Skin itching in a child

Skin itching in a child can be caused by many reasons. Most often, it is provoked by atopic dermatitis, somewhat less often by urticaria, Duhring's dermatitis herpetiformis, eczema, mastocytosis, as well as various infectious and autoimmune diseases. As you can see, itchy discomfort is not such a harmless symptom as it seems at first glance. Therefore, it cannot be ignored or wait until the problem "goes away on its own." We recommend that you carefully read the article and draw the right conclusions about what to do with a child's itching.

Epidemiology

Itching in children is becoming an increasingly common symptom. Thus, over the past thirty years, frequent visits to the doctor for this reason have been recorded: about 17-18% of preschool children and up to 20% of teenagers and primary school students seek help. The reasons for such a surge have not yet been determined. Meanwhile, such a trend is not observed throughout the world, but only in Western Europe, South and North America, and practically throughout the entire territory of the post-Soviet space.

Statistics also claim that itchy problems in children appear in 80% of cases if parents are prone to allergic reactions or have any chronic skin diseases. The pathological symptom affects up to 60% of children in whom one of the parents is prone to allergies.

Causes itchy skin

Weak immunity, an abundance of allergens, viruses, fungi, bacteria - all of this can cause itching in a child, from mild to intense and debilitating. Of course, any parent wants to help the baby as soon as possible. But the help will be incomplete or even ineffective if the underlying cause of the discomfort is not eliminated, so it is very important to detect it in a timely manner, before the disease worsens.

The following diseases and conditions can cause itchy discomfort:

• Insufficient or, conversely, excessive adherence to hygiene rules can lead to the development of atopic dermatitis, a disease that occurs in the presence of certain irritants. In addition to the obsessive desire to scratch, in such a situation, rashes in the form of blisters, swelling of the skin, and redness can be observed. According to statistics, atopic dermatitis is found in one in ten children, and this is quite a lot. But not in all cases, babies immediately show the entire symptom complex: often, itching and rashes become the only initial sign of the problem.
• Allergies are most often detected in childhood. Skin itching and rashes may indicate poor tolerance to food products, medications, hypersensitivity to pollen or dust, wool, chemicals and detergents, etc. The rash can be different - local or focal, or may be absent altogether. The worst-case scenario is anaphylactic shock, which can result in extremely negative consequences, so at the first signs of it, you should immediately call "emergency help". [ 1 ]
• Drug rash is a painful reaction of the human immune system to taking certain medications, and antibiotics often become such medications. Itching after antibiotics in a child is almost always of allergic origin and can manifest itself focally or all over the body. With repeated use of the antibiotic, the itching may intensify, a rash, swelling, and even an anaphylactic reaction may appear. But this is not always the case: in some children, itching becomes the only manifestation of such an immune reaction. [ 2 ]
• Scarlet fever is a disease characterized by the appearance of a characteristic scarlet rash, which is a specific reaction of the body to the release of erythrotoxin. Itching in scarlet fever in a child is moderate, and only in severe and moderate cases can it bother quite intensely. By the end of the acute period of the disease, the rash dries up, but peeling and itching may still be present for some time. [ 3 ]
• Chickenpox is an extremely unpleasant disease, classified as a childhood infection. The itching associated with chickenpox in children is especially painful: the acute viral infection is transmitted by airborne droplets and is caused by a specific virus belonging to the Herpesviridae family. Chickenpox most often affects children aged 4-5 years, but older children can also get sick. [ 4 ]
• Each of us has experienced insect bites, so it is considered that itching from mosquitoes in a child is, on the one hand, a normal phenomenon. But quite often, banal bites develop into a full-blown allergic reaction, and even into an inflammatory process (for example, if a child scratched the bite site and brought in an infection). Therefore, insect bites - not only mosquitoes, but also wasps, bees, midges, bedbugs, ticks - should not be ignored. They need to be treated, and even see a doctor. By the way, predominantly nighttime itching in children is often related to the presence of such insects as bedbugs, ticks or lice (fleas).
• Severe itching in a child can be caused by compression of a certain part of the body by clothing, shoes, holding and fixing bandages (including plaster). Often, a place tied with an elastic band or a lace begins to bother. Itching under a plaster cast in a child occurs as a result of a violation of local blood circulation in the tissues, or due to increased dryness of the skin caused by constant wearing of the bandage. Less often, the cause is contact dermatitis - this is a kind of skin reaction to prolonged irritation of the skin by plaster components (for example, calcium sulfate). If the sensations under the plaster become unbearable, then you must definitely visit a doctor: there are frequent cases of skin and allergic diseases developing under the bandage, requiring immediate medical attention and intervention.
• Pinworms often cause itching in the anal area. The activity of these parasites is activated at night, when they come out and lay eggs in the specified area. To clarify the diagnosis, you should take a stool test for worm eggs, as well as a scraping, which will help to accurately determine the cause of discomfort. Such diagnostics are necessary, since the symptom of perianal itching can be associated not only with the presence of pinworms, but also with the formation of microcracks in the anus - for example, due to prolonged constipation in a baby. [ 5 ]
• Diathesis is not a disease, as many believe, but merely a tendency of the child's body to develop allergic and inflammatory processes. If the cause of such a tendency is eliminated, then the itching will disappear by itself. Therefore, all efforts should be directed towards finding the allergen - most often it "hides" behind the consumption of certain foods. [ 6 ]
• Hives are itchy, reddish or pinkish rashes that resemble blisters, which usually accompany nettle burns. The rashes may appear and disappear on their own within one or two hours. Hives can be caused by exposure to cold or sun, or by an allergen entering the body directly. [ 7 ]
• Measles is a dangerous viral pathology, one of the most common causes of death among young children. Itching with measles in children is not the main symptom, since it is usually not very pronounced and does not require the use of antipruritic agents, but in some cases - for example, against the background of an increase in temperature - discomfort may increase. [ 8 ]

