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Itchy skin is one of the most commonly reported dermatological complaints and it affects almost 8%-9% of the global population in a stretch of any two weeks.
What Is Itching?
Itching is referred to as pruritus in medical terminology. It typically manifests as a normal defensive response of the body to external skin irritants. It can also stem from other dermatological, systemic, or psychological ailments.
An itch is essentially a sensation that makes you want to scratch the affected skin. This urge to scratch can be restricted to specific areas of the skin or affect the entire body as a whole. (1)
How Long Does the Itch Last?
The skin discomfort can range from mildly irritating to severely aggravating, depending upon the underlying cause. The duration of the itch can range from short term or acute to relatively chronic, which can last for more than 6 weeks.
People who suffer from itchy skin usually struggle to get a good night’s sleep. In fact, the constant discomfort can keep you from performing your day-to-day activities and can negatively impact your overall quality of life. (2)
It is easier to identify the cause of itching when it is accompanied by visible symptoms such as a rash, swelling, redness, or other signs of skin irritation.
But in some cases, the itch may sneak up on you without any obvious manifestation, which can make it relatively difficult to diagnose.
For instance, if a mosquito or insect bite causes your skin to turn itchy, it is usually accompanied by redness and swelling around the area where you got stung.
In such cases, your skin doctor can determine the cause of itching simply by looking at the physical symptoms.
On the other hand, if you feel like scratching your skin without any noticeable sting bite or rash, your doctor may have to conduct a more thorough and in-depth analysis to reach a conclusive diagnosis.
What Does “Pruritus with No Rash” Look Like?
If you develop pruritus or itching without a rash, the cause behind the sensation can be hard to detect. You will experience a strong desire to scratch the skin but in the absence of any noticeable signs of skin damage or irritation.
In such cases of pruritus with no rash, the skin changes occur later as a result of incessant scratching and rubbing. As you continue to scratch the itch, the affected skin can become damaged over time and develop the following:
- Scars or scratch marks
- Hyperpigmentation (brown marks)
- Hypopigmentation (pale marks)
- Skin thickening
- Open sores
The Itch-Scratch Cycle
Itchy skin and the natural impulse to scratch it reinforce each other in a cyclic manner, which is referred to as the “itch-scratch cycle.”
The surface layer of the skin is the epidermis, which serves as your body’s outermost barrier against harmful environmental substances or parasites.
If there is a breach in this protective cover, your body will feel that it is under attack and go into defense mode.
The skin cells release certain inflammatory chemicals called histamines to combat the security threat. Histamines make your skin itchy.
Increased skin dryness and exposure to allergens can also trigger a similar inflammatory response in the body.
Subsequently, certain receptors in the skin communicate this inflammatory response to the brain, which in turn signals your body to scratch the newly developed itchiness.
Thus, the human brain is wired in such a way that makes you scratch or rub an itch the minute your experience it. It takes a lot of concerted effort to control the desire to scratch an itch as you have to override your inherent conditioning.
The relief you get by scratching the itchy areas lasts only for a momentary period until your skin begins to itch again, sometimes even more intensely than before.
When you try to quell the itchiness by rubbing or scratching the affected site, the friction at the surface makes the skin cells feel like they are still under attack.
This, in turn, prolongs the itch-inducing response against the suspected source of skin irritation.
Excessive or frequent scratching can lead to further irritation at the affected site. It can compromise the structural integrity of the skin barrier over time. Thus, as difficult as it may be, you must resist the urge to scratch your skin.
Types of Itch
- Pruriceptive itch is a natural inflammatory response to a skin-related issue, allergy, bug bite, or drug.
It is typically associated with skin inflammation or damage, as well as a number of dermatological ailments such as atopic dermatitis (eczema), psoriasis and urticaria (hives).
People with dry skin are more susceptible to this kind of itch.
It is primarily because their protective barrier is devoid of the necessary moisture and skin lipids required to form an effective shield against foreign irritants that can induce an itch-inducing inflammatory reaction in the body.
