Itching at night
introduction
Nocturnal itching is a symptom of which - especially in the late hours - there is sometimes excruciating itching that is hardly present during the day. Scratching often occurs reflexively, but this often does not provide sufficient relief. Under certain circumstances, the itching can be so severe that the person concerned wakes up.
The reasons
Itching can have various causes. If the itching occurs mainly at night, this can somewhat limit the wide range of possible causes. One of the most common causes of itching at night is scabies, an infestation with scabies mites. Worms also often cause itching, which is particularly noticeable at night or in the early morning hours. The itching is then primarily localized in the anal area.
Numerous other causes can trigger itching, which can occur both during the day and at night. These include a wide variety of skin diseases such as neurodermatitis, psoriasis, hives (urticaria), fungal infections, lice infestation or simply dry skin. Various metabolic diseases such as diabetes mellitus, thyroid dysfunction, hormonal changes such as menopause or pregnancy can also cause itching.
Furthermore, itching can occur in malignant diseases such as various types of lymphoma and leukemia. Diseases of the liver and biliary tract such as hepatitis (inflammation of the liver), pancreatitis (inflammation of the pancreas) or biliary build-up (cholestasis) can also lead to itching. Furthermore, impaired kidney function (chronic kidney failure) and an iron deficiency can be accompanied by itching.
Various mental illnesses - for example schizophrenia, depression, eating disorders or deliria - can also have itching as a symptom. Various allergies can also trigger itching. Furthermore, numerous medications can cause itching.
Find out all about the topic here: itchy skin.
The bed bugs as the cause
Bed bugs are parasites that settle in places where people sleep and feed on human blood. Bed bug infestation can lead to a condition called cimicosis. A key symptom is itching. Since the saliva of the animals contains a kind of local anesthetic, the itching often does not appear immediately after the bedbug bite, but sometimes only hours or days later. Therefore, the itching of a bed bug infestation often does not occur at night but rather in the morning.
The itching is triggered by the bed bug bites, which in turn show up as red spots or pustules. Often several such pustules are relatively close to each other in a straight line. The uncovered parts of the body such as arms, shoulders and face are usually particularly affected.
Read more about the topic here: Bed bugs.
The mites as the cause
There are different types of mites. While house dust mites, for example, are primarily known as allergy triggers, itch mites cause - as their name suggests - so-called scabies. This is a disease that is mainly transmitted through close skin contact. Therefore, scabies outbreaks occur more frequently, especially in care facilities or daycare centers.
Also read the article: Rash from mites.
The scabies as the cause
Scabies is a disease caused by mites - the scabies mites. The mites dig into the upper layers of the skin and lay their eggs there. Scabies mite infestation manifests itself on the skin through a wide variety of rashes, such as papules, pustules, vesicles or wheals.
The most characteristic symptom of scabies is itching, which increases sharply when the bed is warm (i.e. under the covers) and can become very painful. Scabies mites typically attack the spaces between the fingers and toes, the area around the nipples, the genital area, as well as the wrists, armpits and navel area.
For more information, read on: The scabies.
Dry skin as the cause
Dry skin is a common cause of itching. The itching can appear both at night and during the day. Concomitant symptoms may be slight flaking of the skin and - with pronounced scratching - a bacterial infection.
Other accompanying symptoms
Depending on the underlying cause, there can be various accompanying symptoms. These can include, for example, the most varied forms of rash such as pustules, blisters, eczema, hives, flaking or dry skin. If the cause is allergic, symptoms such as runny nose, cough or shortness of breath can occur in addition to a rash.
With malignant diseases, accompanying symptoms such as night sweats, weight loss or swelling of the lymph nodes can occur. Fatigue and physical weakness are also possible accompanying symptoms. If the itching is caused by liver or bile duct disease, the skin or eyes may turn yellow (jaundice). If an iron deficiency is the cause, it often leads to paleness and reduced resilience. Diabetes may increase thirst, urination and weight loss.
The diagnosis
Finding out the underlying cause of the itching is often difficult due to the variety of causes. At the beginning of the diagnosis there is a detailed anamnesis (questioning of the medical history), which is decisive for how long the itching has existed, whether it occurs regularly, when it first appeared, whether it is limited to certain parts of the body, whether contact persons are also affected, whether an accompanying rash occurs, whether certain medications are (new) being taken and what pre-existing diseases and allergies exist.
This is followed by a thorough physical examination. If there is a rash, it often provides clues as to what could be the cause. If no conclusion can be drawn from this, blood tests may be necessary, which can also include various allergy tests if there is justified suspicion of an allergic cause. The synopsis of all the findings often leads to a diagnosis.
The therapy
The treatment of nocturnal itching depends largely on the cause. If the itching occurs due to dry skin, regular - i.e. daily - skin care with a moisturizing and lipid replenishing cream is a measure that can often achieve significant relief. If it is itching in the context of neurodermatitis, daily skin care is also in the foreground. Cortisone ointments can be used in the acute stage. They usually provide rapid symptom relief, but should be used with caution and never permanently.
