Recurring itching with no answers

The attacks came out of nowhere, lasting from minutes to hours and usually ending "with her arm a bloody mess," Sanders writes.

"She had long since tried the usual remedies," Sanders writes. "[A]ntihistamine creams and pills; steroid creams; hot-pepper lotions; oatmeal baths; acupuncture. All completely useless."

After watching her mother's intense bouts of itchiness, the woman's daughter offered her a Valium, which helped decrease the intensity of the itchiness, although it did not completely go away. The woman later began carrying Valium with her all the time to treat her sudden episodes of itchiness.

The woman was 62 years old when she experienced her worst itching episode yet. She was on a flight to Honolulu with her daughter, intending to attend the wedding of a close family friend when she caught herself scratching at her forearm and tried to get some ice.

After experiencing "spasms of an intense sensation" flooding her arms, a flight attendant brought her ice which, when combined with the Valium she now kept on hand, eased the itching, but not entirely.

As soon as she removed the ice, the itching would "roar back," Sanders writes.

Once the woman who "was drenched with the condensation" and whose "clothes were dotted with blood," arrived at her destination, her arm ached from the injuries she inflicted upon herself by scratching an itch she couldn't see, Sanders writes.

Within two days of her arrival in Honolulu, the itching had returned to a different arm, leaving her unable to go to the wedding she'd traveled from Los Angeles to attend. Instead, she visited four different doctors, none of whom had answers.

4 years, 5 minutes

After returning home, the woman's itching attacks increased, both in frequency and intensity.

When they first began four years earlier, she experienced just a few attacks a year. Now, she was having "a couple a month on one arm or both, day after day, sometimes for weeks," Sanders writes. 

Noting that her injuries were limited to her forearms, Hartman made a diagnosis in five minutes.

"You need an M.R.I. of your cervical spine," he said. "You have brachioradial pruritus," an injury to a nerve in her lower neck that caused the itch.

The woman's intense itching episodes were caused by her "nerves sending out a kind of distress signal," Sanders writes. Hartman suspected that an MRI would show what was aggravating the woman's nerve fibers, which was later confirmed. 

After prescribing the woman with a new drug that had been approved for treating eczema, she experienced less frequent, less intense attacks. Unfortunately, this only lasted for around a year. 

Still searching for the cure

After returning to Cho's office, "red, scabby arms" on display, Cho came to the conclusion that her itching was inflammatory in nature. He wondered, then, if other anti-inflammatory drugs would work, Sanders writes.

After agreeing to a six-week course of prednisone, a more powerful anti-inflammatory medication, the woman was completely itch-free. The downside? Prednisone's long-term side effects include weight gain, bone loss, diabetes, and hypertension — making it too risky for this woman, now in her late 60s, to continue taking regularly.

After taking another anti-inflammatory drug called methotrexate, the woman experienced very few symptoms for over a year and a half, when she was "shocked by a new itch," Sanders writes.

"It is just one episode, and it wasn't as bad as it has been," the patient told Sanders. "I'm not giving up on it yet."

"Until recently we didn't know much about itch. It wasn't taken seriously," Cho said. "[R]esearchers and drug manufacturers are finally coming around to see this as a huge quality-of-life issue." Progress, Cho said, will take time.