Neuropathic Itch and Why Scratching Doesn't Help

Not all itches are the same. A neurological itch, also known as a neuropathic itch, is a type of itch under the skin that you can't scratch to relieve because it is caused by nerve damage rather than issues related to the skin. The itch tends to be chronic (persistent) and often difficult to treat.

Nerve damage leading to neuropathic itch can be caused by diabetes, shingles, and a number of other conditions.

This article explores how a neuropathic itch differs from other types of itches and discusses the symptoms, causes, and treatment options.

Potential Causes of Neurological Itch

Verywell / Laura Porter

Causes of Neuropathic Itch

There are many things that can cause neuropathic itching. The itching may be a result of the neuropathic pain disorder (a painful condition caused by neurological lesions or diseases) or it may be the primary or sole symptom.

Some of the common causes of neuropathic itching include:

  • Shingles: Some people can have persistent nerve damage (post-herpetic neuralgia) long after the shingles rash clears, causing itching and other symptoms that can last for months or even years.
  • Trigeminal trophic syndrome: This is a condition caused by the misfiring of the trigeminal nerve that relays signals from the face to the brain. Chronic itching is the main symptom.
  • Brachioradial pruritis: This is a type of chronic itch that usually affects the arms and may be related to sun exposure.
  • Notalgia paresthetica: This common condition often occurs in adults. It mainly causes intense itching, burning, or tingling usually on the inner part of the shoulder blade and spine.
  • Spinal cord lesions: Different types of lesions, including neurofibromas (a type of tumor) and cavernous hemangiomas (an abnormal cluster of blood vessels) can cause chronic itching on unrelated parts of the body.
  • Brain lesionsStroke, multiple sclerosis, and other conditions that cause brain damage are also known to cause chronic itching on other parts of the body.
  • Diabetes: Diabetes-related itching can be caused by diabetic peripheral neuropathy—a complication of diabetes that develops when chronic high blood sugar levels cause damage to nerves, especially in the hands and feet.
  • Liver diseases: Itchy skin can be a symptom of certain types of liver disease, such as primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), and hepatitis C.

Neuropathic itching is often accompanied by nerve pain and tends to get worse with scratching.

What Does Neuropathic Itch Feel Like?

Neuropathic itching differs from other types of itching in that it can often happen along with neuropathic pain. This is because the disorders that cause neuropathic itching affect the same nerve pathways that cause neuropathic pain.

Neuropathic itching can have the following symptoms with or without increased or decreased skin sensitivity.

  • Stinging
  • Tingling
  • Electric-like shocks
  • Crawling
  • Trickling
  • Pain

Unlike with some other types of itching, scratching can actually make neuropathic itching worse.

Other Types of Itching

There are several types of itch. They differ in their causes and from which part of the nervous system they originate. This includes the central nervous system (made up of the brain and spinal cord) and the peripheral nervous system (involving nerves outside of the brain and spinal cord).

Neurological (neuropathic) itch is a chronic itch caused by nerve damage. It can involve either the central nervous system or the peripheral nervous system. The other three basic types of itch are as follows:

  • Pruriceptive itch: This is an itch that starts in peripheral nerves in the skin. It can be caused by an allergic reaction, inflammation, skin dryness, or other skin damage.
  • Psychogenic itch: This is a type of itch usually linked to mental illnesses, such as delirium.
  • Neurogenic itch: This is a type of chronic itch that originates in the central nervous system and is caused by organ diseases like kidney failure or cirrhosis.

How Is Neuropathic Itch Diagnosed?

Neuropathic itch can be challenging to diagnose. A healthcare provider will want to know about your medical history and will perform a physical examination to look for characteristic signs of neuropathic itch and to rule out other causes. Lab tests, a skin biopsy, and a radiological exam (MRI or CT) may be needed to confirm the diagnosis.

Treatment

Neuropathic itching is difficult to treat. Typical anti-itch remedies like antihistamines or topical steroids are usually of little to no help. Some conditions like trigeminal trophic syndrome don't respond well to treatment, such that people may need to wear protective gloves to avoid injuring themselves by scratching.

Home Remedies

Home remedies for neuropathic itch focus on preventing scratching. Scratching an itch can cause lesions, and lesions can itch themselves. When you're sleeping or not paying attention, scratching can get particularly bad.

Try these tips to reduce scratching injuries:

  • Cut your fingernails.
  • Wear mittens or gloves to bed.
  • Use moisturizer to keep your skin hydrated.

Medical Treatments

Healthcare providers will often first recommend conservative therapies before moving on to more complex treatments. Treatment for neuropathic itch may include:

  • Ice application, which is especially helpful with brachioradial pruritus
  • Topical capsaicin, a pepper-based cream applied to the skin
  • Topical lidocaine, a type of anesthetic applied to the skin
  • Antiseizure drugs like gabapentin and pregabalin (Lyrica)
  • Antidepressant drugs like amitriptyline (Elavil) and duloxetine (Cymbalta)
  • Thalidomide, a drug used to treat certain cancers
  • Botox injections, used to dull nerve signals
  • Nerve blocks, used to temporarily block nerve signals
  • Neurostimulation, electrical or magnetic devices that help treat nerve dysfunction
  • Mind-body therapies to reduce your psychological response to itching

How Long Does Neuropathic Itching Last?

It's hard to predict exactly how long neuropathic itching lasts. Neuropathic itch is often chronic, meaning that it tends not to go away. Treatment of the underlying condition may reduce or prevent symptoms.

Summary

A neurological itch (also called neuropathic itch) is caused by injury to nerve fibers in the brain, spinal cord, skin, or other parts of the body. Unlike many other types of itch, neuropathic itches often involve nerve pain and often get more intense the more you scratch.

The causes of neuropathic itching are many and often difficult to treat. Treatment options range from ice application and over-the-counter creams to more complex therapies, like anti-seizure drugs and Botox injections.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Peter Pressman, MD
Peter Pressman, MD, is a board-certified neurologist developing new ways to diagnose and care for people with neurocognitive disorders.