Pruriceptive itch is brought on by a release of histamine in the body, and is therefore treated with medications that can alter or curb this innate immunogenic response, such as antihistamines.
People struggling with a neuropathic itch typically experience numbness and tingling along with it.
- Neuropathic itch can be traced back to an underlying nerve damage or impairment of the nervous system.
It is usually observed during a burn injury, stroke, shingles, or chronic neuropathic condition called notalgia paresthetica that affects the upper and middle back.
People struggling with a neuropathic itch typically experience sensations of numbness and tingling along with it. The standard treatment for this particular type of itch is non-narcotic analgesics and capsaicin.
- Neurogenic itch mostly affects people who have been ailing from a liver or kidney disease for a long time.
This type of itch is induced by opioid neuropeptides and can be treated with both narcotic and non-narcotic pain relievers.
- Psychogenic itch develops in response to two neurotransmitters or chemical messengers that are responsible for mood management.
These chemicals, namely, serotonin and norepinephrine, are quite significant in the context of multiple psychiatric issues including stress, depression, obsessive-compulsive disorder, and delusional parasitosis.
Antidepressants and antipsychotic medications are the primary treatment options to control a psychogenic itch. (1)
What Causes Itchy Skin?
Pruritus or itching can be triggered by a number of different causes, which include the following:
- Common skin conditions including eczema, dandruff, psoriasis, and prurigo
- Skin infestation by parasites such as lice or scabies
- Dry skin (xerosis) due to insufficient moisture or oils in the skin
- An allergic response to certain cosmetics, fabrics, metals, dyes, food, or medications
- Skin exposure to or contact with common allergens such as chemicals, poison ivy, stinging nettle, and detergents
- Hormonal changes or disorders
- Excessive perspiration
- Fungal infections such as ringworm, athlete’s foot, and thrush
- Insect bites
- Psychological conditions such as anxiety and stress
- Excessive sun exposure or sunburn
- Conditions that hamper the nervous system such as shingles, multiple sclerosis, pinched nerves, and diabetes
- Some chronic long-term ailments such as thyroid issues, liver disease, kidney disease, and certain forms of cancer
- Superficial skin infections such as folliculitis and impetigo
- Hair regrowth
- Healing wounds
- Nutritional deficiencies including insufficient vitamin A and iron in the body
- Progressive thinning or drying of the skin with advancing age, which is particularly noticeable after the age of 65 (3)
Why Does It Itch More at Night?
The itchiness experienced on account of several systemic and skin-related ailments tends to be at its worse during nighttime.
This can make it extremely difficult for the patient to fall asleep or stay asleep. The continued exacerbation of this nocturnal itch can leave you sleep deprived for as long as the condition persists, hampering your physical, emotional, and mental well-being.
The exact mechanism that leads to the nightly aggravation of pruritus is still not clearly understood, but certain factors may contribute to this tendency.
It is suspected that several key regulatory mechanisms of the skin are altered during the night in a way that increases the intensity of itching.
For instance, the body’s ability to maintain a healthy core temperature irrespective of the external environment may get compromised during sleep.
To be precise, sleep triggers certain variations in the thermoregulatory function of the body that can make your skin itch more.
Your epidermal skin tends to lose more water to the environment by way of diffusion and evaporation when you are asleep.
This transepidermal water loss hampers the integrity of your skin barrier and grants easy entry to pruritogens or external itch-causing irritants.
It has been observed that transepidermal water loss is significantly maximized during the night while staying almost negligible during the morning.
The greater the water loss, the more impaired your skin’s topmost cover. It is on account of such functional aberrations that you may experience a worsening of the itch at night.
Corticosteroids are a class of steroid hormones that are naturally occurring in the body and can also be synthetically produced.
These hormones are produced in the adrenal cortex and are known to suppress the inflammatory response responsible for the itch.
Certain psychological factors may also play a role in the intensification of nocturnal pruritus. There is a gradual loss of energy and external stimulation as you approach the end of the day.
Such loss leads to increased boredom during the late hours of the evening. Because you do not have a distraction, your attention focuses on the itch.
