When to worry about itching

Often it’s just an annoying symptom. But in some cases it is better to seek medical attention.

He wakes up one morning, suddenly. He is scratching his arm, almost without noticing. “A mosquito will have bitten me tonight,” Laura immediately thinks. After a few minutes, after the drowsiness, he realizes that we are in winter. And of mosquitoes there is not even a shade. So why the itching?

Whether it is localized and short-lived like that caused by the bite of a mosquito or more persistent, widespread and of less clear origin, itching is one of the most difficult annoyances to bear.

An annoyance, however, that is often dramatically exasperated by the only means that you have at hand to counteract it: repeated rubbing.

Often it’s just an annoying symptom. But in some cases it is better to contact a doctor: if, in fact, it is probably the most common dermatological condition, it is also true that it can also be the alarm bell of pathologies that do not concern the skin and that it is good to investigate. It is necessary to consult the doctor even if it is persistent and localized at the ocular level, as the itchy eyes could be the symptom of allergic conjunctivitis or infections such as blepharitis.

It is not always a limited problem

Itching originates from certain neurons located below the surface of the skin that have specific receptors.

In most cases itching is an annoying sensation, but mild or harmless and confined to the skin. It is characterized by tingling or tingling and causes scratching (in some cases to the point of causing scratching lesions). It can be alleviated by resorting to a moisturizing and soothing cream or to more specific topical remedies, depending on the triggering cause (for example, an antihistamine or corticosteroid-based ointment in case of insect bites or after contact with stinging plants or other irritants).

Generally, in these situations the origin of the itching is known (or easily identifiable), the symptom localized in a circumscribed area and its duration limited in time.
When these conditions are not respected and an itching, apparently unjustified, more or less intense, manifests itself in a widespread and persistent way (in this case we speak of chronic itching), it is necessary to contact the family doctor and, possibly, the dermatologist to deepen the situation and verify that at the origin of the skin symptom there are not, in reality, systemic diseases of different nature.

Diffuse itching: dermatological causes

itch when I sweat: what can I do? How can I relieve stress itching? What are the causes of winter itching? Is there a link between washing machine detergents and atopic dermatitis? These are just some of the questions that are asked to the family doctor or dermatologist by subjects who suffer, episodically or chronically, from itching.

Itching is in fact a very frequent skin sensation, which everyone experiences on several occasions in the course of life for the most diverse reasons.

In most cases, it is a phenomenon of mild or moderate intensity, linked to completely harmless and transient causes. Other times, however, the irresistible urge to scratch can be the indicator of more serious diseases, to be diagnosed and treated specifically.
At the skin level behind the itching there can be several causes, including, for example, the use of aggressive cleansing products in subjects with particularly sensitive skin. In addition, very often itching occurs in case of dermatosis or dermatitis, inflammation of the skin also characterized by alterations of its surface, such as redness and swelling. They can have different causes and often cause itching only in circumscribed points, but there are cases in which the symptom is widespread to a large part of the body surface. We can mention irritative contact dermatitis or allergic contact dermatitis, which cause similar symptoms (such as itchy hands), but have different mechanisms at the base. In the first case it is an inflammatory reaction, while in the second the contact with a certain substance causes an abnormal immune reaction. Allergy is triggered mainly by metals, but also by some drugs and additives in medicines, vegetables, detergents, detergents. Symptoms (redness, swelling, small blisters, peeling of the skin and itching) initially begin at the sites of exposure to the substance in question, but then may spread to other parts of the body. Other possible causes of itching are represented by the intake of foods that promote the release of histamine or that are rich in it (for example, wine, beer, fish, hazelnuts, strawberries, dyes added to processed foods, etc.). In addition, stress and anxiety can be, if not primary sources, at least serious aggravating circumscribed or widespread itching.

Particularly itchy is atopic dermatitis, or atopic eczema, an inflammatory skin disease that is not contagious but chronic, which mainly affects children and can be associated with allergic diseases. It is characterized by the alternation of acute phases (exacerbations or exacerbations), in which eczema occurs in more or less extensive areas of the skin (which appears red and exuding) to phases of remission in which the skin is thickened, rough and dry.

In the newborn it mainly affects the cheeks, forehead and chin, while in the child the folds of arms and legs (in particular at the level of elbows and knees), feet, hands, neck and trunk. Another inflammatory skin disease is seborrheic dermatitis, characterized by yellowish and greasy scales, which appear, however, especially on localized areas, such as the face and especially the scalp.

But there is also lichen simplex, a chronic inflammation caused by atopic dermatitis or other factors such as anxiety and emotional stress, due to the continuous rubbing and / or scratching with which you try to relieve itching. The inflammation caused by scratching in turn generates more itching, triggering a vicious circle that is generally not interrupted by the disappearance of the triggering cause leading, at the same time, to other disorders such as dryness of the skin, flaking or the appearance of dark patches.

