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Itching – what to do? Symptoms and Treatment

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Itching, term pruritus, is one of the most common symptoms that occur on the skin (sometimes mucous).The desire for scratching, rubbing and rubbing is sometimes almost insatiable and tormenting. The causes behind the unpleasant itching are manifold: 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.

The big Diabetes Lie

Description: What is itching?

The itching is a disturbing, sometimes even tormenting sensory perception, which is accompanied by an insatiable urge of scratching. If the hands can not reach the itchy area, objects are also used to help – not for nothing there are scratching aids for the back.

However, the pruritus is not completely useless: The mechanical friction should remove invaders such as parasites, fleas or lice. However, prolonged scratching damages the skin and causes injuries and tears. Particularly children here mastering the itching diseases difficult, such as chickenpox . Scarring skin can leave disfiguring scars.

Experts know well over a hundred causes of discomfort. Frequently, itching for skin is the advice of various specialists. This is especially true if itching does not disappear after six weeks of treatment. Then there is a chronic pruritus.

There are two main forms:

  • The itching occurs on altered areas of the skin, it is therefore itching in suspected skin disease: a case for the dermatologist. Skin diseases are leading causes of itching.
  • The itching occurs initially on “normal” skin. Dry, mature skin is prone to itching. With strong scratching it can come to skin damage (technical term here: Prurigo nodularis). In case of suspected illness you should first involve the family doctor. He may consult with other specialists, such as an internist, neurologist or psychiatrist to clarify the symptom. Since numerous causes come into question, diagnosis and therapy are sometimes tedious.

The itching can also be classified according to the nature of the skin:

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

Emergence of itching

For a long time, it has been suggested that itching is caused by the same nerve endings as the pain stimulus. However, recent findings suggest that it is a separate subgroup of nerve fibers, which are excited by certain messengers, especially the histamine and serotonin .

This thesis is proven, for example, by the fact that opiates inhibit pain but trigger itching. The itching can be caused by poisons, mechanical stimuli, temperature fluctuations, or even light surges that lead to the release of histamine from the cells. The itching can occur in certain parts of the body (localized) or in the whole body (generalized).

Not infrequently, a strong, chronic itching all over the body to the stress test for the afflicted: It comes to lack of sleep, exhaustion, scratch marks on the skin and the permanent feeling to get through scratching to relief. For some, this leads to psychological problems that can even end in suicide.

The skin may be scalded by scratching bloody or weeping, in the later stage then it is encrusted. It is typical that hard to reach places like the back left out from the injury. But not only scratching brings relief – with some itchy skin diseases, the skin is only pressed and cooled, so that no traces are visible.

causes and possible diseases

Mast cell-releases itch mediators such as histamine
Mast cell: releases itch mediators such as histamine
© Image Source / RYF

No question: Skin diseases and allergies play a major role in itching. A prime example is eczema (also atopic dermatitis). Atopy says that the body is prone to allergies, dermatitis is the inflammation of the skin. Itching rashes occur in many inflammatory skin diseases. If there is no infection , they are also called eczema .

In rare cases, itching can be a symptom of an internal disease – for example, it can be caused by diabetes, a liver or kidney disorder, and leukemia. In such diseases, the itching occurs without skin changes.

However, this is also the case with so-called idiopathic itching which has no apparent cause. Often then put mental problems behind the complaints.

1. Itching in allergy, pseudoallergy, animal poison contact

Although the skin is a protective barrier to the outside, but also irritable and vulnerable. Obviously, those causing itching often come from the environment. Many of the substances that we encounter are well tolerated, others challenge our tolerance.

In case of conflict, the body mobilizes highly active messengers, including the already mentioned histamine. The tissue hormone is one of the strongest mediators of itching in the body. To a considerable extent, histamine occurs in the skin, mucous membranes and nerve cells. It stores mainly in so-called mast cells .

An allergy arises when an actually harmless substance sensitizes the immune system and causes it to form special antibodies. The trigger becomes the allergen, the antibody to the antibody. At the next contact, they both connect with each other and often with mast cells. Then they release their highly active substances, especially histamine.

