Itching

Itching is a distressing symptom. A survey of people with eczema showed that they minded more about the itching than about the appearance of their skin. There are lots of possible causes of itching but, quite often, no cause can be identified.

questions to ask yourself

Is there anything to see? Maybe there is a rash that is red and/or scaly, or maybe there are itchy patches. If so, your doctor should be able to work out the cause.

Is your skin too dry? For an unknown reason, dry skin is itchy skin. This is a particular problem as we get older. Skin produces its own grease to moisturize the skin, but as we get older less grease is produced. Add to this the effects of soaps and central heating, and skin can become dry, scaly and itchy. Our legs have the fewest grease glands and so are particularly affected, producing a ‘crazy-paving’ appearance. It is most common in the winter (‘winter itch’), because of indoor heating.

 

Could it be flea bites? Flea bites are usually raised red areas up to 1 cm across. They are usually in groups of three or four. They are often on the neck, lower leg or at the waist (under the waistband of your clothing). Cat fleas are the usual culprits. You can get cat flea bites even if you do not have a cat, because they can remain in a dormant state in carpets for up to 1 year. When people arrive nearby, the vibration wakes them up. So if you move into a house where there were cats previously, the house can suddenly ‘come alive’ with fleas.

 

Could it be bed bugs? Bed bugs are becoming much more common. Bed bugs are flat insects, up to 7 mm long. They cannot fly or jump, but can run rapidly. During the day their flat shape enables them to remain hidden in cracks and crevices (such as in beds, behind loose wallpaper and in picture frames). They emerge at night to feed. Feeding takes 4–12 minutes and the insects then return to their hiding places. The most common sign is red, very itchy bites, in a line or group representing repeated feeding by a single insect. You may notice specks of blood on the bed sheets.

 

Getting rid of bed bugs can be very difficult. Insecticidal treatments should be combined with frequent laundering of bed linens at a high temperature (initially, every day), vacuuming of rooms, and steam cleaning and vacuuming of mattresses.

 

Could it be scabies? This is the most overlooked cause of itching, and it is becoming more common. It is a strong possibility if anyone else is itchy. Scabies is caused by infection with scabies mites, which are tiny creatures that live on the skin. After mating, the mites tunnel into the skin to make a tiny burrow, often between the fingers or at the wrists, where they live for several weeks and lay their eggs. The eggs hatch within a few days. After about a month, an itchy, scaly rash occurs, which is an allergic reaction to the saliva and faeces of the mites. The rash can be over most of the body, or may be on the finger webs, wrists, elbows, armpits, waist, feet or penis.

 

The mites cannot fly or jump, but crawl from one person to another. You usually pick up scabies by skin-to-skin contact, such as sharing a bed. Itching is often worse at night. Again, see your doctor to get a diagnosis and treatment. 

 

Is the itch all over, or just in one part of your body? If your scalp is itchy, read our articles on head lice and dandruff. If your bottom is the problem, look at the section on anal itching. If the itching affects only your back, alongside the shoulder blade, you have a condition doctors call ‘notalgia paraesthetica’. It is thought to be caused by trapping of very small nerves in the skin.

 

Have you recently had shingles? The area affected by shingles can remain itchy for weeks or months, but it will eventually stop.

 

Does the itching come and go? If so, you may be able to work out the cause. Intermittent raised, red, itchy patches could be ‘urticaria’, a condition that is often the result of an allergy.

 

Is the itching worse at night? Psoriasis is a skin condition that causes scaly patches. It also causes itching that is worse at night and affects the normal-looking skin as well as the scaly areas. Eczema is another skin condition that can cause bothersome itching at night.

 

Could you be sensitive to something? Nickel in jewellery can cause itching in people who are sensitive to it. The itching, and often a rash, occurs where the jewellery has touched the skin. Chemicals from plants or from the workplace can sometimes cause the skin that has been exposed to the chemical to itch. Working with fibreglass can cause an itchy skin irritation.

 

Do you have an itchy pet? If so, it could be fleas (see above) or ‘dog scabies’ (which can affect humans). In the case of dog scabies, your dog would have scaly, bald areas as well as itching.

what you can do

Break the scratching habit. You know you are doing it, but cannot stop. This is quite a common problem. We all know that scratching can relieve itching temporarily. Scientists have now discovered that it stops the nerves in the spinal cord transmitting signals from that area of skin to the brain. Although it relieves itching initially, scratching eventually makes the itching worse, so you scratch more and then itch more. The scratch–itch cycle is hard to get out of, especially if you are feeling stressed, anxious or depressed. Doctors at Chelsea and Westminster Hospital, London, have developed a programme to break the habit of scratching. You could try their method at home.