It is also necessary to mention psoriasis, a chronic inflammatory disease that affects the skin and that can affect localized areas that are not too large, such as elbows, knees, scalp, sometimes even nails, but which can also involve the whole body. The most common form, known as plaque psoriasis, is characterized by reddish, roundish patches, clearly delimited at the edges and covered with overlapping silvery-white scales: these patches can be itchy, more or less intensely depending on the individual reaction.

Finally, it is impossible not to mention urticaria, a rash so called because the manifestations on the skin are similar to those that appear when you come into contact with the nettle plant: raised skin lesions, the bumps, associated with intense itching. It can be acute and generally represent the consequence of an allergic reaction due to the intake of certain foods or drugs, but it can also follow insect bitescontact irritation, excessive sun exposure (in this case we speak of solar erythema), low temperatures (the so-called cold erythema) or particular situations of stress (physical or mental). There is also a chronic form that is not a symptom of allergic reaction but is generally a disease (called chronic spontaneous urticaria) of autoimmune origin.

Widespread itching: can also be due to infections and parasites

To determine the appearance of itching can also be some infectionsmycoses caused by fungi such as Candida albicans or some infestations by parasites.

Among the first, we can remember the infection caused by Herpes virus type 3 (or varicella-zoster). When the virus first encounters the human body, it triggers chickenpox, counted among the main contagious diseases of childhood. After an incubation of about 2-3 weeks, the disease usually begins with fever, general malaise, headache, fatigue and a rash characterized by small spots, or rather papules, pink itchy all over the body, which evolve into vesicles and then, in 4-5 days, dry out and leave small crusts. The outburst is formed in successive waves and lasts even for 10 days.

The chickenpox-zoster can then reactivate, even after many years from the first meeting with the body, triggering a different pathology, called Herpes zoster or shingles: when the virus is reactivated, it spreads along some nerve fibers up to a circumscribed skin area, at the level of which burning, pain, itching with pain and pangs are accused, quickly associated with the appearance of itchy bubbles full of liquid that, usually within a few days, dry out and leave crusts destined to fall.

Among the skin diseases caused by parasites, however, we can remember the infestation of lice, small wingless insects that can infest head, pubic hair and bedding and scabies, caused by a tiny spider-like mite. The insect in question is the Sarcoptes scabiei, which manages to invade the most superficial layers of the epidermis, forming galleries that can appear as a sinuous relief of a couple of millimeters, present in particular at the level of the interdigital spaces of the hands and wrists. Itching is the symptom par excellence and, if initially it affects only the affected area (especially the spaces between the fingers, elbows, armpits, genitals, nipples, submammary folds and under the buttocks), then it becomes generalized and affects the whole body, excluding the face. The mite becomes particularly active when temperatures exceed 20-25 degrees: this causes the rising temperatures – and therefore especially at night – the itching becomes more intense due to the heat of sheets and blankets.

Finally, there are fungal infections, caused by microscopic organisms called fungi (or fungi). The best known and widespread is undoubtedly tinea (or ringworm), an infection caused by dermatophytes of various species, which proliferate causing characteristic ring-shaped lesions and itching. The skin manifestations of ringworm can affect various parts of the body, such as the face and beard (tinea faciei), the trunk (tinea corporis) and nails (tinea ungueum), while their treatment may include, depending on the case, the use of creams or the intake of oral medications.

Diffuse itching: the main non-cutaneous causes

If itching is spread throughout the body and is not connected to external manifestations, it can be the indicator of a problem of endogenous origin.

For example, in addition to being caused by excessive levels of uric acid in the blood, itching is also one of the main symptoms of cholestasis, a condition of reduction or stop of the flow of bile which, in turn, can be due to problems with the liver, pancreas or bile ducts. Itching is probably felt because bile products accumulate in the skin. This symptom is usually associated with jaundice (yellowish discoloration of the skin, mucous membranes and sclerae, linked to the increase of bilirubin in the blood).

Diffuse pruritus can also be associated with renal failure, as a direct consequence of the accumulation in the blood of toxic substances normally eliminated by the kidney through the urine.

Among the other conditions that can cause more or less widespread itching we remember:

In addition, itching (especially after bathing or showering) is one of the symptoms of polycythemia vera, a neoplasm of genetic origin that causes excessive production of blood cells (red blood cells, white blood cells and platelets). Its onset is accompanied by symptoms such as weakness, night sweats and redness and burning in hands and feet, while the diagnosis is made by simple blood tests (blood count)

Finally, in the event that the itching affects the area, it could be caused by an intestinal disorder, such as constipation.

  • iron deficiency anemia (due to iron deficiency);
  • diabetes mellitus (which is often associated with obesity);
  • hyperthyroidism and hypothyroidism (i.e. excessive or reduced thyroid work, respectively);
  • certain forms of cancer (e.g. some lymphomas);
  • certain neurological diseases, affecting the central or peripheral nervous system, or neurodegenerative diseases, such as multiple sclerosis;
  • states of stress or anxiety or psychic disorders (in this case we speak of psychogenic itching);
  • liver diseases, such as liver disease with biliary stasis, cirrhosis of the liver, neoplasms, chronic hepatitis (although in a few cases) etc.;
  • kidney diseases, such as chronic renal failure, hemodialysis, etc.

