Other accompanying symptoms
Depending on the underlying cause, there can be different accompanying symptoms. These may include, for example, various forms of rash such as pustules, blisters, eczema, hives, scaling or dry skin. If the cause is an allergic reaction, symptoms such as a cold, cough or shortness of breath can occur in addition to rashes.
Malignant diseases may be accompanied by accompanying symptoms such as night sweats, weight loss or swelling of the lymph nodes.Fatigue and physical weakness are also possible accompanying symptoms. Liver or bile duct diseases as the cause of itching can lead to yellowing of the skin or eyes (icterus), among other things. If an iron deficiency is the cause, paleness and reduced resilience often occur. Diabetes can lead to increased thirst, increased urination and weight loss.
The diagnosis
Finding out what causes itching is often difficult due to the variety of causes. At the beginning of the diagnosis there is a detailed anamnesis (questioning of the medical history) where it is decisive how long the itching has already existed, whether it occurs regularly, when it first appeared, whether it is limited to certain parts of the body, whether contact persons are also affected, whether an accompanying rash occurs, whether certain medications are (newly) taken and which previous illnesses and allergies exist. A thorough physical examination follows.
If there is a rash, it often gives an indication of what the cause could be. If no conclusion can be drawn from this, blood tests may be necessary. If there is a reasonable suspicion of an allergic cause, various allergy tests may also be included. A summary of all the findings often leads to a diagnosis.
The Therapy
The treatment of nocturnal itching depends largely on the cause. If it is itching due to dry skin, regular – i.e. daily – skin care with a moisturizing and refatting cream is a measure that can often achieve significant relief. If it is itching due to neurodermatitis, daily skin care is also a priority.
Cortisone ointments can be used in the acute stage. They usually lead to a quick relief of the symptoms, but should be used with caution and never permanently. If allergies are the trigger for itching, local antihistaminic ointments such as Dimetinden (Fenistil ®) can be used first.
If this is not sufficient, the use of antihistamines in tablet form may be necessary. Examples are cetirizine, loratadine or Fenistil ®. Antiparasitic substances are used in cases of nocturnal itching caused by parasite infestation, for example scabies.
For scabies, these are applied locally in ointment form. If there is an infestation of bedbugs, local ointments are used to alleviate the itching. For pronounced symptoms, cortisone ointments or antihistamines in tablet form are also used.
Essential with parasite infestation is the removal of the parasites. For this a meticulous renovation of the living environment is necessary. In case of itching at night, which is caused by a systemic disease, other therapeutic measures are often necessary.
If diseases of the bile ducts are responsible for the itching, the drug colestyramine is often used. If itching is caused by liver diseases or malignant diseases, an attempt at therapy with the drugs naloxone or naltrexone can be made. Since these are drugs that are antagonists of opioids, they must be dosed very carefully in existing pain therapy with opioids.
Otherwise, their pain-relieving effect can be significantly reduced. Some antidepressants – such as venlafaxine or doxepin – can also be used to relieve itching. Another therapeutic approach in the treatment of itching is the so-called phototherapy, i.e. light therapy.
Here, the patients are exposed to special UV light for a certain period of time in a controlled manner. This type of therapy is used, for example, for itching in the context of skin diseases such as pronounced neurodermatitis and psoriasis. It is also used for itching in the context of kidney diseases and bile duct diseases. Psychotherapeutic methods also play an important role, especially for itching in the context of mental illness.
