Itchy skin, medically known as Pruritus, is common in many dermatological conditions and can become more prevalent at night. The presence of itchy skin at night can be disruptive to a good night's sleep.
The skin can be especially itchy at night for many people who suffer from chronic itching. This could be due to additional heat in bed that triggers pre-existing dermatological conditions such as psoriasis, dermatitis, and eczema. Additionally, itchy skin can be a symptom of an underlying health condition such as diabetes, anaemia, and kidney disease.
Continue reading to learn more about how to prevent itchy skin, what conditions can cause itchy skin at night, and individuals at higher risk of this disruptive symptom.
Overview
Itchy skin at night, medically known as nocturnal Pruritus, affects most people at some stage in their lives. 80% of patients with an existing skin condition have symptoms of itching.¹ However, chronic pruritus can be disruptive, and to this date, the exact mechanisms for this condition are unknown.¹
Chronic itchiness is present in many dermatological conditions, such as eczema, and can become more prevalent at night disrupting a good night's sleep.² The skin can be especially itchy at night for people with dry skin as the body tends to lose water while you sleep. The increased itchiness can also be due to additional heat in bed that triggers pre-existing dermatological conditions, i.e., psoriasis, dermatitis, and eczema. Additionally, itchy skin at night can be a symptom of an underlying health condition such as diabetes, anaemia, or kidney disease.³
Continue reading to learn more about how to prevent itchy skin, signs and symptoms, and individuals at higher risk of developing itchy skin at night.
Causes of itchy skin at night
A combination of factors can cause itchy skin at night; therefore, pin pinpointing the exact cause can be difficult. From dry skin to bed bugs, a range of factors can cause pruritus, and in some cases, there could be more than one cause.²
Patients with existing dermatological conditions such as psoriasis are more likely to develop pruritus. Itchy skin can affect anyone and can be a difficult symptom to manage. Individuals may have an insurmountable urge to scratch the itch. However, this should be avoided at all costs, as scratching itches can result in a break in the skin, increasing the chances of skin infection and irritation.⁴,⁵
In some patients, it may be one or more factors that cause nocturnal pruritus. Medical conditions associated with night-time itching include eczema, allergic reactions, diabetes, and bed bugs. Bed bugs are tiny pests that can wriggle their way into the clothing and bed sheets, coming out at night to feed on the dead skin. This is just another possible cause of the night-time itch.⁶ However, before you begin to wash all your clothes on a hygiene wash, there are many other possibilities of having a reaction to your bed sheets, such as having an allergy to one of the chemicals in the detergent you use.
Existing dermatological conditions can be flared up at night because the body typically loses water in the night, causing the skin to become dry. Dry skin is a prerequisite for itching, and this, in combination with existing psoriasis or dermatitis, could be another cause for developing a nighttime itch.⁴ Finally, psychological factors such as anxiety can also cause the skin to itch in the evening.
The best way to find out what is causing your nocturnal pruritus is to rule out the possibility of insect bites and allergic reactions. If you think it could be an underlying medical condition or dermatological condition, it would be best to speak to your doctor to get the best course of treatment.
Signs and symptoms of itchy skin at night
Symptoms of itchy skin at night include:
- Rash
- Redness
- Daytime fatigue
- Scarring
- Dry skin
- Inflammation
- Blisters and spots⁵
If you wake up in the middle of the night with the sudden urge to itch your skin and find it difficult to go to sleep due to the discomfort of nocturnal pruritus, this could be an indicator that you are suffering from nighttime itching.⁵
Regardless of how strong the urge may be to itch the skin, it is important to avoid doing this, as this could keep the cycle of nighttime itching going a lot longer.
Diagram of the Itch-scratch cycle, created by Heeral on Canva.
There are various skincare products, such as cooling creams and gels, you can get from the pharmacy or that your doctor may prescribe to help reduce the urge to itch. In the next section, we will explore the management and treatment of itchy skin at night further.
Management and treatment for itchy skin at night
Depending on the cause of your nocturnal pruritus, your doctor may suggest different treatments to help manage your condition. Treatments range from emollients to antihistamines, depending on the cause.⁷
For the case of dry skin, individuals can get over-the-counter anti-itch creams and gels, which can be cooling to the skin and help prevent the urge to scratch the itch. In the case of hives or patients with atopic dermatitis, you may be able to get prescribed antihistamines, which have been proven to be beneficial in reducing redness and rash-like symptoms in some patients.²
In the instance the cause of your nighttime pruritus is an allergic reaction, it may be worth checking your bed for bed bugs as these insects can cause allergic reactions in the skin. The marks and bites are distinctive, and a healthcare professional should be able to help identify the cause. If, in case, these pesky bugs are an issue in your home, do not worry; there are plenty of services you can access online that help debug your bedroom.