Certain components in food or drugs , with appropriate disposition of a person directly – without sensitization and antibody formation – cause the mast cells suddenly open their locks. Then there is a pseudoallergic reaction. Their strength usually increases with the amount of trigger.

Sometimes histamine breakdown in the body is disturbed because the responsible enzyme is missing or blocked. If, for example, too much histamine enters the body via a food, acute reactions are also possible. There are also other types of pseudoallergic reactions.

Allergy- like reactions can occur on contact with nettle poisons , such as from the stinging hair of the oak processionary moth or tentacles of certain jellyfish (animal poisoning reaction ).

General symptoms: Whether an allergy or pseudoallergy is present, can not be derived from the symptoms alone. The skin begins acutely to itch, it can form a rash (technical term: rash ). 

In case of swelling in the respiratory tract with shortness of breath or circulatory insufficiency, there is a direct danger to life: no matter what is the trigger or could be: Alert the emergency doctor immediately .

For a more detailed diagnosis and treatment of suspected allergy and pseudoallergy, a specialist allergic examination is essential. This also applies to the extent to which preventive measures are promising. Examples of allergies, pseudo allergies and animal poison reactions with itching in the connection.

Underestimated red wine side effect
Underestimated red wine “side effect”: pseudoallergic reactions

Foods as a trigger of itching:

Most of them are natural ingredients or additives such as colorings or preservatives in certain foods, which can trigger a pseudoallergic incompatibility reaction. Known candidates are mature cheese, fish, sauerkraut, red wine (containing, among other things, histamine), yeast, bananas, tomatoes, chocolate, tea, coffee. Also in question are spicy spices or flavor enhancers such as glutamate. One of the most common food allergies is cow’s milk protein allergy to infants.

Symptoms: Symptoms may be on the skin (itchy rash, similar to atopic dermatitis, see below), in the digestive tract ( vomiting , abdominal pain) or in the respiratory tract (shortness of breath)) occur. They range from mild to severe, rarely up to a shock reaction.

The good news with cow’s milk protein allergy: Most children gradually tolerate milk and are often virtually symptom-free at the time of enrollment. The Allergiebigung itself (Atopie) remains however .

Allergic-Risk-Milk- Apple-Hazelnut
Allergic Risk: Milk, Apple, Hazelnut, Kiwi & Co. © W & B / Winfried Fischer

Chicken eggs, fish, shellfish, soy, hazelnut and peanut are also on the “allergy index”. Atopic diseases such as hay fever (pollen allergy), allergic asthma and eczema increase the risk of additionally allergic to a food. Examples: Allergy to birch pollen and apple or hazelnut. Symptoms: It can develop a furry feeling on the lips and in the mouth and throat.This often leads to diarrhea , nausea and abdominal pain . Pronounced reactions can cause itchy skin wheals. Shortness of breath and circulatory problems are emergencies (see above).

Medication: Allergic and pseudoallergic reactions possible:

Medication Allergic and pseudoallergic reactions possible
Medication: Allergic and pseudoallergic reactions possible © Creatas / RYF

Whether pseudoallergyor allergy medications can also trigger appropriate reactions. Without further investigation, the distinction is often not easy or impossible.

Experience has shown that drugs such as some antibiotics, antidepressants, hormonal preparations or anti-inflammatory agents (such as NSAIDs, ie non-steroidal anti-inflammatory drugs such as ibuprofen or diclofenac) more often responsible for allergies.

Behind a pseudoallergic drug reaction occasionally drugs such as acetylsalicylic acid (anti-inflammatory), antimalarials, ACE inhibitors (heart and blood pressure medicines), opiates (painkillers), also X-ray contrast media. Even with certain cancer treatments, for example, with some biologicals (antibody therapy), pseudoallergic reactions may develop with itching.

Symptoms: Often different rashes develop, so-called drug eruptions. This usually happens within a few days to eight weeks after the start of therapy. There may be symmetrical, sometimes map-like distributed red spots on the whole body, often interspersed by specks or nodules, with and without itching.

