Chronic itching, also known as chronic pruritus, affects more people than is often suspected. Current studies show that up to 17 % of adults are affected. The lifetime prevalence is even around 25 %, and up to 36 % of patients in dermatology practices report itching symptoms. These figures illustrate the extent of the disease.
In order to be able to treat chronic pruritus, it is of central importance to first find the cause, which is often not at all trivial, as the causes are manifold and are often underestimated. While the general public initially associates the symptom of itching with infectious or parasitic diseases, in everyday clinical practice there are usually other underlying triggers. The main causes include
Particularly in the case of chronic pruritus, i.e. pruritus that lasts longer than six weeks, an itch-scratch vicious circle develops. As a result, the original disease that triggered the itching fades into the background and the diagnosis becomes even more difficult.
The development of itching is a highly complex process, which is why we have simplified it here. The cutaneous nerves, the spinal cord and the brain play a central role. The fine nerve endings in the skin register stimuli and transmit them via the spinal cord to the thalamus, where the itch is perceived as unpleasant. The somatosensory cortex then processes the signals and the cerebellum finally triggers the motor reaction - scratching occurs.
However, in order for our fine skin nerves to perceive a signal, there are two main ways in which itching develops in the skin:
The skin nerves are stimulated by various stimuli. This is a physiological reaction and enormously important for our everyday perception via the skin as a sensory organ. However, prolonged scratching can trigger an overactivity of these fine nerves. Researchers have even succeeded in making these skin changes visible in skin samples. However, neuroanatomical changes occur not only in the skin, but also in the spinal cord, as a result of which other stimuli are also perceived as itching. But that's not all, because our brain is also of central importance in the itch-scratch cycle. Here, the itch signals are further amplified and the reward system is activated by the scratching. This activation makes it very difficult or even impossible to refrain from scratching, as the brain rewards scratching with "happiness hormones" every time. All of the above factors and many more lead to a vicious circle in which the urge to scratch becomes increasingly compulsive.
Effective treatment requires professional help. The exchange with specialists and other affected persons offers valuable support.
The treatment of chronic pruritus is individual and requires patience. A step-by-step therapy regimen is used, ranging from topical treatments to systemic approaches. Newer drugs, such as biologics, show promising results.
It is important to provide those affected with comprehensive information about the disease and treatment options. Guidelines, for example from the AWMF, offer evidence-based instructions for doctors*inside and patient*and are updated regularly.
Here is the link to the guidelines, you are welcome to inform yourself! https://register.awmf.org/de/leitlinien/detail/013-048