All about itching and what you can do

Updated: 16 june 2024

Itching is common. Actually, everyone suffers from it from time to time. The medical term for itching without visible skin abnormalities is pruritus. Itching with skin abnormalities is called prurigo.

Do you suffer from itching yourself? An itch is probably just an itch for you.
And you want to get rid of it before it drives you crazy!

Itching: worse than pain

Itching is a skin stimulus that makes you feel the urge to scratch, pinch, rub or pat. The complaints can vary from mildly irritating to very intense itching. Sometimes the itching is so severe that someone scratches the skin until it bleeds.

Many people with chronic itching therefore state that the itching is worse than pain.

How does itching occur?

Studies show that itching has a complex mechanism of origin. The ends of the nerves that sit on the border of the epidermis and dermis cause the feeling of itching. You will never feel itching in your muscles or joints.

Itching is caused by specific itch nerves in the skin being stimulated by mechanical, chemical, thermal and electrical stimulation, among other things.

• Mechanical stimulation: you get itching through touch, touch, grasping or rubbing. For example, think of hives.
• Chemical stimulation: you get itchy because chemical substances come into contact with your skin, such as ointment, but also agents such as soap or cleaning products.
• Thermal stimulation: you get itchy due to heat from the sun, a warm bath or physical exertion, for example.

A lot of itching is caused by histamine, a substance that is produced in your skin by your immune cells. The histamine is intended as a defense against foreign substances and alerts your skin to the fact that something is going on in that area, such as a mosquito bite.

Other substances in the body that also cause itching are: Substance-P, Cytokines, 5-HT or Serotonin, Proteases, Cytokines such as (IL-2,IL-3, IL-4, IL-6, IL-10), Calcitonin gene related peptide, Neurotrophin, Opiate peptide, Phospholipid metabolites, Eicosanoid and Platelet activating Factor (PAF). You may recognize the last one (PAF), itching during wound healing. Due to the different substances and mechanisms of itching, effective treatment is difficult.

Often the itchy feeling is reduced by cooling the affected area or by administering a pain stimulus. This is why people scratch or hit the affected area with the flat of their hands.

More insights:

1. Neuropathic Itch:
   Neuropathic itching is caused by damaged nerves that send itch signals to the brain. This can happen with diseases such as multiple sclerosis and diabetes.
2. Role of Cytokines:
   Cytokines, such as IL-31, are molecules produced by immune cells that can cause itching by activating itch receptors on nerve cells.
3. Histamine-independent itching:
   In addition to histamine, other molecules such as protease-activated receptors (PARs) and opioids can also cause itching. This is why antihistamines don’t always work.
4. Interaction between skin and nervous system:
   The interaction between the skin and the nervous system plays an important role in itching. Neuropeptides and neurotransmitters are involved in causing itching.
5. Genetic factors:
   Genetic variations can determine how sensitive a person is to itching. Differences in genes that code for receptors and signaling molecules can lead to stronger itch responses.

What can you do yourself to get rid of that pesky itch?

Often a vicious cycle develops. When you itch, you scratch, which breaks the skin and makes you itch more, which causes you to scratch again…

The result? You constantly suffer from the itch and you want nothing more than to get rid of it.

How do you address that?

One of the most important things you can do yourself is to break the vicious circle of itching. Therefore, make sure your nails are trimmed short, filed smooth and clean. This minimizes the risk of skin infection and further skin damage.

Avoid wearing clothing that causes irritation, such as tight-fitting clothing, rough clothing or woolen clothing.

The skin dries out after contact with warm water; this may worsen itching. Therefore, try not to shower or bathe too often, too long and too hot. Preferably, do not use shower gel or soap. Can you really do without it? Then choose a hypoallergenic, perfume-free bath or shower emulsion or oil. After showering, it is better to pat the skin dry instead of rubbing it dry.

Some cosmetic ingredients can reduce itchiness. When purchasing anti-itch skin care products, look for ingredients such as aloe vera, lactate, avena sativa (oat extract), menthol, camphor, and urea. Less known are marshmallow root, calendula, witch hazel (witch hazel or hamamelis) and evening primrose oil (evening primrose oil).

Finding out the cause of (chronic) itching

Have you tried everything, but the itch is still there? Then go to the doctor, because it is important to determine the rootcause. This can be done in various ways. For example, by means of an allergological examination. These are patch tests or prick tests on food or the inhalation of allergens.

A general physical examination may also be required. Blood, urine and possibly faeces are examined for, for example, the presence of worms or parasites.

If skin abnormalities are visible, a skin biopsy can be done when in doubt. If the doctor can’t find a solution, you will be referred to a dermatologist.

There are different types of itching

Within medicine, itching is divided into several groups:

1. Group without skin abnormalities

The whole skin is dry, but there is a variable appearance. Sometimes only a subtle flaking is visible; in others, a crackle effect occurs in the skin. Dry skin is a major contributor to itching.