Intimate itching: the main non-cutaneous causes

Although dermatological diseases such as dermatitis and psoriasis can also involve the genital area, these are often not the causes of intimate itching, which can be associated with hormonal changes (for example those typical of menopause) or infections, such as that of Candida albicans.

In other cases, the discomfort may be caused by an itchy sensation in the or perianal area. It is not always a disorder of skin origin, as for example in cases where itching is caused by hemorrhoids or, especially in children, an infestation by pinworms (parasitosis caused by a species of helminths or worms).

Intimate itching: remedies and cures

Depending on the cause of intimate itching, the remedies are different. If intimate itching appears after intercourse, it may be an allergy to latex contained in contraceptives: in this case it is necessary to use products that are free of it. If, on the other hand, burning and intimate itching occur at the same time, the cause may be candidiasis, which must be treated with antifungal drugs. Finally, stress can also trigger intimate itching, which makes the body more susceptible to infections, even vaginal.

Itching in pregnancy

Many women suffer from intimate itching during pregnancy. The causes can be different: for example, intimate itching during pregnancy can be a consequence of the greater sensitivity of skin and mucous membranes typical of sweet expectation. In other cases, it is caused by vaginal infections, such as candidiasis or vaginal herpes, which must be treated appropriately and quickly as they can be harmful to the health of the fetus.

The first steps to trace the cause

Faced with widespread itching, it may be appropriate to contact the general practitioner for an initial visit that can help in understanding the symptom and / or refer to other specialists. For this purpose, the doctor will make a careful physical examination and will collect, through the anamnesis, valuable information on the clinical history and lifestyle.

To facilitate the diagnosis it is important to know how to indicate to the doctor when it has appeared and how long the itching has been present, if it is constant or if it arises or worsens at certain times of the day (after meals, at night, when you are in hot or cold environments, in contact with water, etc.).

It is also useful to indicate if it appears during specific professional, domestic or recreational activities, perhaps recently undertaken, and if it can be linked to the use of clothing in particular materials or colors (raw wool, synthetic fibers, blue or black fabrics, etc.) or objects containing potentially allergenic substances (for example, latex, nickel, chromium or mercury).

In addition, all the drugs you are taking, including those purchased without a prescription (such as mild sleeping pillslaxatives, anti-inflammatories, etc.), food supplements, herbal products and herbal preparations (essential oils, herbal teas, creams, etc.), as well as any unusual foods recently introduced into the diet (tofu, seitan, seaweed, miso, etc.) should be accurately reported.

Personal and household hygiene products and cosmetics, including hair dyes, should also be included in the list of suspects.

Important checks

If, after this first analysis and any skin allergy tests deemed appropriate, the cause of the pruritus still remains elusive, it will be necessary to proceed with further general and specific investigations in search of possible systemic pathologies not yet diagnosed.

It should be emphasized that in most cases a widespread itching apparently unmotivated is linked to the “trivial” destabilization of the hydrolipid barrier that naturally protects the epidermis and the dehydration that follows. We speak of xerosis, excessive dryness of the skin (a particularly frequent condition for example in the elderly). In other cases, however, the itching persists and is localized. Let’s see what to do to alleviate the discomfort in the two different cases.

What to do?
Seemingly unmotivated diffuse itching It is sufficient to ensure the skin a gentle cleansing and regular application of good quality creams to ensure adequate hydration
Persistent and localized itching It is useful to use creams based on emollient substances, lamellar lipids (naturally present in the skin), which are able to replenish the skin barrier giving relief from itching. The presence of provitamin B5 can promote the elasticity and regeneration process of the skin, making the skin more resistant

In general, you can also benefit from local treatment with sprinkler powders, mentholated talc or antipruritic drugs, often based on antihistamines. There are also cortisone-based drugs for local use, available in the form of creams, ointments or sticks, but generally they are to be used only in cases of itching on small skin areas, while in case of widespread symptom it is good to avoid them, if not under strict medical supervision, because they could have more side effects than benefits. In fact, once the cause of the itching has been identified, the doctor will indicate the most appropriate therapy or prevention strategies: generally by treating or controlling the pathology upstream it will also be possible to resolve the itchy symptom.

Itching: effective remedies

Itching can be treated differently depending on the cause, location and intensity with which it occurs. For example, if you experience dry skin and itching, natural remedies such as a simple fresh compress can relieve the discomfort, but it is good to consult your doctor because they could be symptoms of contact or atopic dermatitis. As for pharmacological remedies, a cortisone cream may be prescribed for particularly intense and lasting itching, especially if of irritative or allergic origin, a capsaicin cream in case of localized itching of neurological origin and / or creams that contain menthol and / or camphor to mitigate the discomfort.

Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.

The blog covers a wide range of topics related to health and wellness, with articles organized into several categories.

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