From contact dermatitis to fungal infections, people suffer from itchy skin for a number of reasons and treatment depends on the cause.
Itching, or pruritis to medics, is a really common symptom which, as a GP, I feel often doesn’t get the attention it deserves. Unlike pain, itching can be easy for others to dismiss as ‘just a bit of irritation’. Although breaking the itch-scratch cycle is important, often people are told just not to scratch, as though they have control over it. But itching is at best annoying and at worst debilitating – it can interfere with daily life and can be responsible for huge psychological distress.
Family GP Dr Lara Batchat outlines the common causes of itching. As with all health conditions, it’s important to know what the underlying condition is, to be able to treat it effectively. Broadly speaking, itching can be the result of a skin disorder (such as dermatitis), a skin infection, an allergy, or more rarely an imbalance of chemicals in the body:
When to see your doctor about itchy skin
As a general rule, it’s best to see your doctor if the itching:
- Has been going on for two weeks or more and hasn’t resolved with home treatment measures.
- Is severe, stops you from sleeping well or interferes with daily living.
- Comes on suddenly with no obvious cause.
- Affects the whole body.
- Is associated with other symptoms such as feeling unwell, having fevers, night sweats or losing weight.
14 itchy skin common causes
From contact dermatitis to fungal infections, itchy skin can have a number of causes and treatment options:
- Dry skin
Dry skin is a really common cause of itching, often affecting the whole body. There is usually no specific rash to see but the skin of the arms and legs particularly, may look generally dry and a little flaky. Dry skin can of course affect anyone, but the elderly are more prone to it.
★ Dry skin causes
Dry skin is more prevalent in the winter months when the colder outdoor temperatures lead people to spend more time in the door heated environment. The combination of the harsh cold outdoor air and dry heat indoors dries out the skin. Having very hot baths or showers regularly can also dry out the skin.
★ Dry skin treatment
A good unperfumed moisturiser (also called emollients) will do the trick to repair dry skin and using a soap substitute can also help. See your pharmacist who will be able to advise you on this.
Remember to dry your body or hands well after washing – paradoxically, leaving moisture on the skin will actually dry it out overall.
Don’t forget to keep well hydrated, too.
- Contact dermatitis
Contact dermatitis is inflammation of the skin as a result of something it has recently come into contact with. The result is patches of red, dry and inflamed-looking skin, sometimes with tiny blisters called vesicles. Common sites are the hands and face and the skin usually feels itchy or sore.
★ Contact dermatitis causes
Common causes of contact dermatitis include:
- Household cleaning products such as washing up liquid or cleaning sprays
- Make-up, perfume or hair products
- Washing powder or fabric conditioner
- Chemicals at work
- Latex gloves
★ Contact dermatitis treatment
The first approach to tackle contact dermatitis is to identify the trigger and avoid it. Next, the skin inflammation should be treated with a week’s course of an emollient and steroid cream, see your doctor or pharmacist, who will be able to advise you. Going forward, try to adopt habits that will prevent the contact dermatitis from recurring, such as wearing gloves to do household cleaning, or using hypoallergenic beauty or washing products.
- Eczema (atopic dermatitis)
Eczema, also known as atopic dermatitis, is a really common cause of itching in both children and adults. I often describe it to patients as a sort of extension of dry skin which has penetrated further into the skin’s layers, resulting in patches of itchy, inflamed and cracked skin. Eczema often presents itself in babies or young children but can persist into adulthood. Usually, the skin will feel and look fine most of the time, interspersed with episodes of eczema, known as flare-ups. In babies, the tummy and cheeks are the most commonly affected areas, whereas in those aged over 1 year the most troublesome sites are the bends of the elbows and wrists and the backs of the knees.
★ Eczema causes
There are a variety of elements that come together to cause eczema, some of which we don’t fully understand. What we do know, is that eczema sufferers often have very dry skin which can’t keep in moisture, and the resultant dry gaps in the skin make it more likely to react to certain triggers.
There is a definite genetic link between eczema and other ‘atopic’ conditions such as asthma and hayfever. Having a history yourself of either of these conditions, or having a sibling or parent with asthma, hayfever or eczema, puts you at increased risk of developing the condition.
