Itch differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Ogechukwu Hannah Nnabude, MD
Overview
There is a very broad differential diagnosis for itching due to an extensive list of possible causes. Itching may be due to dermatologic disease, systemic disease, reactions to chemicals and medications, weather, or psychiatric disease. Symptoms, laboratory findings and other diagnostic tests can help narrow down the list.
Differentiating the Possible Causes of Itching
| Cause | Examples | Sypmtoms | Diagnostic Testing | Other Notes |
|---|---|---|---|---|
| Skin Disease | Scabies, eczema, athlete's foot, Dandruff, sunburn |
Itching in the affected area, characteristic lesions depending on the cause e.g erythema of sun exposed regions in the case of sunburn, erythema, edema, and papules on extensor surfaces as seen in eczema |
May be diagnosed clinically, via skin scrappings with microscopy |
Most are associated with hygiene and exposure to agents that induce skin reactions. |
| Systemic Disease | diabetes mellitus, cholestasis, Hodgkin's lymphoma, uremia, thyroid disease |
Itching is often more generalized, there may be a history of nightsweats, enlarged spleen and weight loss as in Hodgkin's lymphoma, elevated glucose, red blood cells, bilirubin, or creatinine or there may be a history of increased or decreased TSH |
complete blood count, lymph node biopsy, comprehensive metabolic panel, TSH and free T4 levels |
Systemic finding are usually seen as well |
| Skin Disease | Scabies, eczema, athlete's foot, Dandruff, sunburn polycythemia vera |
Itching in the affected area, characteristic lesions depending on the cause e.g erythema of sun exposed regions in the case of sunburn, erythema, edema, and papules on extensor surfaces as seen in eczema |
May be diagnosed clinically, via skin scrappings with microscopy |
Most are associated with hygiene and exposure to agents that induce skin reactions. |
| Skin Disease | Scabies, eczema, athlete's foot, Dandruff, sunburn |
Itching in the affected area, characteristic lesions depending on the cause e.g erythema of sun exposed regions in the case of sunburn, erythema, edema, and papules on extensor surfaces as seen in eczema |
May be diagnosed clinically, via skin scrappings with microscopy |
Most are associated with hygiene and exposure to agents that induce skin reactions. |
Differentiating Pain and Itch
Sensations Associated with Scratching
Pain and itch have very different behavioral response patterns. Pain evokes a withdrawal reflex which leads to retraction and therefore a reaction trying to protect an endangered part of the body. Itch creates a scratching reflex that draws one to the affected skin site. For example, responding to a local itch sensation is an effective way to remove insects on the skin. Scratching has traditionally been regarded as a way to relieve oneself by reducing the annoying itch sensation. However, there are hedonic aspects of scratching as one would find noxious scratching highly pleasurable.[1] This can be problematic with chronic itch patients, such as ones with atopic dermatitis, who may scratch affected spots until it no longer produces a pleasant or painful sensation instead of when the itch sensation disappears.[2] It has been hypothesized that motivational aspects of scratching include the frontal brain areas of reward and decision making. These aspects might therefore contribute to the compulsive nature of itch and scratching.[1]
Contagious Itch
Events of “contagious itch” are very common occurrences. Even a discussion on the topic of itch can give one the desire to scratch. Itch is likely more than a localized phenomenon in the place we scratch. Results from a recent study showed that itching and scratching were induced purely by visual stimuli in a public lecture on itching. There is currently little detailed data on central activation for contagious itching but it is hypothesized that a human mirror neuron system exists in which we imitate certain motor actions when we view others performing the same action. A similar phenomenon in which mirror neurons are used to explain the cause is contagious yawning.[1]