Risk factors

The intensity of itching in a child can vary from a slight scratching to severe discomfort that disrupts the baby's well-being and sleep. In most cases, the pathological sensation is associated with allergic processes in the child's body, but in about every third case, we are talking about pathologies such as diabetes, thyroid disorders, electrolyte imbalance, dysfunction of the digestive or nervous system. Hypersensitivity to certain medications, foods, etc. is also possible.

In addition to the underlying cause, it is also worth noting the presence of provoking factors that directly or indirectly affect itchy manifestations. Such factors include:

• dry skin (associated with dehydration or cold season);
• increased water hardness, use of “adult” bathing products, improperly selected clothing and bedding (for example, synthetics);
• immature nervous system, instability of the mental and emotional state (excessive excitability, phobias, neuroses, etc.);
• irrational nutrition, meager and monotonous food;
• incorrect use of medications, self-medication;
• failure to observe hygiene rules, or, conversely, excessive observance.

Determining the provoking factor is the responsibility of the attending physician. Self-medication can only worsen the problem and prevent the baby from getting better sooner.

Pathogenesis

Quite often, the itchy problem in children is associated with atopic dermatitis, or appears against the background of other systemic disorders. In most cases, the symptom occurs paroxysmally - for example, it bothers only during sleep.

Systemic causes of itching in children include:

• hypersensitivity of the body;
• hormonal changes during puberty;
• reactions to medications (antibiotics, ethanol, etc.);
• some types of therapy (physiotherapy);
• parasitic invasions (onchocerciasis, echinococcosis, trichinosis);
• infectious pathologies (chickenpox, roseola);
• liver or kidney diseases (obstruction, cholestasis);
• hematological pathologies (leukemia, anemia, erythremia);
• endocrine diseases, neurological disorders, intoxication.

There are also such variants of the problem as solar and stress itch.

Allergic itching in children is especially common. Mast cells play an important role in the pathogenesis of its occurrence: their number increases, certain inflammation mediators are released (for example, histamine, tryptase, proteoglycans, eicosanoids, etc.). Mast cells provoke itching due to mediators and NGF, which promotes hyperplastic changes in nerve fibers. Inactivating agents include drugs with antihistamine activity, glucocorticoid hormones, beta-adrenergic receptor antagonists.

