Itching

Itching can affect a small area, such as the scalp, arm, leg, or the whole body of the individual. Itchy skin can occur without any noticeable changes on the skin; however, in some cases, associated symptoms may include:

• Skin irritation
• Strong urge to scratch
• Dry skin
• Pain at the site of itching
• Skin discoloration
• Small bumps on the skin called papules
• Skin rash causing swelling or inflammation
• Broken skin leading to bleeding
• Yellow-to-white fluid leaking from broken skin

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Itching can be a symptom of many health conditions. It occurs when certain nerve fibers called C-fibers are stimulated. These fibers transmit itch signals to the brain in response to various irritants, allergies, or skin conditions, leading to the sensation of itching.

The next section explores the different risk factors associated with these causes.

1. Age
For individuals above 65 years, the skin becomes thinner and loses moisture, which can lead to itching due to dryness.

2. Skin conditions
- Sunburn
- Dry skin
- Eczema
- Psoriasis
- Urticaria
- Dandruff

3. Fungal infections
- Thrush
- Ringworm
- Athlete’s foot

4. Autoimmune disorders
- Dermatomyositis
- Systemic sclerosis
- Sjögren syndrome

5. Nerve disorders
- Multiple sclerosis
- Pinched nerves
- Shingles (herpes zoster)
- Brain tumors
- Brachioradial pruritus (itching or burning around the outer forearm)

6. Psychiatric conditions
- Anxiety
- Obsessive-compulsive disorder
- Depression
- Anorexia nervosa
- Delusional disorders

7. Hormonal changes
- Pregnancy
- Menopause

8. Allergic reactions
Reactions to substances such as wool, chemicals, soaps, and cosmetics.

9. Other conditions
- Chicken Pox
- Liver disease
- Kidney disease
- Anemia
- Certain cancers (blood cancer, skin cancer, liver cancer)
- Diabetes

Learn more about how diabetes can cause several skin issues and ways to manage them.

10. Certain medications
- Aspirin
- Opioids
- Blood-pressure-reducing drugs (e.g., amlodipine, atenolol, hydrochlorothiazide)
- Medications used for cancer treatment

11. Bug bites
- Bed bugs
- Head lice
- Mites (scabies)

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1. History and Physical Examination

To diagnose itching, the doctor will physically examine the skin and gather information about the symptoms and medical history.

2. Laboratory Tests

The doctor might suggest several tests to confirm the diagnosis. Testing helps determine the cause of the symptoms, whether it is due to a primary condition or a symptom of another condition.

• Complete Blood Count (CBC): A complete blood count can provide evidence of an internal condition causing the itch, such as anemia.
• Erythrocyte Sedimentation Rate (ESR): A high ESR can indicate inflammation or infection that may lead to itchy skin.
• Total IgE Test: This test measures the total amount of immunoglobulin E (IgE) in the blood in response to an allergy.
• Specific IgE Test: Measures the level of IgE produced in response to a single allergen. A separate test is conducted for each allergen.
• Allergy Panel: This consists of more than 29 tests that help identify allergens that can trigger reactions and cause symptoms like itching.
• Fasting Glucose: High blood sugar levels over a prolonged period can cause itchy skin and help diagnose underlying conditions like diabetes.
• Liver Function Tests (LFT) and Kidney Function Tests (KFT): These tests assess conditions related to the liver or kidney that can cause itching.
• Blood Urea Nitrogen (BUN): The BUN test measures the amount of urea nitrogen in the blood and is usually advised when signs of kidney disease are present, such as fatigue, itching, muscle cramps, and dark-colored urine.
• Thyroid Function Tests: These tests measure levels of thyroid hormones in the blood, as imbalances can lead to skin problems and itching.
• Stool Analysis: This test analyzes the stool for ova (eggs) and parasites, helping to determine parasitic infections that may cause itching.

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3. Imaging Tests

Chest Computed Tomography (CT) Scan: A CT scan is a diagnostic imaging exam that uses X-ray technology to produce images of the inside of the body. This test can show enlarged lymph nodes and help detect conditions associated with itching.

4. Skin Biopsy

This procedure can help diagnose skin disorders such as psoriasis, eczema, actinic keratosis (precancers), and warts that may predispose to itching. It involves taking a small sample of skin and examining it under a microscope.

Prevention Of Itching

• Drink 8-10 glasses of water a day to keep the skin supple and hydrated.
• Use lukewarm water for bathing. Do not exceed shower time greater than 10 minutes.
• Always use gentle and skin-friendly soaps and body washes.
• Moisturize the skin daily or multiple times a day. Try using an unperfumed moisturizer or emollient.
• Prefer loose, breathable clothing. Avoid wearing tight clothes, especially those made from synthetic fabrics.
• Apply sunscreen and wear UV-protective clothing and accessories while going out.
• Using a sunscreen with an SPF of at least 30 helps prevent sunburn, dryness, and allergic reactions, thereby reducing the risk of itching.
• Use laundry liquids or powders that are not harsh for sensitive skin when washing clothes.
• Use a humidifier to manage moisture indoors to prevent dry skin.
• Reduce stress, as it can initiate itching and make it worse.

The treatment for itching focuses on managing the cause of itching along with symptomatic relief.

1. First line of treatment

• Apply a cold, wet cloth or ice pack to the skin that itches, preferably for 10 minutes until itching subsides.
• Creams containing moisturizing ingredients such as ceramides, glycerin, aloe, hyaluronic acid, vitamin E, petrolatum, and humectants can be used.
• Apply cooling agents, such as menthol or calamine. These can be placed in the refrigerator to achieve a better cooling effect.
• OTC creams with anti-itch ingredients such as crotamiton can also provide relief.
• Mild strength steroid creams are available over-the-counter and should be used only for a few days for small, inflamed areas (e.g., topical hydrocortisone).