Also possible are raised or blistered, very itchy redness (wheals, hives).Occasionally taking a medicine only in certain places, such as the face, hands and feet , itching changes. If the drug is taken after a break, the same spots react again.

First signs of a serious drug reaction can be fever over 38.5 degrees Celsius, respiratory and swallowing, redness andSwelling of the face , possibly also swelling lymph nodes (so-called pseudolymphoma).

This is especially fearedLyell’s syndrome:Skin blisters that come off, heavy fluid loss, circulatory weakness, fever. This severe form of drug allergy is occasionally reported with the use of antiepileptic drugs, certain antibiotics, anti-inflammatory agents (NSAIDs), the analgesic metamizole or the gout agent allopurinol.

In case of severe or severe symptoms call the emergency doctor immediately !

Allergies and other intolerance reactions may also occur after application / contact ofvarious agents on / with the skin , be it medicines, disinfectants, patches, cosmetics, deodorants and others (see section “2nd itching: typical skin disease?” Below, keywords). Eczema “and” allergic contact dermatitis “).

Animal poison contact: Caterpillar hair as a trigger of itching:

The caterpillar and what causes their hair on the skin
The caterpillar and what causes their hair on the skin
© Mauritius / ib / Kreutzer, Okapia / Dr.med.JPMüller

Butterfly caterpillars of the oak processionary moth build their “nest nests” on oak trunks and branch forks. At peacock they embark on processional night walks. Broken fine caterpillar hairs fly far, last for years and can repeatedly lead to unpleasant to dangerous reactions in humans.

The microscopic particles with their barbs exert a mechanical (and toxic) stimulus on the skin with the nettle poisons they contain. The fact that a true allergy develops is rather rare.

Symptoms: Anyone who comes into contact with the “burning hairs” reacts after the contact similar to an allergy or pseudoallergy: with itching and skin symptoms (caterpillar dermatitis).The rashes with redness, wheals or reddish nodules as after insect bites can last longer.

The itching also typically lasts for a while. After inhaling the hair, also as dust, asthma-like shortness of breath is possible. In addition, the toxic effects can be manifested in general symptoms such as fever, tiredness and dizziness , very rarely as a shock.

2. Itching: typical skin disease?

Sun-allergy

  • Hypersensitive to light: “sun allergy” and other photodermatoses

Light dermatoses are caused by substances that make the skin particularly sensitive to light. Whether they only reach the skin or the body makes no difference: Under the influence of UV light, stronger skin reactions are possible.

“Sun allergy ” (polymorphic light dermatosis, PLD): The second term is actually correct. Polymorph means many forms.

The light reaction is not clearly allergic, but in their formation unclear. It is more common in children and young women with increased photosensitivity. After the first intense sunbath of the season sufferers develop an intolerance reaction of the skin.

Symptoms:The skin reaction is most pronounced on the face, neck, décolletage and limbs, with redness, nodules or larger raised plaques, blisters and itching. The individual patient himself always reacts the same, otherwise the changes from one to the other vary, just as polymorphic.

They heal without leaving scars. Over a period of several years, the clinical picture may appear again and again at the first more intense sun dose, but it may improve over time.

Photoallergic dermatitis: Here, the skin is sensitized under UV influence against a substance on the skin or in the body, which has bound to a protein. The skin then reacts allergic to the resulting allergen.

It is an allergic delayed-type reaction. Affected are “exposed” skin after contact with certain substances such as fragrances, sunscreens or disinfectants or drugs, such as estrogen preparations, antihistamines, psychotropic drugs.

Symptoms: Defocused redness (erythema) develops and also “scatters”. It form nodules, which can also produce small bubbles. The skin changes can wet, dandruff and itch. The result is sometimes a slight, light brown skin discoloration, which evaporates over time. Sometimes the complexion coarsens and reacts hypersensitive to UV light.

