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Neuropathic itch is also referred to as neurological or neuropathic pruritus. It is a chronic itch caused by neuron damage in the CNS, the central nervous system, or the peripheral nervous system.
This condition is characterized by severe itching that may feel like pins or needles. Some patients report a burning sensation, electric shocks running down the affected area, or numbness and chilling of the skin.
It can be paroxysmal itching, meaning it starts and stops abruptly. Damage to peripheral nerves can cause a tingling feeling in the hands and feet.
Scratching makes neuropathic itching worse. Since treating neuropathic itch is difficult, most medications focus on reducing the need to scratch. Recommended medication includes ice application, creams to reduce the itching sensation, and mind-body therapies.
Causes of Neuropathic Itch
Neuropathic itching is not fully understood yet. However, damage to neurons in the CNS and the peripheral nervous systems is a significant cause of the neuropathic itch. Injuries to the brain and spinal cord are the most significant risks.
Certain skin conditions such as atopic dermatitis may cause inflammation which has been shown to increase the chances of neuropathic itch.
Many conditions and diseases can cause neuropathic itch. Some of the leading causes are:
1. Brain Lesions
Brain lesions are damage to any part of the brain due to injury, vascular malformations, or disease. They are responsible for 21% of neuropathic itch cases. Common brain lesions include strokes that can cause unilateral neurogenic pruritus.
2. Notalgia Paresthetica
This nerve disorder can cause painful itching around the shoulder or chest. It can be a sign of cervical spine disease or muscular spasm.
3. Spinal Cord Tumor
Though rare, a tumor’s damage to the spinal cord can cause neurological side effects, including neuropathic itch.
4. Shingles
Shingles infection can cause nerve damage leading to postherpetic neuralgia, a common occurrence in shingles recurrence. The virus that causes shingles lies dormant in the nerve tissues. The nerves get damaged, which may induce neuropathic itch.
Common Neuropathic Itch Syndromes
Itchy skin is also referred to as pruritus. It can be uncomfortable to live with, primarily when the itch occurs at night and interferes with sleep.
Neuropathic or neurogenic itch refers to an itch sensation that originates from nervous system damage such as a pinched nerve. There are different types of chronic itching, such as;
Brachioradial Pruritus
This is a type of neuropathic pruritus that occurs on the outer side of the forearm. In rare cases, patients report itchiness on the neck or legs.
Brachioradial pruritus is mainly caused by injuries or diseases such as spinal cord lesions that cause nerve damage. Sun damage has also been highly linked to this particular syndrome of neuropathic itch.
Intractable Postherpetic Itch
Postherpetic itch is common in people with herpes zoster, commonly referred to as shingles. This is when the chicken pox virus lies dormant after infection, only to recur years later. Postherpetic itch is a result of damage to the nerve fibers and can be a hindrance to normal day-to-day activities and sleep schedules.
Trigeminal Trophic Syndrome
This syndrome is common in patients with a history of dental procedures or facial traumas. Other risk factors of a trigeminal trophic syndrome are multiple sclerosis or other procedures that may affect the trigeminal nerve, found all over the face.
How is Neuropathic Itch Diagnosed?
Neuropathic itch is challenging to diagnose because it is often confused with normal skin itch. Most patients with skin conditions will visit a trusted dermatologist first for a diagnosis. When common topical skin itch treatments do not work, the dermatologist may advise you to see a neurologist.
A detailed medical history report may be necessary to diagnose neuropathic itch. Previous diseases such as chicken pox, diabetes, or degenerative spine disease may help pinpoint the irritation’s root cause. It is also necessary to establish when the itch developed and whether it is confined to one area.
Your health provider may carry out a skin biopsy to rule out dermatological issues and determine the presence of a neuropathic itch. Skin biopsies are used to test for skin issues and are not meant as treatment.
Treatment for Neuropathic Pain.
Anticonvulsants are a popular treatment option for neuropathic pain. Gabapentine, which is sold under the brand name Neurontin, is among the best clinically tried and tested anticonvulsants used to treat neuropathic itch. It is mainly used to treat diabetic neuropathy, postherpetic neuralgia, and central itch.
Capsaicin cream is a medication that stops neurons from sending signals to the brain. Capsaicin cream is made from a substance that gives chilies their burning sensation. Capsaicin works by reducing skin sensitivity.
Nerves do not respond to itch messages as they usually would, reducing the need to scratch the affected area. Side effects include irritation, especially on broken skin.
Behavioral therapies are also commonly used in unilateral and central neuropathic itch management. There isn’t strong evidence to support therapy as an optional treatment.
However, since itching may cause chronic pain, being mentally aware not to scratch the irritated area may help patients avoid the pain. Other therapies include acupuncture, relaxation, massage, and physical therapy.
Nortriptyline, sold as Pamelor, Sensoval among others, is a good treatment for nerve pain. It is a prescription drug that comes in tablet form. It is one of the best treatment options for neuropathic itching.
Compounded Medication as Personalized Treatment.
Compounded topical creams are an excellent treatment for a neurological diagnosis. Neuropathic itch is currently still very hard to diagnose and can be confused with other conditions.
Treatment is even less effective, especially with creams such as capsaicin. The general dosage used in mass production does not work for everyone. To address this problem, pharmacists can create personalized compounded medication for individual needs.
Our experienced pharmacists at Fort Worth Pharmacy can recommend compounded medication to suit your unique needs and get the most out of your medicine prescription. Dosage and allergens are considered, giving you the best fighting chance against neuropathic itch.