Office worker Mr. Kim (48) has been suffering from severe full-body itching every night for more than two months, preventing him from getting a good night's sleep. His arms and legs itched so unbearably that he often wore gloves to bed. However, he attributed it to menopause and did not seek medical attention.

Itching is a common symptom that everyone experiences at some point. However, chronic itching lasting more than six weeks, like in Mr. Kim's case, can be a signal of various diseases rather than just simple skin irritation. Professor Kim Hye-won of the Dermatology Department at Hallym University Kangnam Sacred Heart Hospital stated, “One should not scratch just because it itches. In the case of chronic itching, it is important to quickly receive a medical diagnosis to identify the cause of the condition.”

● Itching, Beyond Simple Discomfort to a Threat to 'Quality of Life'

Itching causes repeated scratching of the skin, damaging the skin barrier and leading to wounds and inflammation. Additionally, it is accompanied by sleep disorders, decreased concentration, and stress, significantly impacting the patient's daily life and social activities.

The main causes can be divided into four categories: dermatological itching, neuropathic itching, systemic cause-related itching, and psychiatric cause-related itching. If itching persists for more than six weeks, it is necessary to identify the underlying cause.

The most common cause of chronic itching is skin diseases such as contact allergies and atopic dermatitis. However, there are many cases where it is caused by systemic diseases such as liver, kidney, thyroid diseases, blood tumors like lymphoma, neurological disorders, iron deficiency anemia, and dermatomyositis. Particularly in the elderly, itching commonly occurs due to chronic diseases like diabetes or medication use. However, it is often dismissed as simple skin dryness or aging, leading to reliance solely on steroid ointments without timely medical consultation.

Additionally, 'idiopathic itching,' where the cause is unknown, should not be overlooked. Professor Kim noted, “According to a Danish study, patients with unexplained itching were 2.7 times more likely to be diagnosed with lymphoma or other solid cancers within three months compared to the general adult population,” adding, “If itching persists for more than six weeks without a clear cause and does not respond to treatment, it is important to undergo a detailed examination at a dermatology clinic specializing in itching, rather than just taking temporary medication.”

● New Drugs and Treatment Methods Increase Effectiveness

Itching treatment should be approached individually based on the cause and the patient's condition. Recently, with the development of various new drugs and treatment methods, the effectiveness of treatment has increased. Antihistamines are the most commonly used systemic treatment. They are effective for itching caused by histamine, such as urticaria or atopic dermatitis, and second-generation antihistamines with fewer side effects are mainly used.

Steroids are effective for itching caused by inflammation and skin thickening (lichenification). Recently, non-steroidal ointments have been developed, allowing for periodic use without concerns about steroid side effects, and treatment agents can be selected according to individual skin conditions and symptoms. Additionally, for some patients, antidepressants, neuropathic drugs (such as gabapentin), and opioid receptor antagonists (such as naloxone) may be helpful.

Phototherapy (phototherapy) has been used for decades in the treatment of itching, with 'narrowband UVB' being a representative method. It is effective not only for chronic skin diseases like atopic dermatitis, psoriasis, and vitiligo but also for systemic itching in dialysis patients. During treatment, patients expose themselves to ultraviolet rays while protecting only their face, and it is safe for pregnant women.

Excimer lasers are used for localized lesions, applicable to various conditions such as atopic dermatitis, vitiligo, psoriasis, alopecia areata, and hyperkeratotic hand eczema. Lastly, new treatments are also gaining attention. Immunosuppressants, targeted therapies, and biologics are being developed for patients who have not improved with existing treatments, maximizing therapeutic effects by directly modulating specific immune pathways. These new drugs provide new hope for patients with chronic refractory itching, as their clinical efficacy is widely proven in severe itching conditions like nodular prurigo.

● Avoid Scratching Itchy Areas and Opt for Customized Treatment

Managing lifestyle habits is essential for alleviating itching. Basic rules include △using moisturizers once or twice a day △taking short showers with lukewarm water and moisturizing immediately afterward △avoiding sweat, dust, and irritating fabrics △minimizing the use of detergents and scented products △maintaining a comfortable indoor temperature. Additionally, avoiding food allergies, stress, and medications that can exacerbate symptoms is necessary depending on individual circumstances. In severe cases, keeping an itch diary can help identify the cause.

Professor Kim emphasized, “Itching is not just a simple symptom but an important signal that requires identifying the cause,” adding, “One should avoid scratching itchy areas and aim to regain a comfortable life through customized treatments such as phototherapy, targeted therapies, and biologics.”

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