Actinic reticulo: A chronic allergic light reaction of the skin can rarely lead to an actinic reticuloide. Actinic means generated by radiation, reticulum stands for an accumulation of certain white blood cells ( lymphocytes) in the skin. The disease is considered a variant of chronic actinic dermatitis (see link info on polymorphic light dermatosis below). Rarely, it can turn into a malignant lymphoid cancer .

Symptoms: On exposed skin areas, especially on the face, neck and chest, eczema-like redness, dandruff, nodules, and larger pimples (plaques) develop with severe itching. The skin texture coarsely grows.

Photodermatoses of the skin with itching and various skin changes are also the light urticaria , the actinic prurigo (here is an independent skin disease meant, but not the prurigo as a result of chronic itching with scratching of the skin) and chronic actinic dermatitis .

 

There are many skin diseases, the most common are:

Eczema-arm
Eczema on the crook of the arm
© Your Photo Today / Phanie
  • Eczema (atopic dermatitis): At typical skin such as the armpits, or knees up scaly, itchy skin forms.
  • Psoriasis: In psoriasis, scaly, itchy skin areas develop especially on the hairline, elbows and knees.
  • Eczema and hives (urticaria) typically manifest in pustules, encrustations and pruritus.
  • Candidosis: The infestation with skin fungus causes itchy red skin, which can be unpleasant, especially in the skin folds.
  • Xerodermia: Reduced production of sebum leaves the skin dry and brittle – itching is particularly common here.
  • Parasites: Especially the scabies (itch mite) robs many people by nocturnal itching sleep.
  • Environmental Factors: Toxins released from insect bites, plants, chemicals or parasites often cause severe itching and pain.
  • Autoimmune diseases such as the bullous pemphigoid , pemphigus vulgaris , lichen planus or photodermatosis manifested by various symptoms, including itchy skin.
  • Age itching (pruritus senilis) and winter itching (pruritus hiemalis):Especially in old age it comes on upper arms and lower legs to dry skin , which must be sufficiently cared for. But even a quick temperature change between cold and warm in winter causes itching.
  • Aquagenic pruritus: Water contact or temperature fluctuations in the air can cause itching.
  • Dry skin : Scaly skin when peeling off the summer tan, lack of moisture, showering or drying care products cause itchy skin.

Internal diseases:

Blood analysis
Blood analysis: May contribute to the diagnosis of itching
© PhotoDisc / RYF
  • Kidney Disease: A large proportion of patients with severe kidney failure who receive blood ( dialysis ) suffer from severe, generalized itching shortly after therapy. The exact causes are still unclear.
  • Liver Diseases: Disorders of bile leakage (cholestasis) or liver damage such as cirrhosis of the liver cause an increase in the bile pigment bilirubin . This not only leads to the typical yellowing (icterus) of the skin and mucous membrane, but also to intense itching.
  • Blood and lymphatic system disorders:
  • Hodgkin’s diseaseItching all over the body or only in the area of ​​the lymph nodes can precede the malignant tumor of the lymphatic system for years to come. Pruritus is considered a precursor – patients should be examined several times a year.
  • Polycythemia vera: The thickening of the blood by excess formation of blood cells occurs for the first time as aquagenic pruritus.
  • Iron deficiency :Torn corners of the mouth , brittle hair ,brittle nails and dry, itchy skin are early signs here.
  • Tumors: Cancer causes itchy skin as a result of therapy such as radiation or various medications. The association between a tumor and pruritus is unlikely, even if itchy skin in the anal region is described in colon, prostate or cervical cancer .
  • Metabolic disorders and hormonal diseases:
  • thyroid disorders: Over-heated, itchy skin occurs in hyperthyroidism frequently (hyperthyroidism). In hypothyroidism , pruritus is rare.
  • Hormone fluctuations: Generalized itching can occur during pregnancy, during the cycle or after menopause (menopause).
  • Diabetes mellitusNerve damage (neuropathy) or increased susceptibility to fungal skin infections can cause itchy skin.
  • Anorexia (anorexia nervosa): gluten intolerance ormalnutrition may also be accompanied by itching.
  • HIV infection: The immune deficiency promotes the development of skin diseases caused by fungi or parasites, which are inconspicuous, but may be accompanied by severe itching. But even in the course of antiviral therapy, pruritus can occur.
  • Neurological disorders: Central nervous system damage such as multiple sclerosis, polyneuropathy or viral diseases such as herpes zoster can trigger itchy discomfort.
  • Psyche: Depression, obsessive-compulsive disorder such as washingcompulsion or hallucinations can be responsible for a strong itching.
  • Infectious diseases: chickenpox, measles

