That itch may be more than dry skin
Experts say irritations can often be overlooked and could signal a medical condition
He was so itchy he couldn’t sleep. He couldn’t focus. He could barely work.
And he still had to do heart surgery.
Dr. Sandy Skotnicki remembers being in residence when a cardiologist visited her clinic complaining of an itch so intense it was ruining his life — and putting his patients in danger.
“He told me: ‘I took my skin for granted, because I can’t do anything right now!’ ” Skotnicki, a dermatologist and assistant professor of medicine at the University of Toronto, told the Star.
Itchy skin is often overlooked and underestimated as a medical condition, but can be debilitating. Its causes are myriad — and on rare occasions, an intense itch can even serve as a warning sign of lifethreatening illness, including organ failure.
“There are very high rates of mental illness in terms of depression and anxiety associated with itchy conditions. Part of that comes from just the pain and frustration (of itchiness),” added Dr. Sameh Hanna, medical director of Toronto’s Dermatology on Bloor and president of the Toronto Dermatological Society.
“It’s an incredibly potent ruiner of lives. People will prefer to have pain than itch — that’s why people will scratch themselves raw.”
What causes itchy skin?
Itchiness is a broad symptom with a great number of factors. According to Skotnicki, its most common cause is eczema — a noncontagious, inflammatory skin condition known for causing scaly rashes and dry, reddened patches of skin.
Other common factors include bug bites as well as hives, a skin reaction characterized by itchy, occasionally red welts that vary in size, she said.
“We can also get itchy in the winter in cold climates like Canada because our skin gets very dry,” Skotnicki continued.
Conditions like psoriasis, a chronic disease impacting about two to three per cent of the total population, is also a common cause, Hanna added.
On rarer occasions, itchiness can be a marker of autoimmune diseases such as bullous diseases, the two explained. These can occur when the body’s immune system mistakenly attacks proteins just under our top layer of skin, leading to blisters and sores.
Recent research also suggests common skin bacteria, such as Staphylococcus aureus, can cause itchiness by directly triggering nerve cells.
Back to the story of the itchy cardiologist, Skotnicki said he was eventually diagnosed with scabies — “probably one of the most itchy things that you can ever experience,” she said.
The condition is caused by microscopic mites that burrow into the skin where they live and lay eggs, leading to a pimple-like rash and intense itching.
“We treated him for it and I remember him coming back and thanking us for it,” she said. “He saves people’s lives and he was just laughing, going: ‘I really took my skin for granted.’ ”
Itchiness can be a symptom of serious illness
These common causes are relatively minor, health-wise. But on rarer occasions, especially for those with a whole-body itch but no rash, it can be a sign of something gone very wrong on the inside.
“I don’t want to scare people, but itch can also be a harbinger of something bad that is going on inside,” including advanced liver or kidney failure, she said.
These organs help filter out a substance called bilirubin, created during the breakdown of red blood cells, that has been found to directly cause itch by binding to sensory neurons. If a buildup of this substance is making you itchy, that can be a flag for organ failure, Skotnicki explained.
“You can also get itchy in pregnancy, and part of that is, again, because the liver is not doing its job properly,” she said. “We have a rule in dermatology. If somebody presents to us with significant itching and no rash, we have to do a workup for internal issues.”
Itching can also be a symptom of diabetes as a result of poor blood sugar control; research suggests itchiness is present in 36 per cent of type two diabetics. So too can it be a symptom of certain types of cancer, especially those of the skin, liver, gallbladder and hematopoietic system, studies show.
Other itches may have nothing to do with the skin at all, but rather issues with one’s nerves — known as a neuropathic itch, Hanna explained.
“As we get older, we can see a narrowing of the vertebrae in the spine, and that can impact our nerves,” he said. “So you can have a nerve sending a signal to the brain, telling the brain that there’s itch and it feels like it’s in the skin, but there’s nothing going on in the skin.”
Injuries, inflammation and arthritis can also cause this. So too can certain mental illnesses, medications and even brain tumours, he continued.
“It’s tough when you can’t see a physical change,” Hanna said. “So they’ll scratch a lot, and then they’ll get changes in the skin because of the scratching, and it’s this kind of vicious cycle.”
How to treat itchy skin
Itchiness isn’t a disease in itself, but a symptom of underlying health issues. Unless these issues are resolved, it’s unlikely the itch would go away on its own, Skotnicki said: “You have to really get at the root cause — all the treatments we have for itching, they don’t really get at the cause. They just sort of make you feel a little bit better.”
It’s important to see your doctor or dermatologist to identify and address the root causes, she said — especially as certain treatments, like antihistamines, work for certain itches (like hives) but not others. But there are general, actionable tips to improve your skin health and avoid itchiness.
“Number one, you want to do things that are not going to further harm the skin,” Hanna explained. “When people bathe or shower, I like gentle cleansers that are not fragranced.
“There are a lot of things that people think are gentle because they have the words ‘natural’ or ‘organic’ on them. That doesn’t mean anything — and often those are the opposite of what you want to do,” he said.
If in doubt, Hanna recommends going by the Canadian Dermatology Association’s list of approved, healthy skin care products.
It’s also helpful to keep showers “warm, not hot” and on the shorter side if possible, he continued. When done, it’s important to lock in moisture by applying a non-fragranced moisturizer. Finally, during the dry winter months, Hanna recommends employing a humidifier in the house, or at least in the room where you sleep.
Over-the-counter medications like antihistamines or topical corticosteroids may provide temporary relief. “But certainly if (an itch is) lasting more than a day or two, it’s worth seeking medical assessment,” he continued.
“People who have been living itch due to a variety of conditions, especially psoriasis, eczema, it’s really worth reaching out,” Hanna said. “Even if they were frustrated in the past by the lack of options. There are increasing options for itch management now that are safe and increasingly effective.”
Itching can also be a symptom of diabetes as a result of poor blood sugar control. So too can it be a symptom of certain types of cancer, especially those of the skin, liver, gallbladder and hematopoietic system