What Can You Do About Chronic Itch? Integrative Western and Traditional Chinese Medicine Approaches to Finding the Real Cause
Q: What is chronic itch, and why can it be so distressing?
A: Chronic itch may arise from skin disorders, systemic diseases, neurological or psychological conditions, or medication side effects. Both Western medicine and Traditional Chinese Medicine (TCM) offer treatment strategies—including medications, dietary therapy, environmental adjustments, and lifestyle modifications—to reduce flare-ups and improve comfort.
Have you ever been so itchy that you felt like climbing the walls? A playful tickle from a loved one may feel affectionate, but sudden, relentless itching all over the body can be utterly miserable.
According to the International Forum for the Study of Itch (IFSI), an unpleasant skin sensation that persists for more than six weeks and triggers the urge to scratch is classified as chronic itch.
Studies have reported a prevalence of approximately 16% among German workers and about 8% in Norway. Overall, chronic itch affects roughly 8.4% to 13.5% of the population. The condition becomes increasingly common with age, affecting an estimated 10% to 40% of older adults. This increase is believed to be related to age-related degeneration of the nervous system, including reduced itch-inhibiting mechanisms and declining immune function.
Chronic itch can significantly impair quality of life and has been associated with sexual dysfunction, depression, and sleep disturbances. In aging societies such as Taiwan, it has become an increasingly important public health concern.
Q: How do itch-related problems differ between women and men?
A: Sex differences play an important role in itching disorders. Women often experience itching accompanied by stinging, burning, or painful sensations, while men are more likely to develop itch associated with skin lesions or systemic illnesses.
Women are particularly prone to vulvar itching:
- Before puberty, it is commonly associated with contact dermatitis, atopic dermatitis, or psoriasis.
- During reproductive years, it is often linked to Candida infections or lichenified eczema.
- After menopause, it is frequently related to atrophic vaginitis.
At any stage of life, consuming Job’s tears (Coix seeds) may be beneficial. Coix seeds are rich in soluble fiber, protein, healthy fats, vitamin B1, calcium, phosphorus, and iron, and may help with edema, muscle cramps, and certain skin conditions.
After menopause, foods such as Chinese yam or dodder seed may help alleviate vaginal dryness. Nourishing foods that support the liver, kidneys, and blood may also be considered, such as:
- Goji berries 10 g
- Dong quai (Angelica sinensis) 10 g
- Donkey-hide gelatin (Ejiao) 10 g
- White peony root 10 g
These may be taken twice daily.
Global warming is also expected to increase the prevalence of atopic dermatitis. Individuals with this condition may benefit from consuming mung beans, which are traditionally used to help clear dampness and promote fluid metabolism.
Q: What are the common causes of chronic itch?
A: Chronic itch can result from skin diseases such as psoriasis, scabies, and atopic dermatitis. It may also be caused by neurological disorders, psychiatric conditions, or certain medications.
1. Systemic Causes
- Pregnancy
- Most common during late pregnancy
- Often associated with intrahepatic cholestasis
- Chronic Kidney Disease
- Uremic toxins may trigger itching
- Malignancy
- Lymphoproliferative disorders
- Myeloproliferative disorders
- Solid tumors (less commonly)
- Infectious Diseases
- Hepatitis B
- Hepatitis C
- HIV infection
- Rheumatologic and Autoimmune Diseases
- Scleroderma
- Primary Sjögren’s syndrome
- Hepatobiliary Diseases
- Primary or secondary sclerosing cholangitis
- Primary biliary cholangitis
- Metabolic and Endocrine Disorders
- Hyperthyroidism or hypothyroidism
- Hyperparathyroidism
- Iron deficiency
- Diabetes mellitus
2. Neurological Causes
- Brain tumors
- Multiple sclerosis
- Postherpetic neuralgia
3. Psychological Causes
- Depression and anxiety
- Compulsive scratching disorder
- Delusional itch disorder
4. Medication-Related Causes
- Antihypertensive medications
- Angiotensin-converting enzyme (ACE) inhibitors
- Antibiotics
- EGFR inhibitors
- Targeted therapies commonly used for lung cancer
- Retinoids
- Opioid medications
Q: Why are people with HIV or shingles more likely to experience itching?
A: Individuals living with HIV commonly develop dry skin, seborrheic dermatitis, and localized skin infections, largely due to immune suppression.
HIV patients who also have lymphoma, liver disease, or heart disease may be particularly prone to itching.
From a TCM perspective, herbs such as Astragalus (Huang Qi), Dong Quai (Dang Gui), and Fo-Ti (He Shou Wu) are often used to support immune regulation.
Among patients with postherpetic neuralgia, approximately 30% to 58% experience itching in the area previously affected by shingles. This symptom is most common when the rash occurs on the scalp, face, or neck. Itching may also occur during the acute phase of shingles.
TCM generally attributes acute shingles to patterns involving damp-heat and blood stasis. Herbal formulas such as Long Dan Xie Gan Tang and heat-clearing detoxifying herbs may be considered. During the acute phase, foods such as Coix seeds, mung beans, and loofah are commonly recommended.
In the chronic stage, persistent itching is often viewed as being related to blood stasis and deficiencies of qi, blood, yin, and yang. Formulas such as Bu Yang Huan Wu Tang or Yi Guan Jian may be used, often combined with blood-invigorating herbs such as peach kernel and safflower as part of dietary therapy.