Diagnosing Itchy Skin
To determine the underlying cause for your itchy skin, your dermatologist will review your symptoms, take into account your detailed medical history, and perform a thorough assessment of the affected skin.
The doctor may be able to pin the culprit simply by looking at your rash. If not, he/she may conduct a more in-depth physical examination to reach a conclusive diagnosis.
By conducting a thorough analysis and assessment of your condition, the doctor will be able to make an informed diagnosis and subsequently recommend the appropriate treatment strategy.
If this type of preliminary analysis proves inconclusive, your doctor may order additional tests to get a clearer understanding of your condition. These include:
- Thyroid function tests may be conducted to rule out thyroid issues as the cause of your itchy skin.
- The doctor may take a scraping of skin from the itchy area or collect a swab sample from the affected site to examine it under the microscope for any sign of an infestation or infection.
This skin test may also be performed if the doctor suspects an ongoing allergic reaction to be the cause of your itchiness.
- The doctor may conduct a skin biopsy to identify any underlying skin disorder that may be responsible for the itch.
- Blood testing may be done to steer the diagnosis in the right direction.
- If all other forms of tests fail to yield any definitive results, your dermatologist may order a “pruritus screen” to find any underlying disease of the internal organs that may be causing the itch.
Screen testing involves a combination of different tests, which typically include blood, urine, stool, and radiographic tests.
Once the doctor has a clear diagnosis, he/she will recommend the appropriate treatment to address the root cause of the itchiness.
Treatment for Itchy Skin
To get real relief from itchy skin, you need to treat the underlying skin condition or systemic disease responsible for it.
Meanwhile, you can employ a number of therapies to manage the discomfort.
The preliminary treatment for pruritus focuses on shortening the itch-scratch cycle and reducing the intensity of the itch through topical ointments and oral medications.
People with chronic skin conditions such as eczema and allergic contact dermatitis suffer from repeated flare-ups of itchiness. They have to rely on long-term use of creams and ointments to manage the skin discomfort. (5)
Here are some of the commonly used lotions, creams, and drugs for itch relief, which may be available over the counter or prescribed by a dermatologist:
- Menthol-containing creams to soothe the itchiness
- Topical creams containing anti-itch ingredients such as crotamiton to calm the irritated skin
- Mild steroid-containing ointments such as hydrocortisone cream to bring down the skin inflammation
- Antihistamine tablets to curb any underlying allergic reaction or immune response
- Lightweight anti-itch lotions, which have a thinner consistency than sticky creams, that are specifically designed to control the itching in hairy areas such as your scalp
Trust your skin specialist to recommend the most suitable treatment strategy for your particular case after taking all the relevant factors into account.
It is best not to try any topical or oral therapy without consulting your doctor first.
This is particularly true for antihistamines and steroid creams, which can trigger an adverse reaction and worsen your condition if not taken properly.
Moreover, instead of self-medicating, you must stick to the dosage prescribed by your doctor for the medicine to bring positive outcomes without any side effects.
It is generally recommended to apply medicated skin creams and ointments to the affected areas before applying moisturizer to your entire body, including areas treated with medication.
How to Prevent and Cope with Itchy Skin
Adhering to the following dermatologist-recommended tips can help prevent skin itchiness to a significant degree.
1. Keep your skin moisturized
One of the most basic skincare measures for alleviating itchiness is to treat your skin with a good-quality moisturizer daily.
This type of topical therapy helps in relieving the itch and in strengthening the barrier function of the epidermis.
When it comes to your skin, you must invest generously in the best skincare products. A lot of people make the mistake of associating price with quality and blindly picking the most expensive brand assuming it to be the best.
When choosing your skincare products, you must pick the ones that are best suited for your particular skin type and condition.
For dry and itchy skin, it is recommended to use an oil-based moisturizer that is classified as hypoallergenic. This means that it is relatively unlikely to trigger an allergic response after application.
Moisturizers are available in different forms, but the most preferred options for pruritus treatment are ointments or oils, followed by creams and then lotions.
