itching

Hanna Rutkowski is a freelance writer for the medical team.

More about the experts All content is checked by medical journalists.

Itching (med .: pruritus) is a discomfort in the skin that prevents you from sitting still. The hands wander to the itchy area and begin to scratch - although there is short-term relief, the itching soon starts again. Allergies, insect bites or skin diseases can cause itching. But leukemia and liver disease can also be associated with pruritus. The cause of chronic itching is often not easy to find. Find out here where the itching can come from and what can be done about it.

Brief overview

• Description: disturbing to tormenting sensory perception that induces the person concerned to scratch
• Cause: e.g. allergies, psoriasis, eczema, parasites, kidney and liver diseases, diseases of the blood and lymphatic system, metabolic disorders
• When to the doctor in the case of recurring or long-lasting itching for no apparent reason as well as accompanying symptoms such as fever, fatigue, skin rash
• What to do? Self-help z. B. through skin care, cotton gloves against scratching attacks during sleep, airy clothing, cool compresses with yoghurt, relaxation techniques. The doctor will treat itching depending on the underlying condition, such as: B. with certain drugs or (protracted) therapy

Itching: causes and possible diseases

Itching (pruritus) makes you want to scratch the area. The skin that itches may look normal or it may be changed by a (skin) disease. If the itching does not subside after six weeks, it is called chronic pruritus.

Possible causes of itching are:

Skin reactions and skin diseases

Skin reactions (e.g. to rapid changes in temperature) and skin diseases are the main causes of itching. For example, pruritus can have the following triggers:

• Allergies: Contact with the allergenic substance leads to the release of histamine - itchy pustules and swellings are the result.
• Neurodermatitis (atopic eczema): Scaly, itchy skin forms on typical skin areas such as the crooks of the arms or the hollows of the knees.
• Psoriasis: In psoriasis, flaky, itchy areas of skin develop, especially on the hairline, elbows and knees.
• Eczema and hives (urticaria): They typically manifest as pustules, crusts, and pruritus.
• Fungal infection: An infection with the skin fungus Candida causes itchy reddening of the skin, which can smell unpleasant, especially in the skin folds.
• Xeroderma: A reduced sebum production leaves the skin dry and rough. This very often causes itching.
• Parasites: The scabies (itch mite) in particular robs many people of sleep due to itching at night.
• Environmental factors: Toxins released by an insect bite, plants, chemicals or parasites often cause pain as well as severe itching.
• Autoimmune diseases of the skin: Examples are bullous pemphigoid (formation of blisters on the skin, especially in older people), pemphigus vulgaris (large, rapidly bursting blisters, usually beginning on the mucous membranes), lichen planus (lichen planus, reddish papules appear on the skin , white stripes on the mucous membranes) and photodermatosis (sun allergy, light allergy: redness and itchy blisters on the skin). This autoimmune disease manifests itself through various symptoms, but what they all have in common is itchy skin.
• Itching of old age (pruritus senilis) and winter itching (pruritus hiemalis): Particularly in old age, dry skin develops on the upper arms and lower legs, which must be adequately cared for because otherwise it begins to itch. Rapid temperature changes between cold and warm in winter also cause itching.
• Aquagenic pruritus: Contact with water or temperature fluctuations in the air can cause stinging itching.
• Dry skin: Scaly skin when peeling off the summer tan, lack of moisture, showering or drying care products cause itchy skin.

Diseases of internal organs and organ systems

Many other diseases can also be accompanied by itching:

