2024-02-13 02:00:18
Having unexplained itching that comes on regularly, with no noticeable skin abnormality, is no fun. What could that be?
Laura TenretFebruary 13, 2024, 3:00 am
A 64-year-old woman has had severe and unexplained itching on her shoulder blade for years. “The funny thing is that this is mainly in the evening, when I get ready for the night and change my sweater, blouse or T-shirt for nightwear.” There is nothing to discover on the skin itself, which looks flawless, without a bump, pimple or discoloration. It’s nice that scratching helps, but what could that inexplicable itch on her shoulder blade be?
According to Bing Thio, a dermatologist at Erasmus MC in Rotterdam whose expertise is itching, you can see it as a danger signal for your body. “Itching acts like an alarm bell that indicates: something is wrong. By scratching you go to the place where danger threatens, for example to scare away an animal.”
The only place where itching can be felt is the skin, which contains more than a million tiny nerve endings. Suppose you have been bitten by a mosquito. The itch signal enters the skin via nerve endings, where it is transmitted as an electrical signal to the brain via the nerve system in the spinal cord. They translate that signal as an itch.
“Itching, like pain, is neuroimmunological. ‘Neuro’ stands for nerves and ‘immunological’ has to do with the immune system. So both the immune system and the brain are involved. Yet it is different from pain. This is another red flag: pain tells your body to retreat instead of going out and scratching. For example, if you get something hot against your arm, you also withdraw your arm.”
In addition to external influences such as insects and plants, itching can generally be caused by a skin or nerve disease, an internal condition such as the liver or kidneys or cancer or a psychiatric condition such as depression. Itching is also atopic, meaning that certain people may overreact to certain foods or clothing.
Thio therefore advises the woman to check whether she had atopic conditions such as eczema, hay fever or asthma in her childhood. You may also experience more itching as you get older: with age, not only does the skin age, but the immune system also deteriorates.
Nekhernia
But that mainly concerns itching all over the body. Local itching may indicate something else. In the case of the shoulder blade, especially without a noticeable skin abnormality, it could be a neck hernia, according to Thio. “The itching is then caused by spinal problems that irritate the nerves. For example, a car accident in the past could have caused this. Go to the doctor, who can determine whether it is a neck hernia.”
It is not surprising that someone especially itches in the evening. “During the day your brain has distractions, but at night you are less in your head and feel more.” Whatever the cause, there are numerous ointments and tablets to get rid of it: from antihistamine pills to low doses of antidepressants or anti-psychotic medications.
Scratching hard doesn’t do any harm, says Thio. “Scratching an itch is so tasty and addictive: the reward center in the brain is activated. In principle, you don’t have to worry about scratching an itch. Scratches generally heal within two weeks.”
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