Nervous itching in children is associated with overstrain of the immune system: a failure occurs, in which the immune system attacks its own cells in response to stress. The balance between defense and aggression mechanisms is disrupted. The sensory receptors of the skin are activated and send a signal to the spinal cord and then to the brain. As a result, depending on the degree of activation of the nerve endings, itching or even pain occurs.

Symptoms itchy skin

Itching in children is often found in combination with other painful symptoms - for example, sometimes it is redness and flaking, dry skin, swelling, crusting, rashes, as well as general malaise, fever, headache, etc.

If the desire to scratch is the only symptom present, then its first signs may be expressed in the increased motor activity of the baby, constant anxiety, irritability, tearfulness, capriciousness. The baby may tug at clothes, scratch his limbs and body, rub against objects, cry for no reason. Often, there is a change in appetite, mood instability, insomnia.

Itching in a child without a rash occurs with allergies (at the initial stage of the disease process), as well as with infectious and other diseases, including parasitic lesions. Therefore, this symptom should not be ignored, because it may indicate the development of serious pathologies that require the earliest possible medical intervention.

If itchy small vesicular elements with cloudy contents are found on the skin, tending to group together, which occasionally burst, forming ulcers and crusts, then herpetiform dermatitis can be suspected. Usually, such itching appears on the elbows of a child, as well as in the face or tailbone area. Herpetiform dermatitis is of viral origin and is highly contagious.

A reddish rash and itching in a child that appears suddenly are most likely of an allergic nature: the rash looks like small spots, bumps or blisters. Such a reaction is a consequence of taking certain medications, vitamins, eating certain foods, or direct contact with allergens. Unpleasant symptoms appear in any area of the body, while itchy elements in children are often scratched and take a long time to heal.

It is extremely rare for an allergic process to combine symptoms such as rash, itching and fever in a child. The presence of fever with allergies is an exception rather than a rule. If such a symptomatic triad is observed, then in most cases we are talking about a concomitant infectious disease. Infections are not always accompanied by cough, runny nose and other corresponding symptoms. The course of infectious pathology can be erased, manifested only by an increase in temperature.

Food allergy against the background of intoxication can also be accompanied by hyperthermia. However, "guessing" the diagnosis is pointless and dangerous: it is better to visit a doctor, conduct diagnostics and determine the cause of the problem. It is quite possible that such a cause is chickenpox, rubella - common viral diseases that affect mainly children.

Redness and itching in a child can be a consequence of allergic, inflammatory processes: externally, the rash looks like reddish spots, elevations or blisters, localized on the face or buttocks, or in other, atypical areas of the body. When scratching, such elements quickly become covered with crusts, the itching does not disappear, and even intensifies.

If a child has itching and peeling, then seborrhea or mycosis can be suspected. A careful examination of the skin is often enough to make an accurate diagnosis. With mycosis, there is not only peeling, but also peeling of the skin, the formation of small blisters and areas of irritation. With seborrhea, there is dry skin, the child's itching is intense and is accompanied by redness, the formation of crusts in the eyebrows, eyelids, navel, etc.

Nighttime itching of the skin in a child associated with insect bites requires careful examination of the skin in the morning: for example, after bedbug bites, characteristic red itchy bumps can be found, and with flea bites, small pinkish elements are located in close proximity to each other (as the insect moves along the skin).

Acne and itching found in a child are a reason to contact a dermatologist or parasitologist: if help from another specialist is required, the doctor will give a referral for additional medical consultation.

Forms

There is no generally accepted medical classification of itching in children. This is mainly due to the fact that the itchy discomfort itself is not a disease: it is only one of the symptoms indicating some kind of disturbance in the body, among which hypersensitivity reactions are especially common.

In medical terminology, a symptom can be divided into allergic or non-allergic, local or focal, minor or intense.

Often doctors describe the problem according to its location:

• skin itching – indicates the presence of psychiatric, dermatological, endocrine problems, as well as the presence of allergies;
• anal itching – often a sign of rectal pathology, helminthic invasion;
• genital, inguinal itching – indicates gynecological, andrological, urological, parasitic and dermatological problems.