2. Internal causes of itching

If there is an internal abnormality, the dermatologist cannot help you further. It is a good idea to contact your doctor. Internal abnormalities that can cause itching include:

• Hodgkin and other internal cancers such as leukemia.
• Uremia (kidney disease), including during treatment with dialysis.
• Icterus (jaundice in diseases of the liver or bile ducts). Also during pregnancy, engorgement of the bile ducts can occur, resulting in itching.
• Diabetes mellitus (diabetes) and other metabolic diseases, such as thyroid disease and gout.
• Tension or stress.
• Anemia (anemia), but also polycythemia vera (a blood disorder in which you have too many red blood cells in your blood), can cause itching.
• Toxicodermia, or drug reaction. The likelihood of itchiness increases when 5 or more oral medications are used.
• Worm and parasite infections.
• AIDS.

3. Skin abnormalities that occur in multiple locations

Within the group with skin defects that occur in several places on the body, you can think of:

• Hives come on suddenly over a short period of time and look like mosquito bites. Each individual spot will change location on the body within 24 hours. Scratching causes red stretch marks and a short-term itchiness.
• In response to medicines, a rash sometimes develops consisting of fine confluent red spots mainly on the trunk, but often spread over the whole body.
• Scabies is nocturnal itch. Often several family members/ housemates have symptoms. Itching occurs around the ankles, between fingers and on the wrists.
• Contact allergy is eczema triggered by an allergic reaction. This form of eczema is often recognizable by sharply defined red scaly patches.

4. Local skin abnormalities

Within the group with local skin abnormalities, you can think of:

• Eczema on the lower legs. This type of eczema often occurs as a result of varicose veins with the accumulation of fluid in legs.
• Asteatotic eczema (winter eczema) causes itching because the skin is very dry.
• Constitutional eczema often develops in folds of the skin and becomes apparent from an early age.
• Contact allergy appears as a sharply circumscribed red scaly lesion. Typically, the affected area does not respond to therapy for eczema. Where it itches is the exposure to the substance you’re allergic to. For example, someone with an allergy to shampoo has itching on the hairy scalp.
• Lichen simplex chronicus (a single, chronic itch) often develops on the ankles, but sometimes also on the forearms. The itch-scratch cycle maintains the itchy spots.
• Prurigo nodularis are extremely itchy bumps. The bumps usually occur locally on the arms and legs, but sometimes also on the torso.
• Itching around the anus is often caused by hemorrhoids. Other characteristic symptoms include pain and sometimes blood in the stool. Always see your doctor for this.
• Itching of the vulva can arise from many different causes and is accompanied by increased discharge. Hormonal factors (such as menstruation) often play a role.
• Brachioradial itch (itching of the arms) is common in people who have a cervical spine abnormality.
• Notalgia paresthetica is a special form of itching of the back (shoulder blade). The itch is caused by the compression of a nerve on the back. The end of the skin itches, but the problem is actually in your back or joints. This form of itching can be treated through manual therapy.

Itching ointments or light therapy as a solution

For some forms of itching, cooling lotions, cooling ointments, gels or creams can be useful. Most of these drugs are available by prescription. If you have dry skin, only a greasy ointment or oil can restore the skin barrier. More about the differences between lotions, cream and ointment.

Corticosteroids, also known as hormone ointments, are very suitable itch-relieving agents. But medicinal ointments without hormones, such as elidel and protopic, can also help.

Light therapy using UV-B light can work for itchy skin conditions such as atopic eczema, lichen planus and prurigo nodularis.

Oral agents that can combat itching

Antihistamines, the well-known hay fever tablets, are known to be effective against hives. There is also increasing evidence that anti-nervous drugs, such as gabapentin and pregabalin, are effective against chronic itching.

Sometimes you can be so desperate about the constant itching that a short-term prednisone shock treatment can help to put the itching on hold, as it were. This will not solve the problem, but it will make the itching more bearable. At the same time, ointment therapy can be used to structurally reduce itching.

Going to a manual therapist with your itching symptoms

It may not be the first thing on your mind, but sometimes itching can be caused by a pinched nerve in your back or neck. A spinal or cervical vertebra photo can show whether there is wear or crushing.

Treatments by a manual therapist are often effective in these cases. You will notice improvement after 2 or 3 appointments and you will know whether the itch is indeed caused by a pinched nerve. If you do not notice any effect, then the cause is somewhere else and you can stop manual therapy.

Acupuncture as a solution to itching

It has been proven that acupuncture reduces itching, but it has not yet been proven how this works. Acupuncture is particularly helpful for histamine-induced itching in healthy individuals. For people who do not want to use medication, this procedure can be a good alternative.

Scientific article: Scratching the brain is a better anti-itch treatment.

