What's to know about itchy skin at night?

Several home remedies, as well as over-the-counter and prescription medications, can help reduce symptoms.

In rare cases, however, increased skin irritation at night can be a sign of more serious conditions, such as cancer or organ failure.

What is nocturnal pruritus?

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Approximately one-quarter of adults in the United States will experience long-term skin itchiness during their lifetime. This is called chronic pruritus.

According to a 2016 study, over 90 percent of people with chronic pruritus complain of nocturnal pruritus (NP) or increased skin itchiness at night.

Severe cases of NP often disrupt sleep and make it difficult to get a good night’s rest. Over time, this can negatively impact emotional well-being, workplace performance, and overall health.

Itching can also cause skin damage and increase the likelihood of infection.

Causes

Like many other skin conditions, skin itchiness may increase at night. The natural cycling of certain hormones, molecules, and chemicals that occur in the body during the night can also cause itchiness.

In some cases, the skin may only feel itchier during the night because of a lack of outside distractions. But nighttime itchiness may also be a sign of more serious health conditions.

Natural causes of nighttime itchiness include:

Circadian rhythm

The body regulates hormones and chemicals in part by using a circadian rhythm, which is the body’s natural 24-hour cycle.

The circadian rhythm causes few different fluctuations or changes that can increase nighttime skin itchiness. These include:

• increased blood flow to the skin
• increased skin temperature
• increased cytokine, molecules that coordinate cells communication during immune responses, which may increase inflammation
• decreased corticosteroid, hormones that help reduce inflammation
• disrupted prostaglandin (PG), hormones that cause blood vessels to widen
• water loss from the skin (sweat), leading to dehydration

Menopause and pregnancy

Changes in the level of the hormone estrogen may cause dryness, itchy skin, or flushed skin. Some menopausal women describe the sensation to feel like ants crawling under their skin.

Other causes

Other common causes of nighttime itchiness include:

• hives
• insect bites, including those from bed bugs, lice, flies, or fleas
• allergic reactions to chemicals, dyes, or fragrances
• dry skin
• sunburn or burn
• chicken pox
• stress
• excessive sweating
• nervous habit
• medications, including antibiotics, antifungals, statins, and opioid analgesics (narcotics)

In rare cases, itchy skin at night can be a sign of more serious conditions or those that require treatment. These include:

• eczema, a condition that causes long-term itchiness and a rash
• psoriasis, an autoimmune condition
• fungal skin infections, such as athlete’s foot (ringworm) and pinworm infections
• thyroid conditions, especially an overactive thyroid
• skin cancer
• other cancers, in particular, immune and blood cell cancers such as lymphoma and leukemia
• conditions that affect the nervous system, such as diabetes, shingles, and multiple sclerosis (MS)
• HIV
• kidney or liver failure
• iron deficiency anemia
• severe depression or anxiety

Home remedies

There are several easy ways to help decrease nighttime itchiness without the use of medication.

Common ways to reduce dry skin at night include:

• bathing in cool or lukewarm water before bed, using only moisturizing, scent-free soaps, baking soda, or colloidal oatmeal. These are available to purchase online.
• applying glycerine based, oil- and alcohol-free moisturizers before bedtime, such as Cetaphil, Eucerin, or CeraVe
• using natural ointments and creams with vitamin E and aloe vera
• running a humidifier in the bedroom to moisten the air. Various types of humidifiers are available online.
• applying a cool compress, such as a cold, damp cloth, to the skin before bed
• using a fan to create airflow and background noise as a source of mental distraction
• wearing gloves or mittens to avoid scratching, which can worsen symptoms
• using meditation tapes or techniques when falling asleep. Books and audio guides are available.
• practicing relaxation techniques, such as visualization, before bed
• trimming the fingernails to reduce the chances of further irritating the skin
• wearing loose fitting clothing to allow the skin to breathe
• not allowing pets in the bedroom
• checking the bedroom for signs of bed bugs or other insect infestations, including fleas or biting ants
• drinking a caffeine-free tea, such as chamomile or peppermint, before bedtime
• using 2 to 3 drops of a relaxing essential oil, such as lavender, on the pillow before bedtime. Compare different products before purchasing.

Prevention

Making simple lifestyle changes can help reduce the risk of itchy skin at night.

Ways to prevent nighttime itching include:

• staying hydrated to reduce dry skin
• avoiding saunas and long, warm baths or showers before bedtime to prevent increased body temperature and moisture loss
• wearing clothing made from natural fibers, such as cotton
• avoiding scented or dyed cosmetic, cleansing, or beauty treatments before bedtime
• avoiding chemicals such as caffeine and alcohol that can increase blood flow to the skin
• keeping the bedroom cool, or below 70°F, and make sure there is plenty of air flow
• trying not to do activities that raise body temperature and increase blood flow to the skin before bedtime
• changing bedding regularly, ideally weekly
• treating all household pets that go outdoors with veterinarian-approved medications for parasites such fleas, tics, and ringworms

Treatment

There are also over-the-counter and prescription medications available that can help treat existing symptoms and prevent them from recurring. Over-the-counter medications used to treat and prevent nighttime itchiness include:

• Corticosteroid creams such as hydrocortisone cream, which may help reduce inflammation. Look for products with between 1 and 2.5 percent active ingredient.
• Allergy medications, which may help reduce inflammation. These include diphenhydramine (Benadryl), fexofenadine (Allegra), and cetirizine (Zyrtec).
• Supplements that increase drowsiness, such as melatonin, a natural hormone produced only at night.

Prescription medications used to treat dry skin at night include:

• Corticosteroid creams or pills, which are much stronger than over-the-counter medications and can help reduce itching caused by skin inflammation.
• Antidepressants, such as doxepin (Silenor) and mirtazapine (Remeron) may help reduce itching caused by depression and anxiety.
• Immunosuppressants, such as topical calcineurin inhibitors (Gengraf, Hecoria, Neoral), can help reduce inflammation.
• Phototherapy, which uses UVB wavelengths to help reduce the skin’s immune response and decrease inflammation.
• Gabapentin and pregabalin, which can help treat insomnia and reduce anxiety.
• Kappa opioid agonists, which can help treat insomnia and reduce the sensation of itchiness.
• Hormone replacement therapy, in particular estrogen based medications, which may help reduce dry skin and itchiness.

When to see a doctor

Chronic, or long-lasting cases of nighttime itchiness should be assessed by a doctor, especially those not related to pre-existing health conditions.

A doctor should also be consulted anytime dry skin at night becomes bothersome or interferes with everyday activities.

Reasons to seek medical attention for dry skin at night include:

• sudden, unexplained itchiness that lasts for more than 2 weeks
• dry skin at night that does not improve with the use of home remedies or lifestyle changes
• dry skin that interferes with sleep quality
• dry skin or itchiness that affects the whole body
• dry skin accompanied by other symptoms, such as skin changes, fever, tiredness, or weight loss