‘I scratch so much in my sleep that I have to wear gloves – but still wake up to find I’ve broken skin’: Neuropathic itching affects millions, but help IS at hand – DR MARTIN SCURR

I had shingles on my left shoulder over nine years ago which left me with post-herpetic neuralgia – I take pregabalin for the pain and amitriptyline for sleep and nerve pain. But despite wearing gloves, I scratch when asleep and wake up to find I’ve taken off the glove and have broken the skin. All I want is to stop this and feel ‘normal’ again.

June Bunn, Staffordshire.

Post-herpetic neuralgia – nerve pain after shingles – is a common complication caused by damage to the nerves. These ‘misfire’, sending faulty messages to the brain.

While this usually resolves after some weeks, some patients experience it longer term.

The sensation is known as neuropathic itch, and it may have been exacerbated by age-related skin changes (in your longer letter you mention you’re in your 70s): older skin is fragile and has a reduced barrier function, lower hydration levels, and lower overall nerve density – which contribute to a chronically hypersensitive state, making it prone to reacting with persistent itching following minimal triggers, such as after shingles.

The problem is that scratching will continue to irritate the damaged nerves, so it has become a vicious circle for you.

The medications you’ve been taking help suppress the malfunctioning nerves, and my hope is that some additional topical treatment might help further.

There are two possibilities. One is a medicated patch containing local anaesthetic – 4 per cent lidocaine – which will numb the skin, and can be applied every night. You can buy these without prescription from the chemist.

I would suggest trying this for a month: If it doesn’t help, I’d recommend a product containing capsaicin, the active compound in chilli peppers. This stimulates the skin and perhaps counterintuitively works to desensitise the nerve fibres.

Again, this is something you can buy over the counter, as a cream or, preferably, in a patch. I’d suggest trying this every night for four weeks. And perhaps swap from wearing the gloves to a tight-fitting cotton or silk pyjama top – more tricky to remove when you sleep.

As for medication, it’s worth discussing this with your GP as altering the doses might help. I’m hopeful there is still a chance symptoms can be resolved.

I am 77 and recently had an MRI brain scan after experiencing dizziness. The scan showed Grade 1 atrophy and Grade 3 ischaemia, which my GP said means I am more likely to have a stroke or get dementia. What can I do to stop it getting worse?

Ruth Taylor, St Helens.

You have been understandably alarmed by this information. But please be reassured that there is much you can do to protect yourself from the developments you fear.

Grade 1 atrophy of the brain is a mild degree of loss of brain volume – and pretty normal in someone of your age, and is not in itself clinically significant.

Grade 3 ischaemia describes a moderate degree of small vessel disease in the white matter of your brain, caused by a shortage of blood flow to these small blood vessels. It’s likely this has been progressing for a number of years and is usually associated with high blood pressure, diabetes, smoking and age.

You may not have any noticeable symptoms but there may be small changes in your cognitive function – your dizziness might be part of this.

Your GP is right – that there is an increased risk of stroke, and you should make a concerted effort to minimise this by ensuring your blood pressure and cholesterol levels are under control. If your LDL levels are raised, your GP will doubtless prescribe a statin. Antiplatelet drugs to make blood cells less sticky may also be considered.

I would also advise doing 30 minutes of physical exercise a day. Push yourself (aim to be slightly breathless; and your heart rate should be raised to 100 for half that time).

There is also evidence that a Mediterranean-style diet – rich in olive oil, plus a wide variety of vegetables, fruit, legumes, nuts and wholegrains – can help improve blood pressure, cholesterol, blood sugar levels and any inflammation, all of which play a role in blood vessel health.

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