As a rule, itching in the intimate area of a child, itching of the limbs or anus require different approaches to treatment, so the doctor always pays special attention to the issue of localization of the lesion.

Localization of itching

Itching in a child all over the body with a rash on the skin requires additional diagnostics, since there is no single cause for such a phenomenon. The cause may be either an allergic process or infectious (bacterial, fungal or viral) diseases, systemic pathologies (for example, intoxication or liver disease). Allergies in childhood are especially common, due to imperfect immune protection and many provoking factors (both external and internal). Therefore, when an itchy rash appears all over the body, the doctor must first rule out an allergic reaction.

Itching in the intimate area of a child can bother both boys and girls. Additionally, signs of anxiety, irritability, as well as local symptoms such as burning, discharge, and an unpleasant odor appear. The causes may be a violation of hygiene rules (insufficient hygiene of the genitals, or excessive hygienic activity), anal fissures, allergic processes, pubic lice, candidiasis, etc. Periodic itching in the groin in children can indicate hypersensitivity of the skin to certain materials and substances - for example, if unpleasant sensations occur when putting on synthetic underwear or when using certain detergents.

Vaginal itching in children can indicate various pathologies, for example:

• candidiasis, fungal infection;
• inflammatory processes in the vagina;
• helminthic infestations;
• tumor processes;
• endocrine pathologies (for example, diabetes mellitus).

Sometimes itching of the genitals in a child is caused by banal factors: lack or insufficiency of personal hygiene, wearing synthetic or tight underwear, which becomes a favorable environment for the spread of pathogenic microorganisms. Many underestimate these factors, but they can provoke not only the appearance of itching, but also an unpleasant odor, and even inflammatory processes.

If a child has discharge and itching, this is a reason to see a doctor, and this should be done as soon as possible. With cheesy discharge, it is possible to suspect a fungal infection, and bloody discharge often hides tumor processes. And the appearance of such symptoms during the period of active puberty indicates strong hormonal changes in the body. A doctor's consultation is necessary in any of the listed situations.

Itching in a child's hands and palms is a common symptom that accompanies liver disease. When bile circulation is disrupted, the content of bile acids in the bloodstream increases. These acids have a toxic effect on the receptor network of the skin. As a result, the baby experiences itching. Another common root cause is diabetes mellitus: this disease is characterized not only by a malfunction of the insulin apparatus, but also by a disruption of metabolism, blood circulation and trophic processes in tissues.

Itching between the fingers of a child, as well as in other skin folds (in the armpits, in the groin) often becomes a sign of scabies - a parasitic pathology that develops when affected by the scabies mite. Why does the skin itch with scabies? The fact is that the female parasite, before laying eggs, makes whole labyrinths of passages in the skin layers. The skin, naturally, is damaged, the mites crawl in their own passages, which gives such an unpleasant sensation.

Itching on the legs of a child is caused not only by a fungal infection, but also by a violation of blood circulation in the extremities. Fungal infection manifests itself as severe discomfort between the toes, as well as in the foot area. The nail plates change and exfoliate, sometimes an unpleasant odor appears. Blood circulation disorders are observed as a consequence of other diseases - for example, liver or kidney dysfunction, diabetes, vascular pathologies, infectious and endocrine disorders.

Only a doctor can answer the question of whether itching of the feet and heels in a child is associated with an infection, or whether the root cause should be sought among systemic diseases. You should not ignore a visit to the doctor, since the cause of discomfort is not always harmless.

Itching of the abdomen in a child most often appears due to an allergic reaction. Such a reaction can develop to anything - even to formula or any complementary food product. In small children, signs of allergy are primarily found on the abdomen and in the face area (on the cheeks, on the forehead). When diagnosing small children, such a problem as prickly heat should also be considered, which is characterized by the appearance of a small rash on the abdomen, back, and buttocks. With prickly heat, itching is not very pronounced, but in some children it is one of the basic symptoms (especially with prolonged wearing of a wet diaper).