Here are a few points to consider when selecting a moisturizer:
- Always look for emollient creams or ointments.
- Choose fragrance-free emollients, such as petroleum jelly, over aromatic lotions.
- Go through the composition of the product to make sure it does not contain any potential allergen
2. Change your bath habits
Limit the time you spend in the shower or bath as prolonged exposure to water, particularly hot water, can dry out your skin.
Your skin tends to be extra dry during winters, which is usually accompanied by increased itchiness.
Taking long hot showers or baths can strip away the natural lipids and moisture from your skin, further exacerbating the problem. So, shower with tepid water instead.
Restrict the duration of your showers to no more than 10 minutes.
After stepping out of the shower or bath, apply a generous amount of unperfumed moisturizer on your skin while it is still wet.
This not only replenishes the moisture in your skin but also helps seal it within so that it remains well hydrated for a longer time.
Instead of rubbing your wet skin with a towel, gently pat it dry.
You can also try bath oils to make your skin less dry. Simply add a few drops of these potions to your bathwater, and soak in their hydrating goodness.
But since these oils can grease the floor of your bathtub, you have to be very cautious to avoid any slipping accidents.
A safer alternative is to apply the oil directly on your skin once you are done with your bath. You can also use regular baby oil for this post-bath moisturizing ritual.
3. Wear comfortable clothes
If your skin is extremely itchy, you are recommended to wear lightweight, loose-fitting clothes made of soft, skin-friendly fabrics such as cotton and linen.
Comfortable clothes allow your skin to breathe, whereas tight-fitted clothes made from coarse fabrics such as wool rub against your skin and cause further irritation or itching.
4. Use gentle cold therapy
The same nerve fibers are responsible for carrying the sensations of both cold and itching. Applying cool water on the itchy skin may provide instant but temporary relief from the discomfort.
5. Maintain proper nail hygiene and try not to scratch
When your skin becomes itchy, you cannot help scratching it. But scratching relieves the itch only for a momentary period and comes back.
Then, you are tempted to go at it again with your nails.
The repeated friction can rupture the skin barrier, making it easier for pathogenic invaders to infect the damaged tissue. The constant scratching can also injure your skin and leave scars or discoloration behind.
So, you must fight the urge to scratch no matter how severe the itch. If you find the itch unbearable, simply pat the affected skin to subdue the sensation.
You are also advised to wear cotton gloves at night to minimize the skin damage caused by scratching in your sleep.
Even if you firmly resolve not to scratch, there will be instances when you mindlessly succumb to this overpowering urge.
So, it is essential that you keep your nails clean, short, and filed smooth to minimize the damage from scratching.
6. Take a warm colloidal oatmeal bath or apply lotion
Colloidal oatmeal is essentially oats ground into an extremely fine powder. It is credited with significant skin healing potential.
This topical remedy may help alleviate a variety of skin problems, such as erythema, burns, eczema, rashes, and dry and itchy skin.
Oatmeal in colloidal form is known to exhibit anti-irritating, anti-inflammatory, and skin-soothing properties that may provide quick relief from itching. (6)
An investigator blind study done on 29 healthy female subjects suffering from itchy, dry skin suggested that the dermatological benefits of colloidal oat extracts for itch relief can be traced back to its antioxidant and anti-inflammatory properties. (7)
Another randomized controlled trial conducted on 50 female participants found colloidal oatmeal lotion to be considerably effective as a skin moisturizer, which may help reduce skin dryness and improve its barrier function. (8)
Colloidal oatmeal is recognized as an anti-inflammatory ingredient that may help soothe your dry, itchy skin and improve its barrier function.
7. Soothe skin with aloe vera extract
Aloe vera is recognized as one of the best skin salves there is. It can work as an effective topical therapy for dry, irritated, and itchy skin.
The viscous gel contained within aloe vera leaves is richly supplied with vitamin E. This vitamin is a potent antioxidant that can help nourish your skin and protect it from free radicals and external irritants.
Aloe vera also works as a hydrating agent. It also exhibits excellent anti-inflammatory, antibacterial, and antifungal properties.
