Itching
Definition
Itching is an intense, distracting irritation or tickling sensation that may be felt all over the skin's surface or confined to just one area. The medical term for itching is pruritus.
Description
Itching instinctively leads most people to scratch the affected area. Different people can tolerate different amounts of itching, and the threshold of tolerance can change due to stress, emotions, and other factors. In general, itching is more severe if the skin is warm and if there are few distractions. This is why people tend to notice itching more at night.
Demographics
It is common for children to be itchy occasionally. Prolonged itching in a specific location and generalized itching in many different areas of the body are less common.
Causes and symptoms
The reason for the sensation of itching is not well understood. While itching is the most noticeable symptom in many skin diseases, it does not necessarily mean that a person who feels itchy has a disease.
Stress and emotional upset can make itching worse, no matter what the underlying cause. Itching is often worse at night or at times when there are no distractions. If emotional problems are the primary reason for the itch, the condition is known as psychogenic itching. Some people become convinced that their itch is caused by a parasite; this conviction is often linked to burning sensations in the tongue and may be caused by a major psychiatric disorder.
Generalized itching
Itching that occurs all over the body may indicate a medical condition such as diabetes mellitus , liver disease, kidney failure, jaundice , thyroid disorders, or rarely, cancer . Blood disorders such as leukemia and lymphatic conditions such as Hodgkin's disease may sometimes cause itching as well.
Some children may develop an itch without a rash when they take certain drugs such as aspirin or codeine. Others may develop an itchy red drug rash or hives because of an allergy to a specific drug such as penicillin.
Itching also may be caused when any of the family of hookworm larvae penetrate the skin. This includes swimmer's itch and creeping eruption caused by cat or dog hookworm and ground itch caused by the true hookworm.
Many skin conditions cause an itchy rash. These include:
- atopic dermatitis
- contact dermatitis
- dermatitis herpetiformis (occasionally)
- eczema
- fungus infections (such as athlete's foot)
- hives (urticaria)
- insect bites
- lice
- lichen planus
- neurodermatitis (lichen simplex chronicus)
- psoriasis (occasionally)
- scabies
Itching all over the body can be caused by something as simple as bathing too often, which removes the skin's natural oils and may make the skin too dry.
Localized itching
Specific itchy areas may occur if a person comes in contact with soap, detergents, or wool or other rough-textured, scratchy material. Adults who have hemorrhoids, anal fissure, or persistent diarrhea may notice itching around the anus (called pruritus ani). When children itch in this area, the cause is most likely pinworms .
Intense itching in the external genitalia in women (pruritus vulvae) may be due to candidiasis (yeast), hormonal changes, or the use of certain spermicides or vaginal suppositories, ointments, or deodorants.
When to call the doctor
If the child is itchy all over or has a localized itch in combination with a rash, fever , infection, or is acting sick, the doctor should be contacted.
Diagnosis
Itching is a symptom that is obvious to its victim. Because itching can be caused by such a wide variety of triggers, a complete physical examination and medical history will help diagnose the underlying problem. A variety of blood and stool tests may be needed to help the doctor to determine the cause of the itch.
Treatment
Antihistamines such as diphenhydramine (Benadryl) can help relieve itching caused by hives but will not relieve itching from other causes. Most antihistamines also make people sleepy, which can help children sleep who would otherwise be awakened by the itch.
Specific treatment of itching depends on the underlying condition that causes it. In general, itchy skin should be treated very gently. While scratching may temporarily ease the itch, in the long run scratching makes the itch worse and can lead to an endless cycle in which scratching an itch makes it more itchy.
To avoid the urge to scratch, a cooling or soothing lotion or cold compress can be applied when the urge to scratch occurs. Soaps are often irritating to the skin and can make an itch worse; they should be avoided or used only when necessary.
Creams or ointments containing cortisone may help control the itch from insect bites, contact dermatitis, or eczema. Cortisone cream should not be applied to the face unless prescribed by a doctor.
Probably the most common cause of itching is dry skin. There are a number of simple things that can be done to ease the annoying itch:
- Do not wear tight clothes.
- Avoid synthetic fabrics.
- Take shorter baths.
- Wash the area in lukewarm water with a little baking soda.
- For generalized itching, take a lukewarm shower or oatmeal (or Aveeno) bath.
- Apply bath oil or lotion (without added colors or scents) right after bathing.
Children who itch as a result of mental problems or stress may benefit from seeing a mental health expert.
Prognosis
Most cases of itching resolve successfully when the underlying cause is treated.
Prevention
There are certain things people can do to avoid itchy skin. Children who tend toward itchy skin should take the following steps:
KEY TERMS
Atopic dermatitis —An intensely itchy inflammation often found on the face, in the bend of the elbow, and behind the knees of people prone to allergies. In infants and young children, this condition is called infantile eczema.
Creeping eruption —Itchy, irregular, wandering red lines on the foot made by burrowing larvae of the hookworm family and some roundworms.
Dermatitis herpetiformis —A chronic, very itchy skin disease with groups of red lesions that leave spots behind when they heal.
Eczema —A superficial type of inflammation of the skin that may be very itchy and weeping in the early stages; later, the affected skin becomes crusted, scaly, and thick.
Hodgkin's disease —One of two general types of lymphoma (cancers that arise in the the lymphatic system and can invade other organs), Hodgkin's disease is characterized by lymph node enlargement and the presence of a large polyploid cells called Reed-Sternberg cells.
Lichen planus —A noncancerous, chronic itchy skin disease that causes small, flat purple plaques on wrists, forearm, ankles.
Neurodermatitis —An itchy skin disease (also called lichen simplex chronicus) found in nervous, anxious people.
Psoriasis —A chronic, noncontagious skin disease that is marked by dry, scaly, and silvery patches of skin that appear in a variety of sizes and locations on the body.
Scabies —A contagious parasitic skin disease caused by a tiny mite and characterized by intense itching.
Swimmer's itch —An allergic skin inflammation caused by a sensitivity to flatworms that die under the skin, resulting in an itchy rash.
- Avoid a daily bath.
- Use only lukewarm water when bathing.
- Use only gentle soap.
- Pat dry, not rub dry, after bathing, leaving a bit of water on the skin.
- Apply a moisture-holding ointment or cream after the bath.
- Use a humidifier in the home.
Children who are allergic to certain substances, medications, or foods can avoid the resulting itch if they avoid contact with the allergen. Avoiding insect bites, bee stings , poison ivy , and similar plants can prevent the resulting itch. Treating sensitive skin carefully, avoiding overdrying of the skin, and protecting against diseases that cause itchy rashes are all good ways to avoid itching.
Parental concerns
Children who are itchy should have their finger nails cut short to help ensure that they do not scratch the itchy area enough to create breaks in the skin. Scratching until the skin is broken can lead to infection. Itching can be very frustrating, and, if it is severe, it can interfere with normal activities such as studying or sleeping. Itching is a symptom of many common childhood ailments such as chickenpox and contact with poison ivy, as well as of some more serious conditions.
Resources
BOOKS
Fleischer, Alan B., Jr. The Clinical Management of Itching. New York: Parthenon Publishing Group, 2000.
Yosipovitch, et al., eds. Itch: Basic Mechanisms and Therapy. New York: Marcel Dekker, 2004.
PERIODICALS
Moses, Scott. "Pruritus." American Family Physician 68 (September 15, 2003): 1135.
Yosipovitch, Gil, and Jennifer L. Hundley. "Practical Guidelines for Relief of Itch." Dermatology Nursing 16 (August 2004): 325–30.
Tish Davidson, A.M. Carol A. Turkington