Do you recommend the use of cold compresses?

If not, why not? If so, when and how? For what conditions? And lastly, is a cold compress the same as a wet wrap?

Answer:

Cold compresses can occasionally provide mild relief from bothersome itching and the inflammation that often accompanies it. The cold temperature offers a numbing effect on the targeted area and helps to decrease related swelling. As the effect is generally only temporary, I caution against the frequent or prolonged use of cold compresses as a mainstay of a management regimen. It is important to protect the skin from direct contact with the compress and use a cloth barrier (like a towel) between the two. I also recommend that it not be applied for longer than 20 minutes at a time and allow at least 1 hour in between applications if a repeat is needed.  
 
When applied in a conscientious manner, cold compresses are generally fairly safe to use for a variety of itch-provoking conditions. They are most reasonably employed when the itch is localized and not spread over large areas of the body. Patients suffering from itching related to more obvious sources such as bug bites and sunburns often find relief from cold compresses. Additionally, itching related to conditions such as eczema, mycosis fungoides or psoriasis may also have some temporary benefit as well.
 
That is a great question! These are actually very different therapies. In a nutshell, wet wrapping is the process of creating a moisture barrier on the skin and then dressing the affected areas in damp wraps, followed by dry wraps. This can help relieve some itching by allowing the cream adequate time to penetrate the skin and also provides some cooling of the affected area as the water evaporates.


Answer provided by:
Allister Benjamin Chase, MSN, FNP-BC, AOCNP
Oncology Nurse Practitioner
Private Physician Office

Answer:

Our nerves are responsible for transmitting several sensations, including pain, itch, temperature, and pressure among others. While a lot remains to be understood about how our nerves and brain processes this information, we know that certain sensations, such as pain and itch, can be directly decreased with the use of hot or cold temperatures. Temperature can also indirectly affect the sensation of pain and itch by affecting blood flow, which affects local inflammation and swelling. 

Cold compresses can take on many forms. A cold compress can be made from a homemade plastic bag filled with water and ice, a frozen bag of peas, an instant cold pack, or a cloth soaked with cold water. In general, a cold compress should not be left on for more than 20 minutes at a time to prevent the development of frostbite. 

Cold compresses are best used to suppress sensations of itch, a common problem in patients with cutaneous lymphoma. It can also help with certain types of pain, such as a sprained ankle or knee, where inflammation and swelling is contributing to pain. Interestingly, cooling agents, such as menthol (found in several over the counter creams like Sarna), can also decrease itching. The cold compress should be placed on the areas where the itch is most bothersome and can be rotated around to different parts of the body. 

Wet wraps are different from cold compresses, as their goal is to increase the water content of skin. They involve wearing clothing (e.g. long pajamas) soaked first with warm water, often covered by another layer of dry clothing. They are proven effective in conditions with dry skin and itching, like eczema. Using cool water may provide an even greater advantage for itch relief but as large parts of the body will be damp this may be more uncomfortable. Patient with cutaneous lymphoma should consider use of cold compresses as well as wet wraps to reduce itch caused by their skin disease and dry skin, another common problem. 

Use of hot compresses, or being in hot environments, tends to make itching worse by increasing blood flow, inflammation, and sweat, which can be an irritant to skin. This is why after a warm shower skin lesions of lymphoma can temporarily appear redder and may itch more. Only painfully hot temperatures can briefly decrease the sensation of itch, which is not recommended. Hot showers may seem a tempting solution to itching but this causes worsening dry skin and makes itching more challenging to manage afterwards. Hot compresses are best for helping with muscle cramps or on an infectious boil, abscess, or cyst where increased blood flow is desired to speed recovery. 


Answer provided by:
Cecilia Larocca, MD
Instructor in Dermatology
Harvard Medical School

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