In case itching does not subside after the first line of treatment, the following specific treatment is advised depending on the cause of itching:

2. Topical treatment

• Antifungal creams or dusting powders are recommended for treatment of itching associated with fungal infections. Some common examples of antifungal medicines include:
• Clotrimazole
• Econazole
• Miconazole
• Fluconazole
• Ketoconazole
• Topical steroids: Higher-strength steroid creams are prescription-only and are to be used only under medical supervision.
• Local anesthetics: These are used for the symptomatic treatment of localized forms of neuropathic itching and chronic kidney disease (CKD)-associated itching. Common examples include:
• Benzocaine
• Lidocaine
• Polidocanol
• Pramoxine
• Topical calcineurin inhibitors: These work by reducing inflammation and suppressing the immune response in the skin, providing relief for conditions like eczema. Examples include:
• Tacrolimus
• Pimecrolimus
• Tricyclic antidepressants: These work by blocking certain nerve signals and provide relief for chronic and neuropathic itching. Doxepin 5% cream is commonly used.
• Capsaicin: It is used for localized areas of chronic itching and neuropathic itching. This cream should be applied regularly to achieve its full effect.

3. Systemic treatment

• Antihistamines: These are medicines often used to relieve symptoms of allergies. The most commonly used drugs include:
• Chlorphenamine
• Cinnarizine
• Diphenhydramine
• Hydroxyzine
• Acrivastine
• Cetirizine
• Fexofenadine
• Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications are given to decrease inflammation and discomfort. The commonly used drugs include:
• Paracetamol
• Ibuprofen
• Antidepressants: Antidepressants, also called selective serotonin reuptake inhibitors (SSRIs), may help ease some types of long-term itch. A few examples are:
• Fluoxetine
• Sertraline
• Anticonvulsants: These drugs aid in treating neuropathic itch and chronic kidney disease-associated itching. Examples include:
• Gabapentin
• Pregabalin
• Immunosuppressants: These classes of drugs control or suppress the immune system and help in stopping the itch-scratch cycle that allows the skin to heal and reduce the risk of skin infection. Examples of this class include:
• Cyclosporine A
• Thalidomide

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General tips that help relieve itching and prevent damage caused by scratching are:

• Keep your nails clean, short, and smooth.
• Try tapping or patting the itchy area, rather than scratching it.
• Hold a cold compress over the affected area to cool it down.
• Wear cotton gloves at night to prevent damage from scratching during sleep.
• Avoid alcohol, caffeine, and spicy foods that can affect blood flow to the skin and worsen itching.

Some home remedies that can help relieve the symptoms include:

1. Oatmeal bath: Oats work wonders for dry, itchy skin and can be used on various skin irritations like eczema and rashes as they help restore moisture levels of the skin.
   How to use it? Grind rolled oats into a thin powder, mix the powder in bath water, soak the body in it for 15 to 20 minutes, and rinse.
2. Aloe vera (Ghritkumari): Fresh aloe vera gel is useful in treating rashes or itching due to its anti-inflammatory, antimicrobial, antiviral, and antioxidant properties.
   How to use it? Take a fresh aloe leaf, cut it open, scrape out the gel, and apply it gently to the affected skin.
3. Coconut oil (Nariyal Tel): Coconut oil has the natural ability to penetrate the skin quickly. The oil is good for boosting hydration, improving skin elasticity, fighting itch, and reducing the chances of infection from skin conditions.
4. Peppermint oil: It can reduce itching due to its antimicrobial and antiseptic properties.
   How to use it? Mix peppermint oil with a carrier oil like coconut oil and apply it to the affected areas.
5. Apple cider vinegar (ACV): ACV contains antiseptic properties that can help soothe itchy skin, especially for individuals suffering from psoriasis.
   How to use it? Dabbing diluted ACV on the affected area can help neutralize the itch while balancing the pH levels of the skin, thus speeding up the healing process.
6. Honey (shahad): Honey is loaded with humectants and has antimicrobial and anti-inflammatory properties that can provide relief from dry skin and itching.
   How to use it? Apply by dipping a cotton ball in honey on the itchy area and leave it for 10 to 15 minutes. Rinse with warm water.
7. Neem: Neem is one of the most essential herbs used to treat many skin ailments due to its rich anti-inflammatory and antimicrobial properties that help soothe itchy skin.
   How to use it? Make a paste of neem leaves with water by grinding them. Apply the paste on irritated skin and wash it off once dried.

Chronic pruritus or itching that lasts more than 6 weeks can affect the quality of life and cause the following complications:

• Thickening and hardening of the skin
• Redness of the skin
• Continuous urge to scratch or pick at the skin
• Deep cuts or tears in the skin
• Scarring
• Infections
• Disturbed sleep
• Anxiety and depression

There are several different alternative therapies that can provide relief from itching. However, it is important to consult your doctor before trying anything new. Some of the commonly used therapies for itching include:

• Light therapy (phototherapy): This therapy involves exposing the skin to a specific type of light. This can be a good option for people who cannot take oral medicines. An individual requires a few phototherapy sessions until the itching is under control.
• Homeopathy: Studies have shown that homeopathy can be quite effective in managing skin rashes and itching.
• Chinese traditional therapy: Traditional Chinese medicine can be beneficial in managing itching. It uses oral herbal medicine, herbal fumigation, and external washing as some of the ways to address it.
• Acupuncture: In this therapy, very thin steel needles are inserted into the skin to relieve some health conditions and symptoms. This procedure can reduce the intensity of itching by inhibiting brain activation.
• Behavioral Therapy: This therapy is also effective in the management of itching from atopic dermatitis. In behavioral therapy, participants learn to intentionally suppress the reflex to scratch through diversion and habit reversal.