Psychogenic Itch and Stressful Skin Problems

Psychogenic itch is a skin disorder that is often triggered or aggravated by psychological factors rather than stemming from a physical or dermatologic (relating to the skin) cause. It often occurs in people who have anxiety, obsessive-compulsive disorder (OCD), or depression.

Psychogenic itch is also known as psychogenic pruritus, somatoform pruritus, functional itch disorder, nonorganic pruritus, psychosomatic pruritus, or functional pruritus.

Psychogenic itch is not well researched and is poorly understood by both psychiatrists and dermatologists. The following article will discuss psychogenic itch and its causes and treatments.

Psychogenic Itch: Defined 

Psychogenic itch is an itch that is not caused by skin condition or other physical condition. A more specific definition has not been established due to a lack of consensus on how to classify it.

The French Psychodermatology Group (FPDG)—an expert group that includes dermatologists, psychologists, and psychiatrists—suggests psychogenic itch be defined as an itch disorder where the itch symptom is physically present, but is triggered and aggravated due to psychological factors. The group also considers it "functional itch disorder."

Psychogenic itch is not the same as idiopathic itch (an itch with an unknown cause or origin). To make a diagnosis, first physical causes need to be ruled out, then the medical provider will look for clinical characteristics, an association with psychological disorders, or the presence of stressful life events.

The three broad categories of psychogenic itch are:

• A primary skin condition with itch, such as eczema or urticaria (hives), which leads to the development of psychiatric symptoms/complications (typically depression, anxiety, or OCD are unmasked)
• A worsening in severity of a skin condition (psoriasis or eczema) during times of stress
• A psychiatric disorder that leads to feelings of itch
  

Psychogenic vs. Neuropathic Itch

Psychogenic itch is a different condition than neuropathic itch.

While psychogenic itch is related to psychological factors, neuropathic itch is caused by damage to the nervous system.

Neuropathic itch tends to be accompanied by numbness and tingling sensations. It may occur with notalgia paresthetica (an area of itchy skin on the upper back).

Neuropathic itch may be seen after events such as:

• Shingles
• Stroke
• Burn injury

Neuropathic itch treatments typically include topical medicines, such as local anesthesia and capsaicin, to help reduce sensations of pain.

Link Between the Nervous System and Itching

The brain makes itch possible. While the skin may be irritated, it's the brain that perceives the sensation of itch.

Itch can also start in the brain, such as with central nervous system disorders or psychological disorders.

When we itch (or even think about itching), sensory, motor, and certain areas of the brain are activated at the same time. Itch can be induced mentally, and may involve opioids (made by the brain), and other neurotransmitters, such as acetylcholine.

Cycle of Stress-Induced Itching and Itching-Induced Stress

Itch can affect mental health due to its impact on quality of life. Studies have found that participants who scored higher on depression scales also scored higher for itch intensity compared to participants who scored lower on depression scales.

Stress, depression, and other psychological issues can also cause existing skin problems, such as itching, to worsen.

Life events, both major and minor, have been associated with higher levels of itch in people with skin conditions and in the general population.

In this stress-itch cycle, it can often be difficult to determine which started first, the skin disorder or the psychiatric disorder.

Prevalence and Risk Factors 

Prevalence of psychogenic itch is difficult to determine because psychogenic itch is under researched, tough to pinpoint, and can be due to dermatologic or psychologic/psychiatric causes. Dermatologists see more cases of it than psychiatrists because people experiencing psychogenic itch are more likely to seek care from a dermatologist than a psychiatrist.

One study found that 6.5% of outpatients from a dermatology department at a university medical center were experiencing psychogenic itch, but that number may be skewed as that department is known to specialize in psychosomatic dermatology.

Psychogenic itch occurs most frequently in women than men, with an average age of onset between 30 and 45 years.

Mental health disorders associated with psychogenic itch include:

• Depression
• OCD
• Anxiety
• Somatic symptom disorder
• Mania
• Psychosis

Conditions that may occur simultaneously with psychogenic itch include:

• Body dysmorphic disorder
• Trichotillomania (hair-pulling disorder)
• Kleptomania (impulse disorder resulting in the urge to steal)
• Borderline personality disorder

Which Healthcare Provider Deals With Stress Itching?

Dermatologists see more people with psychogenic itch than psychiatrists do. If a dermatologist consults with a person with psychogenic itch that is out of their professional scope, they may refer that person to a psychiatrist.

Psychodermatology is a field that is well-established in Europe, but lesser known in the United States. Psychodermatology allows for the study and treatment of skin conditions that arise from psychological conditions, and addresses mental health problems that can stem from living with a skin condition.

Treatment and Coping Strategies 

Treating psychogenic itch often involves both medical and/or behavioral approaches.

Over-the-Counter Medicines and Topicals

If a skin condition is present, localized treatments may help the itch, such as menthol or cool compresses.

Moisturizing the skin may help ease dryness and stop you from scratching. Depending on the reason for the itch, antihistamines, topical steroids, antibiotics, or occlusive dressings may be advised.

Prescriptions

There are no clinical trials for psychogenic itch treatments.

However, there are some psychopharmacologic medicines your healthcare provider can prescribe that may be helpful for psychogenic itch. These include:

• Hydroxyzine (an antihistamine)
• Tricyclic antidepressants, mainly Prudoxin (doxepin)
• Selective serotonin reuptake inhibitors (SSRIs), including Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Celexa (citalopram), Luvox (fluvoxamine), and Lexapro (escitalopram)
• Antipsychotics, such as Orap (pimozide), Risperdal (risperidone), and Zyprexa (olanzapine)
• Antiepileptics, such as Trokendi (topiramate), Gralise (gabapentin), and Lyrica (pregabalin)

Psychological Approach

The efficacy of psychological treatments for psychogenic itch has not been well-studied. However, some types of psychotherapy, including cognitive behavioral therapy (CBT) may help.

Stress Management 

Treatments and programs that target stress reduction, relaxation, and problem-solving may be beneficial to people with psychogenic itch. These might include:

• A biopsychosocial model (emphasizes the relationship among biological, psychological, and social and environmental factors)
• Cognitive behavioral therapy (CBT)

Relaxation techniques to help with stress relief might include:

• Breathing exercises
• Progressive muscle relaxation
• Guided imagery

Summary

Psychogenic itch is not well-studied or well-defined. By broad definition, it is an itch in which psychological factors, rather than physical ones, play a role.

Itch can also form a vicious cycle in which skin conditions can negatively affect mental health and mental health factors worsen skin conditions.

Depending on the cause of the itch and the symptoms, psychogenic itch may be treated with topical treatments, medication, psychological approaches, and/or stress management.

A Word From Verywell

If you have a troublesome itch and aren't sure what is causing it, talk to your healthcare provider. If they suspect it is due to psychogenic itch, they may refer you to either a dermatologist or a mental health professional.