Thus, this therapeutic plant has all the makings of a potent skin healer.
Aloe vera is credited with significant anti-inflammatory, skin-lubricating, and antibacterial properties, which make it an effective therapeutic agent for a wide array of dermatological concerns, including itchy, irritated, dry skin. However, just like other topical therapies, it is recommended to do a patch test before applying aloe vera directly to the affected skin.
8. Moisturize with natural oils
Topical application of coconut oil may help relieve eczema in both kids and adults.
This natural emollient not only hydrates your parched skin but also doubles up as a potent antimicrobial agent with significant antioxidant properties. (9)
A study published in Evidence-Based Complementary & Alternative Medicine highlighted the efficacy of virgin coconut oil as a skin emollient with significant antibacterial and anti-inflammatory activity. (10)
Sunflower Seed Oil
Sunflower seed oil is another moisturizing ingredient that is regularly used in a variety of skincare products. This oil derives its dermatological value from its high concentration of linoleic acid.
The suitability of sunflower seed oil for itchy skin is further validated by a scientific review.
Coconut and sunflower oils have long been used as skin moisturizers, and for good reason. The antimicrobial and anti-inflammatory properties of these natural emollients have been supported by multiple researches. Thus, it’s safe to say that the topical application of these lubricating oils can help strengthen the structural integrity of your epidermis and relieve the itchiness associated with dry, irritated skin.
9. Avoid smoking and alcohol intake
You must make the necessary adjustments to your diet and lifestyle to make your skin fare better.
Limit your intake of alcohol, caffeine, and spicy foods as they are known to aggravate itchiness.
Smoking can also lead to increased skin dryness, besides being a hazard for your overall health. Quit this habit at the earliest and avoid exposure to secondhand smoke as well.
10. Use a humidifier
Exposing your skin to drastic temperature fluctuations can lead to skin dryness and subsequent itching. It is important to keep your living space comfortably cool and humid.
People with naturally dry skin or those who have eczema experience a worsening of their symptoms during winters when the air is particularly arid.
Consider using a sterilized humidifier to replenish the moisture in your home atmosphere.
Also, make sure to clean the humidifier regularly to keep it free of mold and other impurities, which may get suspended in your environment.
11. Avoid known allergens
Exposure to certain irritants such as animal dander, cigarette smoke, and chemical sprays can make your skin uncontrollably itchy, more so if you happen to have sensitive skin.
To stave off such allergic skin reactions, make it a point to carefully examine your bathing, skincare, and cosmetic products before buying them.
Always go through the ingredient list to see if the product contains anything that you might be allergic to.
Even if you do not have any known allergies, you must exercise the necessary prudence and avoid any topical product that contains known irritants or ingredient that may dry out your skin.
Also, be cautious about certain food allergens that can trigger your itchy symptoms.
12. Manage your stress
Stress contributes to the worsening of your itch. Hence, managing your stress levels is imperative.
You can try a number of meditative techniques at home and make concerted efforts to avoid high-pressure, stress-inducing situations.
Practicing regular yoga, listening to soothing music, doing deep-breathing exercises, and taking up hobbies that give you pleasure or fulfillment can help take your mind off the everyday struggles.
Besides these stress-busting activities, you can also seek professional psychological counseling and behavior modification therapy for improved stress management.
Acupuncture is another alternative therapy for stress relief, but you must get it done by a trusted professional for it to be safe and effective.
Severe or prolonged episodes of itching can lead to the following complications:
- As itchiness tends to be more intense during night, it can leave you utterly sleep deprived over time.
- When you continue to scratch the itchy skin for an extended period, the tissue may rupture and subsequently become infected.
- Frequent and excessive scratching causes a great deal of friction, which can potentially damage the skin tissue and lead to scarring, thickening, or discoloration of the affected skin.
- The constant scratching of the head due to excessively itchy scalp may result in increased dandruff or flakiness of the skin, head bumps, and hair loss.