• Kidney disease: The majority of patients with severe kidney failure who receive blood wash (dialysis) suffer from severe, generalized itching shortly after treatment. The exact causes are still unclear.
• Liver diseases: Disturbances in the outflow of bile (cholestasis) and liver damage such as cirrhosis of the liver cause an increase in the bile pigment bilirubin. This not only leads to the typical yellow coloration (jaundice) of the skin and mucous membrane, but also to severe itching.
• Thyroid diseases: Overheated, itchy skin is common in the presence of an overactive thyroid (hyperthyroidism). With hypothyroidism, pruritus is rather rare.
• Diabetes mellitus: Nerve damage (neuropathies) and the increased susceptibility to fungal infections of the skin can cause itchy skin in people with diabetes.
• Hodgkin's disease: Itching all over the body or only in the area of ​​the lymph nodes can precede the malignant tumor of the lymphatic system for years. The pruritus is used here as a sign - the patients should be examined several times a year.
• HIV infection: the immune system weakens the development of skin diseases caused by fungi or parasites, which are inconspicuous but can be accompanied by severe itching. But pruritus can also occur in the course of antiviral therapy.
• Other infectious diseases: Chickenpox and measles are also often accompanied by itching.
• Polycythemia vera: The thickening of the blood due to excessive formation of blood cells appears for the first time as aquagenic pruritus (itching after contact with water).
• Iron Deficiency Anemia: Cracked corners of the mouth, brittle hair, brittle nails, and dry, itchy skin are early signs of this form of anemia.
• Anorexia nervosa, gluten intolerance or malnutrition can also be accompanied by itching.
• Neurological diseases: damage to the central nervous system such as multiple sclerosis (inflammatory disease of the central nervous system with symptoms of paralysis and a feeling of stiffness), polyneuropathies (damage to the peripheral nerves, e.g. in the arms or legs) or viral diseases such as herpes zoster (shingles ) can trigger the itchy discomfort.
• Mental health: In some patients, depression, obsessive-compulsive disorders such as compulsive washing or hallucinations are responsible for severe itching.

Medication

There are a number of drugs that can cause pruritus:

• Antibiotics
• opiate
• Anti-inflammatory drugs
• Antimalarials
• Psychotropic drugs (used to treat mental illness)
• Hormones
• Diuretics
• Cytostatics (substances that inhibit cell growth and / or division)
• High blood pressure remedies
• Gold (gold compounds are or were used, for example, in rheumatism therapy)
• Anticoagulants
• Retinoids (derivatives of vitamin A used to treat psoriasis and acne)

Other causes of itching

• Hormone fluctuations: Generalized itching can occur during pregnancy, during the cycle or after the menopause (climacteric).
• Cancer therapies: Many cancer patients experience itchy skin as a result of therapy such as radiation or various drugs.

The direct link between a tumor and pruritus is unlikely, even if itchy skin in the anal region is described in colon, prostate or cervical cancer.

Itching: what to do

When itching, those affected often experience high levels of suffering. The itching is uncomfortable, maybe even excruciating, and should stop as quickly as possible. In some cases of itching, those affected can help themselves, in others a visit to the doctor is necessary.

You can do that yourself

Regardless of the cause of the itching - you can often find relief and relief yourself with simple tips:

• Avoid dry skin: Avoid a dry room climate, frequent showering, bathing, going to the sauna or care products that contain alcohol. Dry skin is often itchy skin too.
• Caring for the skin: Use moisturizing creams and lotions. Showering and bathing dries out the skin in particular - subsequent care is essential here. Care products with urea also donate a lot of moisture to the skin.
• Reduce irritation factors: Very spicy food, alcohol, stress, excitement and anger often lead to itching. Try to limit these factors in your life.
• Bathing in a skin-friendly way: A bath in lukewarm water for a maximum of 20 minutes should replace a quick shower. However, you should avoid drying shower gels. In the case of skin diseases or severe scratches, the skin should not be scrubbed with a towel when washing or drying, but should be dabbed carefully. Then you should re-oil the skin with lotions.
• Wear cotton gloves: Cotton gloves protect the skin from scratching attacks while you sleep. They are particularly suitable for children.
• Choose airy clothing: Wear loose clothing that does not rub against the body or irritate the skin, such as cotton.
• Provide quick relief: If you suddenly experience severe itching, cool, moist compresses with yoghurt or a little vinegar will help. Black tea envelopes also work well. With all moist wraps, however, you should reapply the skin afterwards. Lotions with urea or menthol cool and moisturize the itchy skin.
• Prevent allergies: The only thing that helps here is to avoid contact with the substance that is causing the itching.
• Use relaxation techniques: Some methods such as autogenic training, progressive muscle relaxation or yoga not only help to reduce stress, but are also intended to distract from scratching, especially in the case of chronic pruritus.

Itching: what does the doctor do?

Sometimes patients need to see multiple doctors until the cause of the itching is found. The first point of contact is the dermatologist, who recognizes changes in the skin and skin diseases. Doctors from other disciplines (internists, psychiatrists, etc.) are in demand when the cause of the itchy skin is not "clearly on the skin" but rather is hidden in the body.

In a detailed consultation with the patient (anamnesis), you should describe to the doctor when the pruritus occurred exactly, where the itching is particularly severe, whether something will help or whether the itchy skin wakes you up at night. It is also important whether the itchy skin is triggered by contact with water or mechanical stimuli. Existing allergies, the infestation of family members with parasites, recently visited vacation spots and the use of medication can provide the doctor with the first important clues as to the cause of the itching. You should also mention any other ailments, even if they seem insignificant, such as dizziness or weakness.

