Itching is an unpleasant feeling that causes a desire to scratch or rub the skin. It is caused by excessive secretion of histamine, prostaglandins, proteases, and cytokines due to various stimuli such as physical and chemical contact, changes in temperature and humidity. If the skin is repeatedly rubbed or scratched due to itching, the skin becomes thicker like a leather (Lichenification), and the nostrils, anus, and the vulva are particularly sensitive to itching. Most itching is accompanied by diseases of the skin itself, but it is important to find the correct cause and treat it as there are cases related to systemic and mental diseases.
Itching can be caused by a variety of causes. Depending on the cause, the types of itching can be divided into itching with skin diseases, itching with systemic diseases, and itching with psychiatric diseases.
1.Itching with skin disease
Itching is most often accompanied by skin diseases. Herpes dermatitis, scabies, ear infections, insect bites, hives, atopic dermatitis, contact dermatitis, psoriasis, lichen planus (a symptom that the skin looks thick and wrinkled), and neurodermatitis cause itching.
In winter, itching occurs in more than 50% of people aged 70 and over. The main cause is that moisture decreases due to aging of the skin, and the skin becomes dry as the secretion of sebum decreases, and itching occurs well in the arms and shins. Frequent bathing in winter, excessive use of soap, and dry, high room temperatures worsen symptoms. Anal itching is often accompanied by rectal anal disease or infection. When the anus is contaminated or irritated with feces, it is common when there is a colon and anus disease such as dentition (a tear in the anal canal), hemorrhoids (hemorrhoids), a fistula (exudation from inflammation around the anus), and chronic diarrhea. Infections such as bacterial infection, Candida infection, and herpes simplex virus can also cause anal itching. Also, eating spicy foods can lead to severe anal itching.
Itching of the vulva can be caused by rubbing, sweating, pregnancy, pads, birth control pills, vaginal wash fluid, and condom use. Infections such as candidiasis and trichomonas vaginitis are also causes. Men’s scrotum is an area where chronic lichen planus, which thickens the skin, can persist for many years even with intensive treatment. Water-borne itching lasts about an hour with a needle pricking discomfort within minutes after exposure to water. Scalp itching is a symptom that can occur even without obvious lesions on the scalp. It is common among middle-aged and older and worsens when tired or stressed.
2. Itching with systemic disease
Itching is well accompanied by systemic diseases such as jaundice, chronic renal failure, malignant hematologic tumors, true erythropoiesis, parasites, hyperthyroidism and hypothyroidism, and acquired immunodeficiency syndrome (AIDS). Itching occurs in 20 to 25% of patients with jaundice, and in patients with obstructive biliary tract disease, chronic liver disease, and cirrhosis in which the flow of bile is blocked, jaundice is accompanied by systemic itching, where the whole body is severely itchy. There is itching in about 20-50% of patients with chronic kidney failure who take hemodialysis. Malignant tumors and iron deficiency anemia also cause itching. About 50% of people with true erythrocytosis experience severe itching within minutes of contact with water. This is because an increase in skin blood flow increases the skin surface temperature and lowers the threshold for itching (the minimum intensity of irritation that can cause symptoms).
In hypothyroidism, myxedema can cause severe skin dryness and systemic itching. Itching is common among diabetics. Due to diabetes, sensitivity to itching becomes more sensitive, and systemic itching occurs due to diabetic kidney failure. In the case of acquired immunodeficiency syndrome, systemic diseases such as scabies, lice, candidiasis, seborrheic dermatitis, kidney failure, and cholestasis are often accompanied, and itching occurs well.
3. Itching with psychiatric diseases
Frequent scratching due to mental stress from skin diseases causes lichenification in which the skin becomes hard and thick, resulting in a vicious cycle of repeated itching. The hair growth wall is a neurosis in which hair is pulled out of an abnormal desire. Mental and social stress is the cause, and stress at home or in social life, a sense of competition, moving, hospitalization of the family, and family relationships can be a problem. Artificial dermatitis is a dermatitis caused by artificially injuring one’s skin with chemicals, corrosive agents, nails, sharp tools, hot metal, etc. to induce sympathy or avoid responsibility. Patients injure their own body to satisfy their psychological needs, often denying or indifferent to creating the lesion.