★ Eczema treatment
During an eczema flare-up, the mainstay of treatment is emollients and steroid creams. Emollients reinforce the protective moisture barrier on the skin and can be slopped on thickly and all over – the general approach is, the more the better. I’d advise applying these at least twice a day and using moisturising soap-substitutes in the bath or shower, too. In fact, even when the eczema flare-up has passed, it’s still crucial to keep moisturising daily, to prevent further episodes.
Steroid creams are used during a flare-up to lessen the inflammation and ease the symptoms. There are different strengths of steroid creams and only the milder ones can be purchased over the counter, because stronger steroids can cause side effects such as thinning or bleaching of the skin. If you are an experienced eczema sufferer, you may know what works for you and may be able to self-manage with creams bought over the counter. However, if in doubt, an appointment with your GP will allow an assessment and treatment plan tailored to your needs. It’s important to remember that unlike emollients, steroid creams should be applied sparingly, to the affected area only, and for a limited time, usually 7-14 days.
If the steps above have been taken and aren’t working, or if the eczema is recurring frequently, it’s important to see your doctor. A referral may be needed to a see a dermatologist or allergist, or it may be appropriate to use other medications to keep the inflammation at bay.
Finally, it’s crucial to consider factors that may trigger eczema flare-ups and to avoid these. Identification of these triggers may be made easier by keeping a symptom diary, but common culprits are:
- biological washing powder
- soap and shampoo
- clothing made of wool or synthetic fabrics
- household dampness and mould
- pets at home
- food allergies such as dairy, eggs, peanuts, soya or wheat – if food allergy is suspected, be sure to discuss this with your doctor.
Allergies to food or other substances can sometimes show in a particular rash called weals (also known as hives, welts or nettle rash), which medics call urticaria. This is usually seen as blotchy patches of raised, red and intensely itchy skin which can vary in size from spots of a few millimeters to larger patches about the size of a hand. They can appear anywhere over the body or face. In people with darker or brown skin, the redness can be more difficult to spot. The rash typically comes and goes over the course of minutes to hours and can also move around.
★ Urticaria causes
Common triggers of urticaria include:
- Peanuts or other nuts
★ Urticaria treatment
Urticaria can be effectively treated in the short term with antihistamine medication such as cetirizine. This is available over the counter and should offer quick relief from the itching and rash.
As is often the way, prevention is better than cure – identifying the trigger and avoiding it, is important. All new cases of suspected allergy should be discussed with your GP, it may be that further tests are needed or there may be specific dietary advice to take into account.
Rarely, urticaria can be part of a more severe allergic reaction called anaphylaxis, which is a life-threatening emergency. If you develop hives associated with swelling on the face, lips or tongue, discomfort in the throat or difficulty breathing, seek urgent medical attention.
- Fungal skin infections
Fungal skin infections are a really common cause of intense itching. The area of skin that’s affected becomes colonised by thrush (also known as candida) or other fungi, known as dermatophytes. This usually happens in areas that are warm or damp and so typical sites include the groin, feet and skin folds such as under breasts or armpits. Common types of fungal infections include jock itch and athlete’s foot.
The different types of fungal skin infections can vary in appearance but the skin often looks red and shiny, feels itchy and there may be flaking or cracking of the skin. In ringworm, which is a specific type of fungal infection, the rash is usually circular or ring-shaped.
★ Fungal skin infection causes
Most people will develop a fungal skin infection at one point or another in their lives and this isn’t necessarily a sign of ill-health. However, people with diabetes or a suppressed immune system may be more likely to develop fungal infections as a result of their underlying condition. They are also more likely to occur in people who are overweight or obese or bedridden or immobile.
Fungal skin infections are contagious and can be passed on from people who have fungal skin infections (either through direct contact or indirectly through objects they have touched) or from pets. They are often picked up from swimming pools, shared showers, shared towels or clothing.
Damp or humid conditions are ideal for fungal infections to thrive. It’s important to maintain good hygiene, wash regularly and wear clean clothes, especially after exercise or if you are in a hot environment.
★ Fungal skin infection treatments
Fungal infections usually respond quickly to an antifungal cream (with or without a steroid component) and careful washing with a non-irritant soap. Regular changing of clothes and avoiding prolonged heat exposure and letting air get to the area are vital. Be careful to dry carefully after showing and wear loose cotton clothing.