Itching in the anus of a child is an unfavorable sign, which can be caused by several reasons. In this situation, you need to contact either a pediatrician, or a parasitologist or pediatric proctologist. It should be taken into account that itching from worms in a child is the most common case, the provocateurs of which are pinworms - intestinal parasites, the peculiarity of which is the night laying of eggs in the anal area. This is what is associated with the appearance of uncomfortable sensations, to get rid of which you need to undergo antihelminthic treatment and strictly adhere to hygiene rules. Parasite infestation is often accompanied by other symptoms - for example, dizziness, lack of appetite, headaches, digestive disorders. In addition, signs of anemia are often found - pale skin, dark circles under the eyes, sleep disturbances.

Itchy back in children is no less common and is associated with the following pathological conditions:

• allergic reaction, atopic dermatitis;
• neuro-allergic processes;
• scabies, in which discomfort increases in the evening and at night;
• dermatitis, folliculitis, impetigo;
• xeroderma (hereditary pathology);
• seborrhea (impaired production of sebum);
• lichen planus;
• psoriasis.

If the interscapular region is especially itchy, then it is possible to suspect thyroid dysfunction, diabetes, liver pathologies. Itching on the neck of a child occurs after insect bites, after exposure to ultraviolet light, or occurs as a result of prolonged friction of the skin against the collar of clothing, which is especially common with those with sensitive skin.

Itching of the head and face in a child is a characteristic symptom of pediculosis (infestation with lice). If you carefully examine the scalp, you can see traces of bites, scratches from scratching, and even parasitic eggs called nits. In this situation, discomfort in the baby occurs because the lice bite the skin, secreting their own secretion into the wound, causing quite strong itching sensations.

Itching on the cheeks of a child is most often a consequence of food or contact allergies, but sometimes it also indicates a cold or sun reaction, which develops when the skin is sensitive to temperature changes or ultraviolet rays. In small children, the problem is associated with dysbacteriosis, since problems with the digestive system in babies often affect the condition of the skin of the face, thighs and buttocks. Sometimes, to completely eliminate discomfort, it is enough to organize the diet, restore the balance of intestinal microflora.

Itchy eyes in a child are the first sign of incipient conjunctivitis or fungal infection of the conjunctiva. In many children, this is how an allergic reaction begins to manifest itself – for example, if the allergen is pollen, animal hair or house dust. Usually, the itchy sensation is followed by redness of the eyes, swelling and even pain, stinging and burning.

When there is an excessive accumulation of sulfur secretion in the ear canal, itching in the child's ears occurs. This itching is constant and may be accompanied by a slight decrease in hearing function. Other possible causes sometimes include:

• allergic processes;
• otomycosis, fungal skin lesions;
• diabetes mellitus;
• the presence of a foreign body or insect in the ear canal;
• erysipelas of the auditory canal.

Itching and burning sensations can manifest themselves in any area of the body, and they arise for a variety of reasons. As it becomes clear, itching is not always accompanied by a rash, just as a rash can appear in a child without fever and itching. In any case, if there is an itching moment, as well as peeling, inflammation of the skin, discharge or pain, you need to immediately show the baby to a medical specialist. Complex drug therapy may be required.

Complications and consequences

Constant intense itching in a child can lead not only to anxiety and irritability. Most children scratch the affected areas, resulting in scratches and bloody wound surfaces. In turn, opportunistic and pathogenic microorganisms can penetrate the wounds, which is fraught with tissue infection and the development of a purulent infection. As a result, complications such as pyoderma (purulent inflammation of the skin), fungal diseases, abscesses, phlegmon, etc. can arise.

In most cases, the affected area turns red, swells, the inflammatory process spreads to healthy areas, and purulent discharge appears.

To avoid unpleasant consequences, treatment should be started promptly, under the supervision of a medical specialist.

Diagnostics itchy skin

Diagnostic measures when itching is detected in a child are reduced to identifying the root causes of the problem.

If there are other skin manifestations against the background of itching, then you need to see a dermatologist, with a mandatory consultation with a therapist. Such an approach will allow you to assess the health of the skin and exclude the presence of general pathologies. If necessary, these specialists will facilitate consultations with a hematologist, allergist, etc.