Tests for Diagnosis
Check the location and persistence of itching, and check the history of medications that cause itching. It is most important to find and treat the cause of itching, both itching caused by skin diseases and itching accompanying systemic diseases. Examination including rectal anal examination, pelvic examination, general blood test, chest radiographic examination, stool examination, thyroid gland, liver and kidney function tests, and blood sugar tests are performed to examine the presence of the underlying disease and then treat.
Systemic administration of corticosteroids or applying them to a portion (topical application) is effective for itching due to inflammation or lichenification. It is also helpful to cool the skin with calamine lotion or menthol lotion. Various first- or second-generation antihistamines are commonly used as oral medications. Antidepressants and anti-anxiety drugs are helpful for itching, which does not respond well to treatment.
1.Itching with skin disease
For winter itching, it is effective to apply a moisturizer to dry skin several times a day. Do not smear or use excessive soap, and apply a moisturizer immediately after bathing to prevent dry skin. Topical steroids can help, and the ambient temperature and humidity must be controlled. Anal itching should be checked for rectal anal disease or infection and avoid irritating foods and drugs. It is essential to keep it clean without scratching around the anus.
In the absence of fungal infection, antihistamines and topical steroid ointments are effective for itching and associated dermatitis. After defecation, it should be wiped with soft paper and, if possible, it is recommended to wash it with water using non-irritating soap. Candida vaginitis is treated well with antifungal vaginal suppositories, and trichomonas infections can be treated by taking antibiotics or by placing them in the vagina. Phototherapy can also help.
2. Itching with systemic disease
Treating the underlying systemic disease is a fundamental principle. For example, itching of patients with obstructive jaundice accompanied by jaundice requires antihistamine, cholestyrase, and phototherapy, plasmapheresis, or surgical treatment to clear the blockage of the bile.
3. Itching with psychiatric diseases
In chronic lichen planus, it is most important to improve itching by using antihistamines and anti-anxiety drugs. Since the skin has become hard, steroid ointment should be used as a high strength formulation. Patients with hair growth barrier and artificial dermatitis who pull their own hair by themselves should be treated with psychiatric medication and behavioral therapy in addition to skin lesion treatment.
Frequently Asked Questions
1. What are some ways to prevent itching?
Itching is affected by temperature changes around the body, so use thin and light clothes and bedding. It is advisable to avoid the use of irritating fabrics such as chemical fibers or wool and to change the scratching habit. It’s also a good idea to avoid mental strains like stress. Caffeine, alcohol, and cola, which are high in coffee, tea and chocolate, can worsen itching. It is recommended to avoid frequent bathing for itching due to dry skin, which is common in the elderly, and apply a moisturizer to the whole body after bathing.
2. My skin often itches. Am I not getting scabies?
Scabies is an itchy skin disease caused by tiny ticks that live on the surface of the skin. When caught in scabies, very itchy red spots develop in several places. It itches worse at night.
It is particularly common in the groin and fingers. The scabies mite creates tunnel-like scabies mite burrows in the outermost stratum corneum of the skin. It is often transmitted through physical contact, so everyone in the family must be treated at the same time.
Diagnosis can be diagnosed by characteristic itching, discovery of scabies mite, and family history, and can be confirmed by checking scabies mite under a microscope.
3. When the skin is dry and itchy, sauna seems to relieve it. Is this a good way?
The basis of treatment for dry skin is to moisturize and maintain the skin’s surface and protect it from external harmful environments. To do this, you should avoid smearing, excessive use of soap and sauna.
In the case of severe itching, care should be taken to avoid secondary inflammation or wounds caused by continuous rubbing or scratching of the skin.
4. What should I do if my skin is dry?
The skin is very sensitive, so use a mild cleaning product.
It is recommended to apply a moisturizer immediately and regularly use a moisturizer as it starts to dry after 3 minutes after bathing.
It is recommended to keep the indoor temperature at 20 degrees Celsius (68 degrees Fahrenheit) so that it is not too hot, and to use a humidifier. When there is no humidifier, it is recommended to hang wet laundry indoors or place a wet towel.