For more than 50 years Martyn Pring’s life was dominated by an ‘uncontrollable’ urge to itch – and nothing doctors suggested seemed to help.
It began after a bout of German measles when he was two, and from then on Martyn, now in his sixties, would regularly be overcome by an urge to scratch at his skin until it was raw and bleeding.
The sensation affected every part of his body except his face, regularly interrupting his sleep, and even as an adult he would have to wear mittens to bed to try and stop his incessant scratching.
‘I was tried on every emollient cream [medical moisturiser], lotion and medicine out there but nothing worked,’ says Martyn, a university researcher and author, who lives with his wife in Swanage, Dorset.
‘I was hospitalised with the itching for two weeks on more than one occasion.
Martyn Pring suffered chronic itching for more than 50 years, from the age of two
‘I would be covered in bandages and bathed in emollient creams [medical moisturisers] and I was so tightly bandaged I had to stay in bed.
‘But the itching always returned.’
It was in 2018 – more than five decades after the itching, diagnosed as eczema, began – that his dermatologist suggested Martyn go on a clinical trial of a new treatment called dupilumab (brand name Dupixent). This treatment may be given to patients whose eczema hasn’t responded to other treatments, and works by stopping the immune system overreacting, reducing inflammation.
For Martyn the jabs he’s now given every fortnight at his GP surgery have ‘changed my life in a way I can’t describe’.
‘No one knows how unbearable chronic itching is until you go through it,’ he adds.
Around one in six (17 per cent of us) is plagued by a generalised itch (all over the body, rather than in one spot) without an obvious skin condition – this figure is thought to rise to half of older people, according to the Primary Care Dermatology Society.
The causes vary from allergies to liver or kidney problems, diabetes and in rare cases, cancer.
Last year, scientists at Harvard Medical School found a common microbe that lives on the skin — Staphylococcus aureus — could be responsible for the persistent itch suffered by those with skin conditions such as eczema.
Their research, based on animal studies, revealed that the microbe, which normally lives harmlessly on around 30 per cent of people, may be found in higher quantities in some people with eczema. They release a chemical, protease V8, which activates a protein (PAR1) on the skin nerves: once activated it transmits signals from the skin to the brain resulting in the urge to scratch.
Conditions such as eczema, hives and psoriasis, also cause inflammation, which results in chemicals being released by immune cells known as cytokines – they recruit other immune cells to the site, prompting nerve cells in the skin to message the brain, triggering an itching sensation, explains Dr Haytham Al-Rawi, a consultant dermatologist at University Hospitals Birmingham NHS Foundation Trust.
As for people who don’t have a skin condition, the most common cause of itching is dry skin, explains Dr Elise Kleyn, a consultant dermatologist at Salford Royal NHS Foundation Trist and spokesman for the British Association of Dermatologists.
That’s because dry skin is due to a compromised skin barrier, making it susceptible to irritation, she says.
Some women feel their skin is itchier during and after the menopause, too, as the drop in protective oestrogen levels can make it drier.
Whatever the cause there’s a good reason not to scratch an itch as the more you scratch, the more you irritate the skin – making it itchier still.
‘This is known as positive feedback cycle,’ says Dr Al-Rawi. Instead he advises applying something cool to the area. (Cooling acts on certain nerve fibres, encouraging them to send soothing signals to the brain.)
The risk is that scratching can make the issue chronic, as the nerves may become hypersensitive so ‘something which wouldn’t typically cause itch – such as pressure or touch – can trigger a response and cause generalised itching’, says Dr Al-Rawi.
Alison MacColl developed an itch on her left foot after she gave birth, which remains 12 years on
Alison MacColl can relate to this. The mother of two developed a distracting itch around the arch of her left foot after the birth of her daughter Iona – and 12 years later still has an itch in exactly the same spot.
At first, she assumed it was heat-related, as it was summertime. ‘I was so busy focusing on my baby that I didn’t think much of it,’ recalls Alison, 57, an aromatherapist who lives with her husband Alistair, 57, a lawyer, their daughter Iona, and ten-year-old son, Angus, in East Kilbride in Scotland.
Alison admits her scratching made matters worse, with the skin on her foot becoming red and a golf-ball sized blister forming. ‘It continued to itch until the blister burst,’ she says.