• The first stage is simply to become aware of how much you are scratching. Obtain a counter (from sports shops) and click it each time you scratch. You will probably be surprised at the high count. Also, note the circumstances in which you are likely to scratch.
• The second stage is to replace the action of scratching by another ‘safe’ action. For example, you could clench your fists to a count of 30, then if the itch remains (often it will have gone), pinch the skin gently. Continue to log your scratching using the counter.
• As your scratching decreases, concentrate your efforts on the times you scratch most (usually first thing in the morning, getting home after school or work, and last thing at night).

If you feel you have to scratch, try scratching a few centimetres away from the itchy area. This may relieve the itch, with less risk of damaging the skin by constantly scratching the same place.

Use a moisturizer (emollient)

• If the urge to scratch is overwhelming, try smoothing on some moisturizing (also called ‘emollient’) skin cream; this will be less damaging to your skin. A pharmacist will be able to recommend something suitable. For some people, emollient cream (such as aqueous cream) can itself be irritating if left on the skin (but all right for washing); if this happens, change to an ointment (Dermatology in Practice 2004;12(3):16–20).
• Take advice from readers of the Dr Le Fanu column in the Daily Telegraph. To relieve itching, they recommend gently rubbing the itchy area with the inside of a banana skin.

Keep cool

• Itching is usually worse when people are warm. Also, dry air will dry out your skin and worsen itching. So try to keep cool, do not overdress and turn your heating down, especially for sleep.

Your clothes

• Avoid wool or rough synthetic fabrics against your skin. Cotton is less irritating.
• Check the detergent you use for washing your clothes. Avoid those labelled ‘biological’ or ‘enzyme’. Instead, choose one labelled ‘for sensitive skin’. Choose an unperfumed fabric softener or one labelled ‘for sensitive skin’.

When you wash

• You do not have to bathe every day to be clean. Bathing strips natural, protective grease from your skin. If you think your skin is dry, bath or shower only twice a week – you can easily wash the smelly parts of your body separately. Use warm, not hot, water.
• Avoid perfumed or drying soap. Choose an unperfumed ‘cream bar’ type or use aqueous cream (from pharmacies) instead of soap.
• Do not put any disinfectant in the bath or, worse, directly onto your skin. This can start a dermatitis reaction and make the problem even worse. An unperfumed ‘dermatological’ bath oil is a good idea, because it will help to prevent dry skin. You can buy suitable oils from pharmacies – ask the pharmacist for advice. But remember that bath oils can make the bath or shower very slippery!
• Do not scrub your skin.
• Take warm, not hot, baths or showers.
• Moisturize your skin after bathing, when the skin is still slightly damp, as this seals in the moisture. So after washing, towel-dry your skin gently, then apply a moisturizing cream.

If your pet is itching

• Treat the pet for fleas. If this does not work, take your animal to a vet. Human itching from dog scabies goes away when the animal is treated

how your doctor can help

If the simple measures given in itching: what you can do, do not control the itching, you should see your doctor.

Diagnosing the problem. Your doctor will check your skin for signs of skin disease, such as eczema or folliculitis (an infection that is sometimes picked up from hot-tubs), and will also look for scabies. If you think you have urticaria, your doctor can help work out the cause. Itchy skin with nothing to see can sometimes be caused by diseases (such as diabetes, thyroid dysfunction, iron deficiency and liver problems). Therefore your doctor will ask about your general health and do some blood tests.

 

Possible treatments. Obviously, if your doctor finds a reason for the itching, you will receive the appropriate treatment. Sometimes it can take a while for the itching to go. For example, after scabies is treated, the itch may persist for a few weeks.

 

If no specific cause can be found, don’t be too dismayed. This is a common situation. The good news is that this type of itching often clears up after a few weeks or months. Meanwhile, a moisturizing cream (also called an ‘emollient’) and an antihistamine drug can help. Some antihistamines can make you feel drowsy and have been responsible for road accidents, so be very careful about driving while taking them. An antihistamine before bedtime can help night itching. If antihistamines do not deal with the problem, various other drugs can be tried. For ‘notalgia paraesthetica’ (itchy back), capsaicin cream may help.