- Specific infective rashes
There are some infections which cause specific combinations of symptoms including an itchy rash.
Red fluid filled blisters caused by chickenpox can affect the whole body, usually starting on the torso. These appear in crops and heal in succession. There is often also a fever, body aches, sore throat and loss of appetite.
Sometimes, the re-emergence of chicken pox as shingles can cause a painful itchy rash. This affects a patch of skin on one side of the body, reflecting the fact that a specific nerve area, or ‘dermatome’ is affected by the virus. A rash on both sides of the body is therefore unlikely to be shingles. The rash looks like a cluster of small blisters and is often preceded by tingling or itching. It is important to seek medical treatment promptly so that your doctor can prescribe antiviral medicine, which reduces the chance of persisting pain in this area once the shingles has healed up. It is also important that infections involving the eye/head and neck area are examined by a doctor.
Measles symptoms include fever, red watery eyes, sore throat, loss of appetite, cough and runny nose. There may be what we call kolpik spots – tiny red spots with blue centres in the mouth first. A red spotty rash usually appears behind the ears and then spreads down from the face down the body 3 to 5 days after symptoms start. Measles can be very serious and is highly infectious, so it’s important to seek medical attention urgently if you suspect this.
- Insect bites
Insect bites are intensely itchy and can easily be treated at home. Applying aloe vera gel can help soothe the itching and medicated anti-histamine creams or antihistamine medication by mouth, are also useful ways of getting relief.
Insect bites can be avoided by using insect repellent spray if you are in an area where mosquitos are prevalent.
If the area where an insect has bitten is becoming progressively swollen, red and sore, this may represent bacteria having gotten under the skin causing an infection. It’s important to see your doctor if that is the case, who will likely prescribe an antibiotic cream or medication.
- Prickly heat
Prickly heat is an uncomfortable rash that will normally resolve by itself after a few days. Any part of the body can be affected and the rash looks like small raised spots which feel itchy and prickly, hence the name. There may also be a red background to the spots, although on darker skin this may not be obvious.
★ Prickly heat causes
Prickly heat is common in the summer months when the weather is hot and sticky. It happens due to excessive sweating which causes sweat glands to get blocked, trapping sweat inside. Anyone can be affected, but babies are particularly vulnerable because their ability to control their temperature is not fully developed.
★ Prickly heat treatment
The best way of treating prickly heat is to keep the skin cool using the following strategies:
- Wear loose cotton clothing
- Take regular, cool baths or showers
- Use lightweight bedding
- Keep well hydrated by drinking often
- Soothe the skin with cool, damp cloths
- Apply calamine lotion to the affected area
- Antihistamine creams or medication can be used
- Skin infestations
Itching can be from an infestation with scabies, lice or biting from bed bugs.
Scabies is caused by tiny mites that lay eggs in the skin leaving silvery lines with a dot at one end. This then becomes a rash of small red spots, or it may appear brown or black on darker skin. The itching can be debilitating and is especially worse at night. A tell-tale sign is often that the starts between the fingers.
★ Scabies causes
Scabies is caused when tiny mites get under the skin and lay eggs. It can spread very easily by skin-to-skin contact with another person who has the infection and anyone can catch it.
★ Scabies treatment
The pharmacist or doctor will give you a specific lotion to use that you repeat after a week and your close contacts and family will also to be treated.
All clothing and bedding should be washed at 50 degrees C or higher on the first day of treatment.
Bed bugs are small insects that live in furnishings and the red rash they cause is intensely itchy. Antihistamines and steroid cream can be used to calm it and you will have to seek advice of the local pest control service to eliminate it from your home.
Head lice can cause intense scalp itching and sores on the scalp from itching. Usually, the lice and their eggs (nits) are visible. They can be treated with nit combs and special solution available from the pharmacy and you will often need to repeat the treatment after a week or so to destroy newly hatched nits.
Flea bites can also cause intense itching and will characteristically be on the ankles near the pet or carpet that is infested, you must treat the source as well as symptomatically treating your bites.
Any bite causing intense itching can mean we are vulnerable to a secondary skin infection, as described above. So be sure to contact your GP if the skin feels sore or you see worsening redness or swelling.