In general, diagnostics usually includes the following steps:

• external examination of the skin, lymph nodes;
• blood tests (general, biochemical, determination of glucose in the blood), general urine analysis;
• if pathological lesions and elements are detected on the skin, then instrumental diagnostics are carried out in the form of dermatoscopy, scrapings, and biopsy;
• ultrasound examination of organs located in the abdominal cavity.

If the child's itching is in the anal area, then, in addition to a visual examination, a stool test for parasite eggs and protozoa will be required. Additionally, the little patient is prescribed a coprogram, and if necessary, a rectoscopy, colonoscopy.

If itching is detected in intimate areas, the doctor will visually examine the genitals, take a smear for microflora with sowing and determination of sensitivity to antibiotics, a smear for the presence of atypical cells. General clinical blood and urine tests, coprogram and feces for parasite eggs also become mandatory.

Differential diagnosis

Differential diagnosis of itching in a child is usually carried out with diseases such as atopic dermatitis, scabies, seborrheic dermatitis, allergic contact dermatitis, ichthyosis, psoriasis, and some immunodeficiency conditions (hyperimmunoglobulinemia E syndrome, Wiskott-Aldrich syndrome).

It is important to consider that itching in a child may occur as a result of stressful situations: this reason is often simply underestimated and ignored. First of all, the search for causes is based on such diseases as scabies, allergies, dermatitis, and fungal infections. Stress itching usually goes away after taking sedatives, but you should not try to diagnose the baby yourself by offering him or her certain medications. This approach will not only harm the child's health, but will also complicate the subsequent diagnosis by the doctor.

Treatment itchy skin

Classic treatment for itchy skin in children consists of eliminating the causes of discomfort. For example, in case of allergies, it is necessary to find and neutralize the potential allergen, and in case of stress, to eliminate its source.

With mild itching, sedatives prescribed by a pediatrician on an individual basis are very helpful. In addition, antihistamines are used in almost all cases, for which relieving itching is one of the therapeutic directions.

There is no need to try to eliminate the problem on your own. There are often cases when parents immediately run to the pharmacy for antihistamines, not paying attention to the fact that the cause is not always an allergic process. In many patients, the "culprit" is an infection, systemic diseases (for example, liver disease) or parasitic lesions. Therefore, it is better not to waste time and seek help from doctors. The doctor will prescribe the appropriate treatment as soon as the underlying cause is established.

It is important to understand that the doctor is not always able to determine the provoking factor immediately, during the initial consultation. It is likely that the child will have to undergo a series of diagnostic procedures - blood and urine tests, stool analysis for intestinal parasite eggs, perianal scraping, etc. If an allergic process is suspected, the doctor will refer the child for provocative tests or for blood testing for the presence of allergens. If an infectious pathology is suspected, skin cultures may be performed.

Prevention

Itching in a child is a consequence of some pathology, and not an independent disease. Therefore, the main point of prevention is preventing the causes of itching. Here is what is meant by this:

• timely referral to a doctor for treatment of digestive disorders, endocrine disorders;
• timely detection and treatment of skin infections;
• prevention of parasitic infections, observance of hygiene rules, regular washing of hands, as well as vegetables, fruits and greens, consumption of only heat-treated products of animal origin;
• regular preventive visits to the doctor;
• if there is an allergy, avoid contact with allergens, follow a dietary diet, and organize a hypoallergenic environment for the child at home;
• preventing stressful situations, ensuring the child has sound and healthy sleep, and, if necessary, consulting a psychologist;
• switching to a healthy diet, drinking enough fluids;
• preventing dehydration, using skin moisturizers (for example, special baby creams);
• if necessary, taking vitamin and mineral complexes that improve metabolic processes in the child’s body).

Forecast

Only in half of the cases the cause of itching in children is determined immediately. Unfortunately, quite often the cause cannot be found and eliminated at all, so the symptom takes on a wave-like recurring form. At the same time, in 60% of cases the itching in a child is completely stopped over the years, while in other children it may persist and periodically recur (this course is typical for allergic processes).