People are itching a lot recently and the number of patients that come to my office complaining about this is significant. Fortunately, many if not most of these people have simple issues such as dry skin, irritation or allergic reactions. A small fraction of them will have skin diseases that cause itching for reasons that are complicated but that require intervention. An even smaller number of these people have metabolic or systemic diseases that frequently go unrecognized. These may include cancers in other parts of their bodies or deficiencies that require supplements.
Itching is almost always worse at night. The reason for this is that there is so much stimulation during the day that the nerves that conduct the sensation of itching are suppressed. Right around midnight, however, there is almost no distraction (none if you are married) and itching increases.
Some simple things can help alleviate this type of itching. Changing to fragrance free and dye free detergents (Tide Free/ All Free) and using moisturizers can help. Over the counter cortisone creams and anti itch lotions (Aveeno and Sarna are good) will also make you feel better. If these simple things don’t alleviate the itching, it is time to see a dermatologist.
Patients that end up in a dermatology office with itching will frequently have eczema. This is an allergic response of the skin and it is common in patients that have asthma, hayfever or family members with these entities. Treatment with topical steroids is helpful and some patients benefit from oral antihistamines. Unfortunately, many patients are also infected with bacteria and some of the bacteria are resistant to common antibiotics. However, using antibiotics will help to reduce bacterial counts enabling the skin to heal. Since eczema (atopic dermatitis) is a chronic disease, ongoing maintenance care is needed.
Not everything that itches and forms a rash is eczema and other diseases are also included in the differential. Certain types of lymphomas (cancers of the blood cells) can involve the skin and a wide variety of other processes may also cause itching and rashes. A skin biopsy performed by a dermatologist and interpreted by a board certified dermatopathologist can help to separate out the various types of causes.
Itching may also occur in the absence of a rash. Metabolic and hormonal changes can cause itching as well. Various problems ranging from iron deficiency to thyroid deficiency to infections and hidden cancers and lymphomas can cause itching. A minimal workup for itching should include this and may also include certain blood tests and a chest x ray or CT scan. Discovering the cause may be a very time consuming and expensive process. In this scenario, it is best to work with a dermatologist that can help interpret the data.
Whatever the cause, itching can have a dramatic impact on the quality of life and various measurements have shown that it can cause depression and self image. Treatments from steroids to ultraviolet lights to topical creams can all help the symptoms without changing the underlying cause. I would recommend that you seek the care of a dermatologist when faced with long standing itching and that he or she proceeds on a reasonable diagnostic evaluation that includes blood work and a skin biopsy.
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