What causes chronic itching

Chronic itching: When the skin goes nuts

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The most puzzling stories are often hidden behind symptoms. For example that of Hermann Bantam *, a passionate hunter. His elbows and knees hurt. The family doctor suspected joint inflammation and prescribed cortisone. The symptoms disappeared and Bantam gradually stopped taking the cortisone. But then the 73-year-old was tweaked all over: "It's like wearing a scratchy wool sweater. In the morning I only put on light clothes, even when it was cold outside." But Bantam's skin was flawless, and his family doctor didn't know what to do next. A case for the itching ambulance at the University Hospital of Münster.

Besides pain, itching is one of the most common symptoms in medicine. Every sixth person in the working population suffers chronically from these complaints, i.e. itching that lasts for more than six weeks. It torments many people no less than chronic pain. Insomnia, exhaustion and depression often push those affected to their limits, and even the risk of suicide for patients with psoriasis or neurodermatitis is significantly increased. But for a long time, itching was considered a triviality among doctors, the "little brother of pain". "At the university, itching has not yet been taught across the board in medical training," says Sonja Ständer. "Pain has a lobby, itching doesn't." The head of the itching clinic has started to change that.

Every year 2,500 patients come to the Competence Center for Chronic Pruritus in Münster because the ointments and medication no longer work or the cause of the plague has not been found. Patients sit in the corridor, iPads on their knees. The task: Over 100 questions have to be answered about the severity, type and duration of the itching, quality of life, previous illnesses and medication taken. All of this is important because itching can have very different causes. There are over 50 possible triggers, and many are non-skin related. The spectrum ranges from insect bites to allergies, metabolic disorders, neurological diseases, side effects of drugs and the early symptoms of cancer, for example lymphoma. In around ten percent of cases, the itching is the result of a disease of internal organs, such as primary biliary cirrhosis, a chronic inflammation of the liver and bile ducts.

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Every year around 500 patients - including Hermann Bantam - are admitted to Münster for more detailed examinations. On a scale from zero (no itching) to ten (most severe itching imaginable), he initially rated his symptoms at four. His yardstick shifted: "When I see some patients here who have scratched themselves very bloody, I'm doing very well," he says.

The doctors at the clinic examined his skin, x-rayed him, measured his internal organs with ultrasound, and took blood and tissue samples from his right lower leg. Finally, Sonja Ständer opened up an astonishing diagnosis to the hunter: the cortisone temporarily caused the blood sugar metabolism to get out of control. Even this brief episode of hypoglycaemia was apparently enough to damage tiny nerve fibers in the skin. That is why they fired with gentle touch. Doctors call it "small fiber neuropathy".

Beginnings of itch research

Beginnings of itch research

The decisive year for modern pain research was 1965. At that time it was discovered how the psyche can influence the transmission of pain stimuli. Although pruritus uses the same nerve fibers, it took another 32 years before a new age began for pruritus research. In 1997, the physiologist Hermann Handwerker discovered its own itch receptors in the skin. In 2005 the International Forum for the Study of Itch was founded in Heidelberg; Among others by Sonja Ständer, who runs an itch ambulance in Münster and fights internationally for research on itching.

The case is an example of how closely itching and pain are related. Neuropathies, which often occur in diabetes, in most cases cause pain instead of itching. Almost all parts of the system that processes pain stimuli in the body are also used by the itching system. They are warning systems: the pain warns of external dangers from which one would rather run away, like thorns or tigers; the itching of small threats in the skin - parasites, plants, allergies - which one turns to scratching. The symptoms are related, yet contradicting one another.