During the physical exam, the skin is examined carefully. The genital region, hair, nails and the mucous membranes in the mouth are also examined. It is not uncommon for germs to be hidden in skin folds that are easy to overlook. Chronic itching can often be recognized by nails rubbed smoothly or by eyebrow hair loss.

The physical exam also includes palpation of the liver, spleen, lymph nodes, and kidneys to identify organic diseases.

If the itchy skin appears for no apparent reason, further investigations will follow. Blood tests can reveal changes in the liver, gall bladder, kidneys, inflammation or worrying changes. Further tests can be used to check the blood for autoimmune diseases.

Often smears of the skin and mucous membranes or small tissue samples are taken, which are then examined under the microscope for parasites, fungi or bacteria.

If there is a suspicion of a disease of internal organs such as liver, kidney or tumor disease, imaging examinations such as X-rays, ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) can be informative.

The pruritus can also be a sign of Hodgkin's lymphoma before the disease itself appears. Since the blood values ​​and other examinations are normal here, the search for the cause of the pruritus should be repeated at least once a year.

Itching: Medical treatment

Patients with itchiness sometimes need to undergo a series of tests until the cause is found. The subsequent treatment always depends on the underlying disease and can therefore be very different. Relief is often provided by simple measures, such as avoiding allergenic substances or certain medications. In other cases, protracted therapies are necessary, for example in the case of liver, kidney and cancer diseases.

Itching: description

In order to be able to at least roughly assess where the itching could be coming from and whether a visit to the doctor is necessary (if it lasts longer than six weeks, it is in any case!), It helps to understand the phenomenon of "itching".

Itching is a disturbing, sometimes tormenting sensory perception that is accompanied by an insatiable urge to scratch. If the hands cannot reach the itchy area, objects are also used - there is a good reason why there are scratching aids for the back.

However, the pruritus is not just annoying and uncomfortable. It also has a use: the mechanical friction is intended to remove intruders such as parasites, fleas or lice.However, prolonged scratching damages the skin and causes injuries and tears. It is especially difficult for children to control itchy diseases such as chickenpox. The scratched skin can leave disfiguring scars.

Development of itching

For a long time it was assumed that itching is triggered by the same nerve endings as the pain stimulus. However, recent findings indicate that it is a separate subgroup of nerve fibers that are excited by certain messenger substances, above all histamine and serotonin. This thesis is supported, for example, by the fact that opiates inhibit pain, but trigger itching.

The itching can also be caused by toxins, mechanical stimuli, temperature fluctuations, or even slight electrical surges that lead to the release of histamine from the cells. The itching can appear on certain parts of the body (localized) or all over the body (generalized).

When scratching, pain stimuli arise that briefly mask the itchiness and provide relief. However, the mechanical stimulation of the skin releases messenger substances, which in turn promote itching - a vicious circle arises. The itchy skin can also be perceived as burning or slightly painful.

Severe, chronic itching all over the body often becomes a stress test for the afflicted person: there is a lack of sleep, exhaustion, scratches on the skin (such as bleeding or weeping wounds) and the permanent feeling of being relieved by scratching. For some, this leads to psychological problems that can even result in suicide.

Classification of itching

The itching can also be divided according to the texture of the skin:

• Pruritus cum materia: The itching is based on an already clearly visible skin disease.
• Pruritus sine materia: The skin still appears visibly healthy and without changes.
• Pruritus with chronic scratch marks: Here the skin is scratched so far that it is no longer apparent whether a skin disease is the cause.

Itching: when do you need to see a doctor?

Itchy skin after an insect bite or an allergic reaction is very uncomfortable, but usually goes away on its own within a short time. These one-off events are not a reason to seek medical attention. If, however, prolonged itching occurs again and again, which occurs for no apparent reason, a specialist should examine the pruritus carefully.

In older people in particular, itching often occurs as a result of systemic diseases, sometimes accompanied by dizziness, insomnia and a feeling of weakness. With very long-lasting itching, those affected can increasingly withdraw from their fellow human beings - social isolation threatens. Psychological help is absolutely advisable here.

In general, you should see a doctor if:

• the pruritus occurs for an unusually long time and for no apparent reason (all over the body)
• Additional complaints such as fatigue, tiredness or fever are added
• the skin shows changes in addition to the itching

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