For sensitive skin, changing the detergent used for your bed sheets and replacing it with a sensitive product instead may help reduce the chance of nocturnal pruritus. This also goes for other skin products that you may be using before bed, such as perfumed creams, shampoos, and shower gels.⁸
Other methods to help reduce nighttime itching include but are not limited to reducing the room temperature, applying a skin-sensitive moisturiser before bed, or accessing a mental health professional to help reduce stress and anxiety; you may even be prescribed antidepressants.⁷
Diagnosis
Contacting your doctor is the best way to get a diagnosis of your nocturnal pruritus. The steps in getting a diagnosis may involve the process of elimination, and your doctor may request a medical examination, conduct various tests, i.e., blood and allergy tests, and ask to see images of your rash.¹⁻³
Questions from your doctor may involve asking where the rash presents itself on your body when you first started noticing symptoms, whether you’ve been using new skincare products recently, if the nighttime itching is preventing you from sleeping, and other queries to help get closer to what might be causing your itchy skin at night.
At first, it may be difficult to identify the cause of your night-time itching since there are many possibilities, but with the help of your doctor, you will be closer to finding a solution for your nocturnal pruritus.
FAQs
How can I prevent itchy skin at night?
Depending on the cause of your nighttime itching, prevention may not be possible in all cases. However, there are steps you can take that can help reduce the likelihood of developing itchy skin at night and may help alleviate symptoms. Preventative measures include establishing a hygienic sleep environment; for example, clean bed sheets, minimal dust, and reduction of light from phone screens are all thought to make a difference in the quality of sleep.⁸
Bathing before bed has also been proven to improve sleep quality and could be helpful in pruritus. Having a shower for as little as 10 minutes significantly reduced the time it took for a person to get to bed, helping the body and mind relax and cool down.⁹
What conditions can cause nocturnal pruritus?
A variety of conditions can result in itchy skin at night; the most common are
- Skin conditions
- Mental health conditions such as stress and anxiety
- Thyroid disease
- Kidney disease
- Anaemia
- Diabetes
Who is at risk of nocturnal pruritis?
Individuals at risk of nocturnal pruritus are those who may have pre-existing dermatological conditions and got allergic reactions to products in the past, those with a suppressed immune system, and those with an underlying condition that may either be unmanaged or undetected.³
What can I expect if I have nocturnal pruritus?
If you have itchy skin at night, you may develop a rash; this may be present in different forms depending on skin colour and type. However, you may see redness, raised bumps, or spots and feel an irresistible urge to itch the skin. The urge may be so strong that it wakes you up in the middle of the night and disrupts your sleep. It is important to suppress this urge as this could lead to further problems and prolong the itch-scratch cycle.¹
When should I see a doctor?
Visit your doctor if your nocturnal pruritus is preventing you from sleeping, interrupting your daily life, or affecting your mental health. If you think you have signs of inflammation and infection due to scratching the itch, it would be important to go to the doctor as soon as you can.
Summary
Nocturnal pruritus can be a troublesome condition that disrupts your sleep, mood, and physical health. There are many causes for this itchy irritation, ranging from bed bugs to psoriasis, but with the help of your doctor; you can identify the cause and get the right treatment for you so that the next time your skin is itchy at night, you can carry on, and get a good nights rest.
References
- Wang X, Lai Q, Zheng B, Ye L, Wen S, Yan Y, et al. <p>Both Prevalence and Severity of Pruritus are Associated with Age in Chinese Patients with Skin Diseases</p>. CCID 2021;14:217–23. https://doi.org/10.2147/CCID.S300458.
- Moniaga CS, Tominaga M, Takamori K. Mechanisms and Management of Itch in Dry Skin. Acta Dermato-Venereologica 2020;100:9–20. https://doi.org/10.2340/00015555-3344.
- Song J, Xian D, Yang L, Xiong X, Lai R, Zhong J. Pruritus: Progress toward Pathogenesis and Treatment. BioMed Research International 2018;2018:e9625936. https://doi.org/10.1155/2018/9625936.
- Jaworecka K, Muda-Urban J, Rzepko M, Reich A. Molecular Aspects of Pruritus Pathogenesis in Psoriasis. International Journal of Molecular Sciences 2021;22:858. https://doi.org/10.3390/ijms22020858.
- Sutaria N, Adawi W, Goldberg R, Roh YS, Choi J, Kwatra SG. Itch: Pathogenesis and treatment. Journal of the American Academy of Dermatology 2022;86:17–34. https://doi.org/10.1016/j.jaad.2021.07.078.
- Kamath S, Kenner-Bell B. Infestations, Bites, and Insect Repellents. Pediatr Ann 2020;49. https://doi.org/10.3928/19382359-20200214-01.
- Lavery MJ, Stull C, Kinney MO, Yosipovitch G. Nocturnal Pruritus: The Battle for a Peaceful Night’s Sleep. International Journal of Molecular Sciences 2016;17:425. https://doi.org/10.3390/ijms17030425.
- Podder I, Mondal H, Kroumpouzos G. Nocturnal pruritus and sleep disturbance associated with dermatologic disorders in adult patients. Int J Womens Dermatol 2021;7:403–10. https://doi.org/10.1016/j.ijwd.2021.02.010.
- Haghayegh S, Khoshnevis S, Smolensky MH, Diller KR, Castriotta RJ. Before-bedtime passive body heating by warm shower or bath to improve sleep: A systematic review and meta-analysis. Sleep Med Rev 2019;46:124–35. https://doi.org/10.1016/j.smrv.2019.04.008.
