A neuropathic itch is an itch that results from nervous system damage rather than issues with the skin. There are many causes of neuropathic itch, including stroke, diabetes, and shingles.
Itches are a common feeling and are typically the result of disruption to the skin barrier. However, nerve damage can lead to itching sensations too. Doctors refer to this as a neuropathic itch.
Below, we look at the symptoms, causes, and treatment of neuropathic itch. We also discuss the outlook for people with this condition.
A neuropathic itch happens
Nerve damage can be the result of direct trauma injuries or several different chronic health conditions, such as multiple sclerosis, spinal cord compression, and alcohol-induced neuropathy.
A neuropathic itch may produce an itching sensation or a feeling of pins and needles. The itching may be very severe.
A neuropathic itch may also produce the following sensations:
- burning
- wetness
- electric shocks
- numbness and tingling
- crawling
- severe cold
Some people with neuropathic itch may also experience other symptoms, such as:
- prickling and chilling of the skin
- increase in skin sensitivity
- decrease in skin sensitivity
In people with neuropathic itch, scratching can also make the itch worse.
There is very little understanding of the bodily mechanisms that create itching sensations.
Lesions in the nervous system that damage itch-related neurons may cause neuropathic itch. Conditions and diseases that may cause neuropathic itch include:
- notalgia paresthetica
- brachioradial pruritus
- peripheral neuropathy, which can occur in diabetes
- nerve irritation
- shingles
- stroke
- vitamin deficiencies
toxin exposure - trigeminal trophic syndrome
- burns or keloids
- spinal tumor
- brain tumor
- inflammatory disorders, such as lupus, sarcoidosis, and Sjogren’s syndrome
- multiple sclerosis
Doctors may have difficulty diagnosing neuropathic itch, as they may initially assume that the problem is skin related because skin conditions are a much more common cause of itching.
However, a dermatologist can rule out any dermatological causes of itching.
Doctors usually prescribe topical treatments to people who present with itching. They may suspect neuropathic itch when these treatments do not work.
Doctors may perform a skin biopsy when the cause of persistent skin symptoms is unknown. If the cause of a persistent itch isn’t known, a skin biopsy can sometimes be part of the diagnostic process.
Treating neuropathic itch is difficult as many anti-itch medications may not provide relief.
Treatments typically involve local anesthetics or physical barriers to prevent scratching, as scratching too much or too hard can cause painful lesions or other unintentional self-injury.
Other treatments and therapies may include:
- Topical medications, such as lidocaine creams or patches.
- Oral medications, including anti-seizure drugs and some antidepressants.
- Injections such as botox and certain anesthetics.
- Complementary therapies such as neurostimulation techniques and acupuncture.
- Therapeutic practices such as meditation, mindfulness, and cognitive behavioral therapy (CBT).
Other behavioral interventions may include:
- cutting the fingernails
- wearing protective garments
- applying moisturizer regularly
- avoiding warm or hot temperatures
- wearing loose clothing
There is no research on the associated risk factors for neuropathic itch. It is possible for two people to have the same health condition and only one of them experience neuropathic itch as a symptom.
In some people, the nervous system injury also causes loss of sensation, meaning they would not be able to feel the injuries they can cause from excessive scratching.
Skin changes due to constant itching can also occur. If people scratch so much that they break the skin, this can also lead to an infection.
It can be challenging for people to cope with neuropathic itch. Although an itch may seem innocuous to many people, being unable to find relief from chronic, severe itching can significantly affect a person’s quality of life.
For instance, it can impair their ability to sleep and perform regular activities.
As neuropathic itch is difficult to treat, managing the condition often involves taking measures to prevent scratching.
People with this type of chronic pain may benefit from joining a support group or attending therapy sessions.
People who end up scratching vigorously in their sleep, for example, may need to protect the skin by covering it with a helmet or bandages.
A neuropathic itch is an itching sensation that results from nerve damage, rather than alterations to the skin. Several conditions can cause neuropathic itch, including multiple sclerosis, peripheral neuropathy, and stroke.
As a result, people experiencing neuropathic itch may need a diagnosis and treatment from several different physicians, including a primary care doctor, neurologist, dermatologist, or rheumatologist.
Treating the underlying cause can often resolve symptoms. However, oral, topical, and injectable medications can all provide short-term relief of symptoms.