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What helps against chronic itching?

Status: 02.12.2019 10:27 a.m. | archive
Chronic itching can be excruciating for those affected.

If the skin burns, tightens, or itches for more than six weeks, doctors call it chronic itching. Those affected often have a high level of suffering: for example, they scratch themselves sore or can no longer sleep properly. The itching is noticeable on the skin, but the trigger is often elsewhere in the body. Possible causes are inflammation, medication, allergies, diseases of the liver or kidneys, diabetes, tumors and neurological diseases. In many cases, the cause of chronic itching is not recognized or is only recognized very late. Around twelve million people in Germany suffer from chronic itching.

How itching occurs

The skin may itch on individual parts of the body or on the entire body if ...

  • certain nerve fibers are excited by the messenger substances histamine and serotonin
  • mechanical stimuli, toxins or temperature fluctuations lead to the release of histamine

Recognize the causes of itching

Especially in the cold season, itching can have harmless causes, for example dry skin. A detailed description of where and when it itches can help the doctor figure out the cause of the itching:

  • Itching on the head - can be triggered by intolerance to shampoo, dry scalp or fungal infections
  • exclusively itching at night on the skin - occurs with scabies, a parasitic skin disease caused by the grave mite or scabies mite
  • Itching in Groin, crease in the neck or armpits - Hodgkin lymphoma can be the possible cause
  • Itching of the Sole of the foot - Liver problems can be the cause
  • itching after contact with water - Possibly the reason is a rare disease of the blood-forming cells in the bone marrow, in which there is a chronic proliferation of red blood cells (erythrocytes)
  • itching on or in the nose -this can be eczema, in very rare cases it is an indication of a brain tumor
  • itching On different parts - Kidney problems can be the trigger, but also multiple sclerosis, HIV infection or diabetes

Cholestatic itching from the liver and gall bladder

If diseases of the liver or gall bladder are the cause, it is so-called cholestatic itching. This occurs in the early stages of the disease and can indicate jaundice (jaundice), for example.

An increase in symptoms in the early evening and night hours is typical. Often the itching occurs on the soles of the feet and on the inner surfaces of the hands. It can lead to insomnia and depression. Scratching the skin often does not bring relief from cholestatic itching, but can lead to so-called secondary skin changes such as skin abrasions, small wounds, bleeding, crusts and itchy nodules (prurigo nodularis). And that in turn can trigger itching again.

In 80 percent of those with primary biliary cirrhosis (PBC) or primary sclerosing cholangitis (PSC), itching is the predominant symptom. With chronic hepatitis C infection, five to 15 percent of those affected suffer from chronic itching. Itching occurs relatively rarely with chronic hepatitis B infection and alcoholic liver diseases.

Causes of Cholestatic Itching

If the secretion of bile acid is disturbed, so-called bile-dependent substances accumulate in the blood and in the tissue. They can contribute to itching. Female sex hormones are also discussed as substances that cause itching. Women with cholestatic liver disease often report particularly severe itching. The body's own opioids could play a role as a trigger in liver disease.

Treat cholestatic itching

The first choice for the treatment of cholestatic itching is the so-called exchange resin colestyramine. It should be taken before and after breakfast. However, it must be taken at least four hours apart from other drugs, as this can interfere with their absorption in the body. Possible side effects include feeling unwell, gas, and diarrhea.

The antibiotic rifampicin is the second choice in the treatment of itching. As a side effect, it can cause additional liver damage. The liver values ​​should therefore be checked regularly during rifampicin therapy. Opioid antagonists such as naltrexone as a tablet or naloxone as an infusion can also be used to treat chronic itching. Therapy should begin with a low dose and treatment should be paused two days a week so that there is no habituation effect to the drug.

Treat neuropathic itching

The so-called neuropathic pruritus differs from cholestatic itching. It occurs when there is strong pressure on the sensitive nerve fibers of the skin, such as a herniated disc. As a rule, neuropathic itching affects a specific, clearly delimited area of ​​skin. Cooling the skin helps against neuropathic itching, for example with menthol-containing creams and drugs that are used to treat epilepsy (anti-epileptics such as gabapentin or pregabalin). Apparently they dampen the transmission of certain impulses to the brain.

Antihistamines for itching

Itching can also be reduced with so-called antihistamines:

  • Fenistil and Tavegil are first generation antihistamines - they can make you very tired.
  • Cetirizine is an effective and less fatiguing subset of the second generation.
  • Those who get too tired from the first and second generation antihistamines can ask their doctor about a third generation drug, such as fexofenadine.

Treat neurodermatitis with antibodies

In atopic dermatitis, the administration of the antibody dupilumab has proven itself.

Light therapy for chronic itching

A very effective treatment option with no side effects is light therapy. These are applications in a special cabin with light at a wavelength of 311 nanometers. The applications must be carried out two to three times a week over a period of around eight weeks. The light therapy is not reimbursed by health insurance companies. However, it is taken over as part of a dermatological rehabilitation measure.

All therapies are only effective with simultaneous moisturizing care.

Tips against itching

Itching is not only caused by illnesses: There are a number of factors that can irritate the skin. For example, the moisture of the skin decreases with age - the skin becomes drier and itchy. Those who suffer from itching should keep these tips in mind:

  • Treat the skin regularly with moisturizing creams, especially after showering. It is important that the creams or lotions contain urea, which supplies the skin with moisture.
  • You should avoid a dry room climate, frequent showers, long baths, saunas or alcohol-based care products - they can dry out the skin.
  • Stress, excitement, alcohol, and very spicy food can also make it itchy.
  • If the itching occurs more intensely at night in bed, mite infestation can be the cause - if necessary, replace the mattress.
  • So that the skin is not mechanically irritated, those affected should not wear clothing made of cotton that is too tight.
  • At night, cotton gloves can protect the skin from scratching.
  • If itching suddenly occurs, cool, moist compresses with yogurt, black tea or a little vinegar will help. Then apply lotion to the skin.
  • Relaxation techniques like yoga, progressive muscle relaxation, and autogenic training can help manage itchiness better.

Dry skin: what helps in winter?

Cold and heating air can dry out the skin, itchy and reddened. With the right care, the skin stays supple and healthy even in winter. more

Experts on the subject

Prof. Dr. Stefan Werner Schneider, director
Clinic and Polyclinic for Dermatology, Andrology and Venereology
University Medical Center Hamburg-Eppendorf
Martinistrasse 52
20246 Hamburg
(040) 741 05 26 30

Dr. Claudia Zeidler, senior physician at the Department of Skin Diseases
Competence center for chronic pruritus
University Hospital Münster
Von-Esmarch-Str. 58
48149 Munster
(0251) 835 65 01

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