When the aggravating cycle continued for a year, Alison saw her GP who prescribed an anti-fungal cream, which made no difference.
Over the next few years she returned to her doctor three times.
She was given antihistamine cream in case it was caused by an allergy and a hydrocortisone cream (containing steroids) – neither helped. Finally, a stronger hydrocortisone ointment proved effective, and she now uses it sparingly for flare-ups.
The cause of Alison’s itch has yet to be pinpointed but it appears to be a simple case of itchiness, but that’s not always the case. Generalised itching without a skin condition ‘could indicate an underlying issue such as kidney disease or liver problems so should be investigated’, says Dr Al-Rawi, who is also a consultant dermatologist at the Spire Little Aston Hospital.
Kidney problems lead to itching – as waste products build up in the blood, irritating the nerve endings and triggering the ‘itch response’. An unexplained itch can also be a sign of kidney failure alongside anaemia, tiredness and nausea, says Dr Al-Rawi.
Itchy skin can also point to a poorly-functioning liver, he adds – as it struggles to clear bile salts from the blood, they accumulate under the skin, irritating nerve endings.
This can be due to liver disease or can also occur in the later stages of pregnancy, when the liver may not be working as well as usual.
Your GP may suggest blood tests to rule out this or other itching triggers such as iron-deficiency anaemia, thyroid problems, and coeliac disease (an autoimmune condition with symptoms triggered by eating gluten) – but it’s not fully understood how these cause itching.
A blood test can also be used to diagnose diabetes which can cause itching because high blood sugar levels make the nerve endings more sensitive.
Medication, such as opioids (morphine and codeine), may result in an itch, possibly because they cause excess histamine to be released – the chemical then attaches to mast cells that cause blood vessels to expand and the surrounding skin to become itchy.
Itching can be a symptom of cancers of the blood or lymph nodes – caused by irritation to nerve endings from the cytokines released by the immune system in response to the cancer. ‘There will usually be other symptoms such as weight loss and night sweats,’ says Dr Al-Rawi.
People with anxiety or obsessive compulsive disorder can also experience itching, it’s thought due to a habit or coping mechanism for stress.
While itching due to a specific medical condition can be eased by treating that condition, it can be challenging to treat an itch where no underlying cause is found, says Dr Al-Rawi.
Moisturising creams are the first line of treatment – the next step is steroid creams and antihistamines (the chemical histamine is released when there is inflammation on the skin, triggering the itch sensation).
Light therapy – in the form of exposure to UV light in a booth for a few minutes three times a week for around 10 weeks – can work because ultraviolet light calms the immune system, reducing the inflammatory response.
Sometimes certain antidepressants, such as amitriptyline, are prescribed at a low dose because they reduce the sensitivity of nerve endings.
If persistent itching is significantly affecting someone’s quality of life, immunosuppressants such as methotrexate or ciclosporin can be given, and the last resort – due to the cost – is biologic drugs which target the immune response, such as nemolizumab.
‘These novel therapies are very expensive, but they’re the future of medicine – they’ve revolutionised treatment for psoriasis, they’re helping people with eczema and hives, and they’ve reportedly helped with generalised itching,’ says Dr Al-Rawi. They work by targeting specific pathways of the immune system, reducing the inflammatory process at an early stage.
Researchers continue to look into new treatments. A new immunotherapy treatment for severe atopic dermatitis and eczema, nemolizumab, which blocks protein Interleukin-31 (IL-31) is being trialled in the UK. IL-31, normally released by the immune system to fight off disease-causing organisms, causes both the urge to itch and skin inflammation whenever we get an itch.
But could itching sometimes be a good thing?
Certainly there’s a reason some people love a good back scratch – it triggers the release of feel-good hormones such as serotonin, says Dr Bernard Ho, a consultant dermatologist at St George’s Hospital, London, and spokesman for the British Skin Foundation.
Itching around a scar after surgery can be a positive sign, indicating that the nerves are regenerating and that it’s therefore starting to heal.
As for Alison, her itch still comes and goes but she has managed to identify certain triggers, including alcohol and chocolate.
‘I had flare ups after eating chocolate eggs at Easter – some people might get spots on their face from chocolate, but I get an itchy foot.
‘But fortunately I’ve learned to keep it under control.’
Additional reporting: Julie Cook