The article “Frontiers in pruritus research: scratching the brain for more effective itch therapy” published in the Journal of Clinical Investigation provides an in-depth overview of the latest research into itch, also known as pruritus. The authors highlight the complexity of itching, as a symptom that has both external and internal influences on the body.

The main points of the article are:

Neuropathophysiology of itch: The authors explain how itch can be caused by external stimuli such as chemicals and allergens, but also by internal problems such as inflammatory diseases. They discuss the interaction between the nerves in our skin and the neural pathways in our brain, which is crucial for how we experience and respond to itch.

Therapeutic approaches: The article looks at new treatments that target specific molecular targets to relieve itching. This includes targeting immune responses, blocking specific substances that cause itching, and influencing the neural pathways involved in itching.

Challenges and Future Directions: Despite advances in understanding itch, there are still challenges such as the complex interactions between different systems in the body and the difficulty in developing effective and long-lasting treatments.

This article provides a glimpse into the future of itch research and the development of new, more effective treatments for this irritating problem.

Summary

Everyone suffers from itching from time to time, and sometimes you can do something about it yourself. It is always good to break the itch cycle. This starts with clean nails, avoiding irritating clothing and reducing long and hot showers.

Do you suffer from chronic itching and your own approach is not helping? Then see your family doctor. Who will investigate what is causing your itching and find an appropriate solution. This can vary from ointment therapy to the use of medication, light therapy or treatments by a manual therapist or acupuncturist.

[Lees meer over oorzaken en behandeling van en droge huid]

[Read more the different between lotions, cream and ointment]

Frequently asked questions

Why does itching often seem to get worse at night?

Itching can seem worse at night for several reasons. First, during the night there are fewer distractions, so you are more focused on the sensation of itching. Second, the body’s circadian, or biorhythms, can influence the production of certain substances that cause or aggravate itching, such as cytokines. In addition, the change in temperature and humidity at night can affect the skin condition, increasing itching. It is therefore important to adjust skin care routines before bed to minimize itching.

Can psychological factors cause or worsen itching?

Yes, psychological factors such as stress and anxiety can cause or worsen itching. Stress can lead to an increase in certain body chemicals such as cortisol and adrenaline, which in turn can affect the skin condition and cause itching. In addition, anxiety can increase the perception of itching, making a person more likely to scratch. Relaxation techniques and stress management can help reduce the intensity of itching.

Learn more about: Stress and skin problems

How does wearing synthetic clothing affect itching?

Synthetic clothing can make itching worse, especially in people with sensitive skin or skin conditions such as eczema. Synthetic fabrics allow less air to pass through than natural fabrics, which can lead to an increase in sweat and moisture on the skin. This can irritate the skin and cause itching. In addition, some people may be allergic to the chemicals used in the production of synthetic clothing, which can also cause itching. Wearing loose, breathable clothing made from natural materials is therefore recommended.

Why does cooling often help reduce itching?

Cooling helps reduce itching because it causes a temporary numbing of the skin, which reduces the activity of the itch nerves. This can have an immediate relieving effect on the feeling of itching. Cooling also reduces inflammation and swelling, which can often cause or worsen itching. Applying a cold compress or taking a cool bath can be effective ways to relieve itching.

What is the connection between itching and insomnia?

Itching can have a significant impact on sleep quality. The incessant feeling of itching can make it difficult to fall asleep or stay asleep, which can lead to insomnia. Prolonged sleep deprivation can in turn lead to increased stress levels, which can further worsen the itching. Additionally, the vicious cycle of itching and insomnia can negatively impact overall quality of life. Treating the underlying cause of itching and practicing good sleep hygiene are essential to tackling this problem.

About Francis Wu

‘In my dermatology practice, I often encounter people who suffer from itching. I see what they struggle with and unfortunately I often notice that certain care products help someone get out of the rain.
Because I want you as a user to be able to rely on the product you apply, I have developed my own skincare line: Iconic-Elements. A complete skin care line that stands out because it works (evidence-based)!’

Literature

Schmelz M, Schmidt R, Bickel A, Handwerker HO, Torebjörk HE. Specific C-receptors for itch in human skin. J Neurosci. 1997;17(20):8003-8008.

Ringkamp M, Meyer R. Pruriceptors. In: Carstens E, Akiyama T, editors. Itch: Mechanisms and Treatment. Boca Raton (FL): CRC Press/Taylor & Francis; 2014. Chapter 9

Andrade Miranda A, Franco JVA, Sanclemente G, et al. Interventions for pruritus of unknown cause. Cochrane Database Syst Rev. 2018;2018(9):CD013128.

Dawid-Pać R. Medicinal plants used in treatment of inflammatory skin diseases. Postepy Dermatol Alergol. 2013;30(3):170-177.

Paus R, Schmelz M, Bíró T, Steinhoff M. Frontiers in pruritus research: scratching the brain for more effective itch therapy. J Clin Invest. 2006 May;116(5):1174-86.

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