Drugs

There are a number of medications that can cause pruritus:

  • antibiotics
  • opiate
  • inflammatories
  • Antimalarials
  • Psychoparhamaka
  • hormones
  • diuretics
  • cytostatics
  • Remedy for high blood pressure
  • anticoagulants
  • retinoids

Itching during pregnancy

Itching is a symptom that often occurs during pregnancy. About 20 percent of all pregnant women are affected. It is believed that in most cases, the hormonal changes in the body are the trigger. Often the symptoms can be alleviated by regular creaming with a moisturizing lotion.

However, severe itching, which occurs in the last trimester of pregnancy, may indicate liver disease – a so-called intrahepatic pregnancy scholestasis.

Although less than one percent of all pregnant women are affected by this condition in United States, it should nevertheless be ruled out if there is severe itching. For the liver disease can result in both a premature birth and a stillbirth.

What to do against annoying itching?


If itching occurs along with a rash, you should consult a dermatologist and have the exact cause clarified. If necessary, the doctor can prescribe suitable medications. For example, cortisone-containing ointments can help relieve itching.

If itching without skin rash, you should first check whether your skin may be too dry. If this is not the case, or the symptoms are not less despite careful skin care, a doctor must examine whether there is a disease. If this is the case, the treatment depends on the particular underlying disease.

If it is idiopathic itching, usually, itching remedies can help. Externally applied are local anesthetics, which inhibit the transmission of stimuli between the nerve cells. Likewise, isoprenaline – an ingredient in the group of betamimetics – as well as cooling ointments and gels with menthol or camphor can help to relieve the itching. If in doubt, talk to a doctor before using any of these remedies.

If the itching occurs over a large area of ​​the body, the intake of H1-receptor blockers, which inhibit the effect of histamine in the body, provide relief.

Likewise, in many patients, treatment with UVB rays has proved helpful. It is very important that you do not scratch the itchy areas even if you have itching. Because of the scratching, it can not only lead to unsightly scratch marks on the skin, but it can also cause infections.

Regardless of the cause of the itching – remedy and relief you can often do even with simple tricks:

  • Avoid dry skin: Do not use a dry room climate, frequent showering, bathing, sauna or care products containing alcohol. Dry skin is often itchy skin.
  • Skin care: Use moisturizing creams and lotions. Showering and bathing dries out the skin – subsequent care is absolutely necessary here. Urea care products also provide the skin with extra moisture.
  • Very spicy food, alcohol, stress, excitement and anger often cause itching. Try to limit these factors in your life.
  • Baden wants to be learned: A bath in lukewarm water for a maximum of 20 minutes should replace the quick showers. But you should refrain from drying out shower gels. In the case of skin diseases or severe scratch marks, the skin should not be scrubbed off while washing or drying with the towel, but carefully dabbed off. Then you should backfat the skin with lotions again.
  • Cotton gloves against itching in sleep: cotton gloves protect the skin from scratching attacks while sleeping – they are particularly suitable for children.
  • Airy Clothing: Wear loose clothing that does not rub or irritate the skin, such as cotton.
  • Quick relief: In case of sudden itching, cool, moist compresses with yogurtor some vinegar help . Envelopes with black tea are also good. For all wet wraps, however, you should cream the skin afterwards again. Lotions with urea or menthol cool and moisten the itchy skin.
  • In case of allergies only the avoidance of contact with the substance, which causes the itching helps.
  • Relaxation Techniques : Some methods such as Autogenic Training, Progressive Muscle Relaxation or Yoga not only help reduce stress, but to distract from chronic scratching especially in chronic pruritus.

 

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