When to See a Doctor
You may need professional assistance from a skin specialist (dermatologist) in the following cases:
- If the itching becomes so intense that your breathing becomes labored
- If you experience dysphagia, or difficulty swallowing, along with the itch
- If the itchiness continues unabated despite adequate self-care measures for more than 2 weeks
- If the itch is so severe that it hampers your daily routines
- If you experience frequent itching spells that have a sudden onset and no discernible cause
- If the itch encompasses your entire body
What your doctor may ask you:
- How long has the itch persisted?
- Does your skin itch consistently or do you experience recurring itching spells?
- Do you suffer from any active allergies?
- Did you apply any lotion, oil, or cream to relieve your itch?
- What cosmetic products do you use?
- What area of the skin appears to be most itchy?
- Are you currently on any medication or have you recently been on any medication? If so, what?
- Does your itchy skin ooze out a watery discharge on scratching?
- Have you recently been exposed to or been in contact with any irritant?
What you may ask your doctor:
- Why does my skin itch so much?
- Is the itchiness a sign of some allergy?
- What antiallergic medicine can I take if I see a bump/rash with the itch?
- Are there any dietary changes that can help reduce the itchiness?
- What should I do if the itch becomes unbearably severe?
- Is pruritus or itchiness contagious?
- How long will it take for the treatment to work?
Everyone tends to get itchy skin from time to time, usually due to increased skin dryness.
However, if the pruritus is accompanied by other distressing symptoms, a more serious underlying condition may be present, which may need prompt medical attention.
- Excessive thirst, sudden weight loss, and an unusually frequent urge to pee can be symptomatic of diabetes.
- Unusual fatigue, weakness, numbness, or a tingling sensation in your skin along with the itchiness may indicate a nervous system disorder.
- Abdominal pain or yellowing of the eyes and skin can signal a liver or gallbladder ailment when presented with itchy skin.
- If the itchy skin is accompanied by unexplained weight loss, feelings of exhaustion, and night sweats, you may have a serious underlying infection or a tumor.
Itchiness is a discomforting but largely harmless condition. It can usually be managed with proper skincare and nonprescription ointments. However, if you suspect that an underlying medical condition is causing the itch, visit your healthcare provider immediately.
Expert Answers (Q&A)
Answered by Dr. Michelle Levy, MD (Dermatology)
Itchy skin can be caused by a number of factors. These include rashes such as eczema, psoriasis, and hives, certain medications, dry skin, nerve problems, and allergic reactions.
Uncommonly, itchy skin can be a sign of an internal disease such as kidney disease, liver disease, and certain cancers.
Short lukewarm baths are best for those with itchy skin. Hot water removes some of the natural oils that the skin produces, making it prone to dryness. Dry skin can lead to inflammation and can make the itch worse.
Certain types of food allergies can cause rashes and itchy skin, and for several reasons, it is best to avoid foods that you have a known allergy to. For the most part, though, foods do not contribute to itching in most people.
When a woman is pregnant, mild itchiness of the skin on the abdomen is very common as the skin stretches to accommodate the growing baby. Widespread severe itch or the new onset of rashes may require further testing and needs to be evaluated by a doctor.
Colloidal oatmeal may improve itch by reducing inflammation and contributing to the moisturization of the skin. It can be added to bathwater or is found as an additive in some moisturizers also.
While some people may anecdotally find baking soda or apple cider vinegar helpful, there is little scientific evidence to support their use at this time.
For most people, changing their diet will not improve itch. But, of course, if you are allergic to certain foods, then remove them from your diet. Also, seek medical attention if any food gives you rashes.
– Proper skin care can be very helpful in improving itch, particularly if it is caused by dry skin or eczema.
– Short lukewarm baths or showers followed immediately by the use of a rich moisturizer will seal the moisture into the skin and may treat and prevent dryness.
– Harsh soaps and fragrances can irritate the skin and fragrance-free cleansers and moisturizers are preferred.
About Dr. Michelle Levy: Dr. Levy is a board-certified dermatologist with 15 years of experience. She is in private practice in Toronto, Canada, practicing medical and cosmetic dermatology.