Psoriasis causes characteristic patches of silvery scaly skin and reddened areas that can be intensely itchy or not itchy at all. Typically, the patches are seen on the scalp, elbows, knees and lower back. Like eczema, psoriasis sufferers often have periods when the skin is fine, interspersed with flare-ups. Psoriasis can develop at any age but usually starts in adults under the age of 35 years old, affecting about 2% of the UK population. It is a long-term condition and the severity ranges from person to person – in some cases it can be very mild, in others it can really interfere with daily life.
The most common type of psoriasis is called plaque psoriasis, and this causes the typical symptoms as detailed above. But there are also some other subtypes of psoriasis, including:
- Flexural or inverse
- There may be different treatments tailored to each. About a third of patients also have their joints involved in a condition called psoriatic arthritis.
★ Psoriasis causes
We don’t fully understand the causes of psoriasis, but what we do know is that there is a much faster turnover of skin cells than normal in patients with the condition. The increased production of skin cells results in thick, scaly patches of skin.
There is evidence that this faster regeneration of skin cells is due to an immune system problem called autoimmune disease. This means the body’s immune system (the function of which is to fight off germs invading the body) attacks part of its own body in error, in this case the skin.
What causes this immune problem isn’t clear but research suggests there are genetic factors involved (meaning the condition can sometimes run in families) as well as environmental factors, known as triggers. Common triggers include:
- Injury to the skin
- Certain medications
- Throat and skin infections
- Cold, dry weather
★ Psoriasis treatment
Treatment for psoriasis is focussed on managing the condition, because there is no current cure. The most common form of psoriasis is plaque psoriasis and this is usually treated with topical treatment, which means medicines applied directly onto the skin such as medicated creams or ointments. Usually a combination of moisturisers, steroid creams, vitamin D creams or coal tar preparations will be used. Sometimes specialist doctors will offer phototherapy (a course of certain types of ultraviolet light). If this is ineffective, they may prescribe special medication by mouth or injection, to try to dampen down the immune system.
- Pityriasis rosea
Pityriasis rosea is a harmless condition that causes a short-lived rash on the skin, which can look quite striking. It can happen in anyone but usually affects children and adults under the age of 35. Usually by the time people see a doctor, the rash is widespread, mainly over the torso. The rash looks like small, raised, red scaly patches that are each around 1-2cm in diameter. Sometimes the rash can be itchy, though it isn’t always.
Interestingly, in retrospect people often remember feeling a little unwell before the onset of the rash, with aches and pains or a mild fever. They may also recall seeing what medics call a ‘herald patch’ – a single pink oval patch of scaly skin around 2-10cm diameter, a few days to weeks prior to the widespread rash appearing.
Pityriasis rosea usually resolves any time between 2 to 12 weeks after onset, though sometimes it can last longer.
★ Pityriasis rosea causes
We don’t know what exactly causes pityriasis rosea, though it is currently thought to be triggered by a viral infection of some sort.
★ Pityriasis rosea treatment
There’s no need to treat pityriasis rosea as the symptoms will resolve by themselves over time. However, if the skin feels very itchy, a combination of moisturisers, steroid creams and antihistamines can be used for relief.
- Systemic causes of itchy skin
‘Systemic’ is a word used by medics to mean something that affects the whole body, rather than a single organ or body part. Generalised itching, especially in the absence of any visible rash, can sometimes be the result of a systemic illness, which has caused the build-up of chemicals in the body. This is rare but important to exclude and so it’s advisable to see your doctor. After discussion and examination, they may wish to check for systemic causes by running some blood tests to check for the following conditions:
- Liver disease
- Blood disorders such as anaemia, leukaemia and myeloma
- Kidney disease
- Of course, should any of these be found, treatment will be focussed on the underlying cause.
- Psychological causes of itchy skin
We all know that being stressed or nervous can make us itch and fidget more, but in some conditions this can be part of something more serious. General anxiety, depression and obsessive compulsive disorder can all trigger increasing itching. Treating the underlying cause is key and the itching should resolve in due course.
- Pregnancy and itching
Pregnancy can cause itching. This can simply be due to the tummy skin stretching. There will often not be much to see except possible scratches most commonly across the abdomen.
Very rarely (about 1 in 100 women) it can be more severe and part of a condition called intrahepatic cholestasis of pregnancy that needs medical attention.
The perimenopause can also be linked to itching as hormone levels change.