In the case of allergies as a trigger for the itching, local antihistamine ointments such as Dimetinden (Fenistil ®) can be used first. If this is not enough, antihistamines in tablet form may be necessary. Examples are cetirizine, loratadine or Fenistil ®.
Antiparasitic substances are used for nighttime itching caused by parasite infestation, for example scabies. For scabies, these are applied locally in the form of ointments. If bed bug infestation is present, local ointments are used to relieve the itching. If the symptoms are pronounced, cortisone ointments or antihistamines in tablet form are also used. In the event of a parasite infestation, it is essential to remove the parasites. For this, a meticulous renovation of the living area is necessary. Other therapeutic measures are often necessary for nighttime itching caused by a systemic disease. If diseases of the biliary tract are responsible for the itching, the drug colestyramine is often used.
In the case of itching caused by liver disease or malignant diseases, a therapeutic attempt with the drugs naloxone or naltrexone can be made. Since these are drugs that are antagonists of opioids, they have to be dosed very carefully with existing pain therapy with opioids. Otherwise their pain-relieving effect can be significantly reduced. Some antidepressants - such as venlafaxine or doxepin - can also be used to relieve itching.
Another therapeutic approach in the treatment of itching is the so-called phototherapy, i.e. light therapy. Here, the patients are exposed to special UV light over a certain period of time. This type of therapy is used, for example, for itching in the context of skin diseases such as pronounced neurodermatitis and psoriasis. It is also used for itching in the context of kidney and biliary tract diseases. Psychotherapeutic methods also play an important role, especially when it comes to itching in connection with mental illness.
The duration
Both the duration and the prognosis of nocturnal itching depend largely on the underlying disease. Parasitic pathogens can be effectively eliminated through household cleaning and appropriate skin therapy, which means that the itching can be treated quickly. In chronic skin diseases, itching can occur in recurring attacks, which are interrupted by symptom-free intervals.
With progressive diseases of the liver, kidneys and biliary tract and with malignant diseases, causal therapy is often only possible to a limited extent. The itching can become an agonizing symptom in the long term. Here it is extremely important for those affected that the therapeutic options are used.
The localization
The whole body
Nocturnal itching that occurs all over the body is often a sign of a systemic - that is, the whole body - disease. Possible examples of this are allergic reactions from food, pollen, house dust mites, animal hair or the like.
Diseases of various organs such as hepatitis (inflammation of the liver), cholestasis (biliary congestion) or severe kidney function impairments (renal insufficiency) with urine poisoning (uremia) can lead to itching that occurs all over the body. Likewise diabetes mellitus.
In the genital area
Itching in the genital area can have various causes. The cause can be, for example, infections by bacteria, fungi or parasites. A physical examination, swabs or mucous membrane samples can be used to identify more precisely what type of pathogen is involved. Antibiotics or antimycotics (drugs against fungi) are used therapeutically.
In women, menopause with its hormonal changes can also lead to itching in the genital area. For example, ointments or gels containing hyaluronic acid can have a therapeutic effect here. Alternatively there are creams containing estrogen, vaginal suppositories or tablets which can often significantly reduce the itching. A worm infestation can also lead to itching in the genital area because it is very close to the anus, especially in women.
Also read the article: Itching in the vagina.
On the anus
Itching of the anus can be an indication of poor hygiene. In this case, it is enough to thoroughly cleanse the anus with warm water after each use of the toilet. The itching then usually disappears quickly.
But worms also often lead to itching of the anus. Especially at night there is excruciating itching in the anus and - in women - in the genital area. Sometimes the worms can be seen with the naked eye. In addition to drug therapy with tablets, compliance with hygiene measures is essential.
Itching in the anus? Read on here.
On the legs
Itching of the legs can have several causes. If the itching occurs only on the legs, this may be due to new care products that are only used on the legs. Various skin diseases that only exist in the legs can also be the cause.
However, various other diseases can also cause itching-like symptoms on the legs. These include, for example, the restless leg syndrome, which occurs especially in the evening and night hours, also known as Restless Leg Syndrome (RLS). This leads to tingling, pulling or burning sensations in the legs which lead to a pronounced urge to move. Sleep disorders are often the result. Polyneuropathy, i.e. damage to the nerve endings in the feet and legs, can also lead to itching-like sensations in the legs. Such a polyneuropathy is often caused by diabetes mellitus or chronic excessive alcohol consumption.
Read more about the topic here: Restless Leg Syndrome.
On the arms
Itching that only occurs in the arm area can be caused by dry skin or other skin diseases and allergies. In this sense, there are no specific diseases in which itching occurs exclusively on the arms. Nevertheless, many of the above diseases can cause itching, which is also localized in the arm area.
Also read the article: Skin rash.
On the scrotum
Itching on the scrotum can have different causes. One of the most common reasons is the combination of moisture and warmth, which can occur especially in the summer months. Regular washing and "airing" usually help.
Another cause can be allergic reactions, for example to a new detergent or shower bath. If (under) pants are too tight, the genital area can be chafed, which in turn leads to unpleasant itching. Infections with bacteria or fungi can also cause itching on the scrotum. In this case, therapy with appropriate medication - usually in the form of ointments - must take place.
