Is there anything to see? Maybe there is a rash that is red and/or scaly, or maybe there are itchy patches. If so, your doctor should be able to work out the cause.
Is your skin too dry? For an unknown reason, dry skin is itchy skin. This is a particular problem as we get older (MIMS Dermatology 2007;3:40–42). Skin produces its own grease to moisturize the skin, but as we get older less grease is produced. Add to this the effects of soaps and central heating, and skin can become dry, scaly and itchy. Our legs have the fewest grease glands and so are particularly affected, producing a ‘crazy-paving’ appearance. It is most common in the winter (‘winter itch’), because of indoor heating.
Could it be flea bites? Flea bites are usually raised red areas up to 1 cm across. They are usually in groups of three or four. They are often on the neck, lower leg or at the waist (under the waistband of your clothing). Cat fleas are the usual culprits. You can get cat flea bites even if you do not have a cat, because they can remain in a dormant state in carpets for up to 1 year. When people arrive nearby, the vibration wakes them up. So if you move into a house where there were cats previously, the house can suddenly ‘come alive’ with fleas.
Could it be bed bugs? In the UK, bed bugs are becoming much more common. Bed bugs (Cimex lectularius) are flat insects, up to 7 mm long. They cannot fly or jump but can run rapidly. During the day their flat shape enables them to remain hidden in cracks and crevices (such as in beds, behind loose wallpaper and in picture frames). They emerge at night to feed. Feeding takes 4–12 minutes and the insects then return to their hiding places. The most common sign is red, very itchy bites, in a line or group representing repeated feeding by a single insect. You may notice specks of blood on the bed sheets.
Getting rid of bed bugs can be very difficult. Insecticidal treatments should be combined with frequent laundering of bed linens at a high temperature (initially, every day), vacuuming of rooms, and steam cleaning and vacuuming of mattresses.
Could it be scabies? This is the most overlooked cause of itching, and it is becoming more common. It is a strong possibility if anyone else is itchy. Scabies is caused by infection with scabies mites, which are tiny creatures that live on the skin. After mating, the mites tunnel into the skin to make a tiny burrow, often between the fingers or at the wrists, where they live for several weeks and lay their eggs. The eggs hatch within a few days. After about a month, an itchy, scaly rash occurs, which is an allergic reaction to the saliva and faeces of the mites. The rash can be over most of the body, or may be on the finger webs, wrists, elbows, armpits, waist, feet or penis.
The mites cannot fly or jump, but crawl from one person to another. You usually pick up scabies by skin-to-skin contact, such as sharing a bed. Itching is often worse at night. Again, see your doctor to get a diagnosis and treatment.
Is the itch all over, or just in one part of your body? If you are a woman, and the itch is in your genital area, look at the section on vulval itching. If your scalp is itchy, look at the section on head lice and dandruff. If your bottom is the problem, look at the section on anal itching. If the itch is in the groin, read the section on jock itch. If the itching affects only your back, alongside the shoulder blade, you have a condition doctors call ‘notalgia paraesthetica’. It is thought to be caused by trapping of very small nerves in the skin.
Have you recently had shingles? The area affected by shingles can remain itchy for weeks or months, but it will eventually stop.
Does the itching come and go? If so, you may be able to work out the cause. Intermittent raised, red, itchy patches could be ‘urticaria’, a condition that is often the result of an allergy.
Is the itching worse at night? Psoriasis is a skin condition that causes scaly patches. It also causes itching that is worse at night and affects the normal-looking skin as well as the scaly areas (Lancet 2003;361:690–694). Eczema is another skin condition that can cause bothersome itching at night.
Could you be sensitive to something? Nickel in jewellery can cause itching in people who are sensitive to it. The itching, and often a rash, occurs where the jewellery has touched the skin. Chemicals from plants or from the workplace can sometimes cause the skin that has been exposed to the chemical to itch. Working with fibreglass can cause an itchy skin irritation.
Fungal infections such as thrush, ringworm and athlete’s foot can cause itching. Itchy skin is also common in pregnancy and the menopause.
Do you have an itchy pet? If so, it could be fleas (see above) or ‘dog scabies’ (which can affect humans). In the case of dog scabies, your dog would have scaly, bald areas as well as itching.
First published on: embarrassingproblems.com
Reviewed and edited by: Fiona Elliott
Last updated: December 2020