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By Karen McKoy, MD, MPH, Assistant Clinical Professor, Dermatology;Senior Staff, Harvard Medical School;Lahey Clinic Dermatology
- Itching and Dermatitis
Itching can be very uncomfortable. It is one of the most common reasons people see doctors who specialize in skin disorders (dermatologists).
Itching makes people want to scratch. Scratching temporarily relieves itching but can damage the skin, sometimes resulting in more itching or infection. Over time, the skin can become thick and scaly.
Causes of Itching
Itching can result from
Skin disorders (most common cause)
Disorders of other organs (systemic disorders)
Drugs and chemicals
The most common causes of itching are skin disorders:
Contact dermatitis (an allergic rash resulting from direct contact with a particular substance)
Insect bites and parasitic skin infections, such as scabies, can cause intense itching.
Systemic causes are less common than skin disorders but are more likely if there is no visible skin problem.
Some of the more common systemic causesare
Allergic reactions—for example, to foods, drugs, bites, or stings—that affect the body all over (called systemic allergic reactions)
Disorders of the gallbladder or liver, such as gallstones, particularly when they cause jaundice
Less common systemic causes include hyperthyroidism (an overactive thyroid gland), hypothyroidism (an underactive thyroid gland), diabetes, iron deficiency, dermatitis herpetiformis, and polycythemia vera (a cancerous overproduction of red blood cells).
Some disorders that affect the nervous system, such as multiple sclerosis, may cause itching. Some people who have mental disorders may have itching for which no physical cause can be found. This type of itching is called psychogenic itching.
Drugs and chemicals can cause itching when taken internally or when applied to the skin. Usually the itching is caused by an allergic reaction. A few drugs, such as morphine and some radiopaque contrast agents used when taking certain x-rays, can also cause itching without causing an allergic reaction.
Evaluation of Itching
Not every episode of itching requires immediate evaluation by a doctor. The following information can help people decide whether a doctor’s evaluation is needed and help them know what to expect during the evaluation. Most conditions causing itching are not serious.
The following may indicate that the cause could be serious:
Weight loss, fatigue, or night sweats—symptoms that may indicate a serious infection or a tumor
Weakness, numbness, or tingling—symptoms that may indicate a nervous system disorder
Abdominal pain or a yellowish discoloration of the skin and eyes (jaundice)—symptoms that may indicate a gallbladder or liver disorder
Excessive thirst, abnormally frequent urination, and weight loss—symptoms that may indicate diabetes
When to see a doctor
People who have weight loss, fatigue, or night sweats should see a doctor as soon as convenient, probably within a week or so. People with any of the other warning signs or with severe itching should probably see a doctor immediately or as soon as possible.
What the doctor does
Doctors ask many questions and look at the skin. Often, a person needs to undress so that the entire skin surface can be checked. If no clear cause is found after checking the skin, doctors may do a complete physical examination to check for systemic causes. Testing may be necessary to diagnose certain systemic causes and sometimes skin disorders.
If itching is widespread and begins shortly after use of a drug, that drug is a likely cause. If itching (usually with a rash) is confined to an area in contact with a substance, particularly if the substance is known to cause contact dermatitis, that substance is a likely cause. However, allergic causes of widespread itching can be difficult to identify because affected people have usually eaten several different foods and have been exposed to many substances that could cause an allergic reaction before itching develops. Similarly, identifying a drug that is causing the reaction in a person taking several drugs may be difficult. Sometimes the person has been taking the drug causing the reaction for months or even years before a reaction occurs.