 1 Yeah, I mean, have you ever like stopped and thought about something and thought, there's, there's the path to madness right there. I'm staring down it right now.

Speaker 1 I should probably not keep thinking about this.

Speaker 1 I don't really get like that. Oh, no.

Speaker 2 No, I'm very easily kind of led on to the next shiny thing. I guess.

Speaker 1 I'm like a bird. Yeah.
Yeah. Basically.
That's probably for the best. It is.

Speaker 2 It has its drawbacks, though.

Speaker 2 What else you got? Well, one thing it says in here is that

Speaker 2 having someone else scratch your itch does apparently does not do the trick. So you have to scratch your own itch.

Speaker 1 Yeah, I mean, somebody can. Like, obviously, like, you know, if you're like, a little left, a little left, up, up, up.
Yeah, see, that get works. I agree with that.

Speaker 2 Oh, man. Not you.

Speaker 2 Them saying. Oh, right.
Like, I think it definitely helps.

Speaker 1 I think what they're saying is it doesn't have quite the same relieving properties as if you do it yourself. Oh, yeah.

Speaker 2 And if you could reach that area of your back, it would be better than that. Yeah, I guess so.
I got a pretty good back scratcher now, though.

Speaker 1 Oh, yeah? What's it made of? Bamboo?

Speaker 2 No, it's metal, but it's

Speaker 2 telescoping, so it's not you know two feet long gotcha but it can be but it's metal

Speaker 2 yeah it looks like a like what are the a bear claw not the pastry but a oh a real bear claw which actually is looks like the pastry yeah i guess it does that's why they call it that i never thought about that why do you think that was called that i'm just kidding i actually should call it a bear paw it looks more like a bear paw than a bear

Speaker 2 I'm going to try and bring that around.

Speaker 1 Unless you get somebody who really goes the extra mile and puts almonds on the tips to make it look like the claw.

Speaker 2 Yes.

Speaker 2 And not just haphazardly scattered about the bare paw.

Speaker 1 Exactly. Yeah.
That's the difference between a baker who loves their job and one who's just in it for the money.

Speaker 2 Yeah.

Speaker 1 A couple more things, Charles. Like we said, there's still plenty of mysteries around itches.
Yeah. Why, say, does a feather tickle sometimes but itch other times?

Speaker 1 Big question. They don't know.
Right.

Speaker 1 But I'd like to know.

Speaker 2 Well, maybe the Germans will get active on this again. Yeah.

Speaker 2 They're the only ones who can solve it.

Speaker 1 Only the Germans can save us. You got anything else? No, I don't.

Speaker 1 I don't either. Itching.
Nice work. Thanks, man.
Same to you.

Speaker 2 Thank you. And you haven't scratched in a while, so.

Speaker 1 No, I'm actually.

Speaker 1 I've been scratching the same spot and it's starting to get a little tender, so I'm stopping.

Speaker 2 Man, there's nothing worse in a movie and i've seen it i feel like i've seen this a few times in movies where someone is compulsively like scratching until it becomes a sore and then they're scratching it it's just like uh through to their brain well yeah

Speaker 1 so i guess the moral of this one is what would tom petty do i'll ask him tomorrow if you want to know uh more about itching or what tom petty would do you can type those words in the search bar at houstuffworks.com and since i said said search bar, it's time for listener mail.

Speaker 2 I'm going to call this one of the many emails we got on the swearing episode. Did you notice that? People really seemed to like that one.
Yeah, they did. A lot of response.
Yeah. From mostly from

Speaker 2 fellow potty mouths.

Speaker 2 Which were very filthy emails too, which were great.

Speaker 2 And I responded in turn by cursing at them and my replies, which I hope they enjoyed.

Speaker 1 In all caps?

Speaker 1 No.

Speaker 2 I didn't want to be too aggressive.

Speaker 2 So this is from Emily Allen. Hey guys, long time listener.
First time writing in.

Speaker 2 Writing about swearing, I should start by saying that it's funny I'm writing about this episode because I almost never curse. And when I do, it's normally not a very offensive swear.

Speaker 2 However, your intro made me think of something interesting I wanted to share. You talked about how you really censor yourself during recording in order to keep your show family friendly.

Speaker 2 It got me thinking about how our jobs really shape our vocabulary, how we express ourselves. I noticed a major change in the way I speak since becoming a teacher.

Speaker 2 I primarily teach kindergarten to second-grade students, and I found this really changed the way I express myself. For example, I try to avoid even saying things are dumb or stupid around kids.

Speaker 2 We'll often say, Well, isn't that silly? instead. This works in the classroom, but I often get laughs from friends and family when I refer to a situation as silly,

Speaker 2 like a disagreement with a colleague or something a politician does.

Speaker 2 There are other expressions I use with the kids that often slip into regular conversation as well. The most embarrassing when I'm out and excuse myself to go potty.
That always gets a laugh.

Speaker 2 Anyway, I just wanted to share and thank you for all the great work you do.

Speaker 2 I've learned so much from listening each week, and I'm always excited to see the new episode, Offerings, every Tuesday and Thursday. That is from Emily Allen.

Speaker 1 Thank you, Ms. Allen.
Very silly.

Speaker 1 That was a very nice email. Yeah.

Speaker 1 If you want to get in touch with us, like Ms. Allen did, you can send us an email, the stuffpodcast at howstuffworks.com.
And as always, join us at our home on the web, stuffyushouldknow.com.

Speaker 1 Stuff You Should Know is a production of iHeartRadio. For more podcasts, my Heart Radio, visit the iHeartRadio app, Apple Podcasts, or wherever you listen to your favorite shows.

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Speaker 2 Support for the show show today comes from Public.com. You're thoughtful about where your money goes.

Speaker 2 You've got core holdings, some recurring crypto buys, maybe even a few strategic options plays on the side. The point is, you're engaged with your investments, and Public gets that.

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Speaker 3 Paid for by Public Investing. All investing involves risk of loss, including loss of principal.

Speaker 3 Brokerage services for U.S.-listed registered securities, options, and bonds in a self-directed account are offered by Public Investing Inc., member FINRA, and SIPC.

Speaker 3 Crypto Trading provided by Zero Hash. Complete disclosures available at public.com/slash disclosures.

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