Itching in Multiple Sclerosis

A Rare and Distressing Symptom

Itching and MS
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Do you find yourself constantly lifting up your pant leg to vigorously scratch away that itchy sensation? While simply feeling itching does not mean you have MS (there are a number of other potential causes), it may be another burdensome or annoying symptom (of the many) that a person or loved one with MS experiences.

The Neuropathic Itch in Multiple Sclerosis

Unlike itching caused by skin irritants like poison ivy, itching in MS is a neuropathic itch.

So, there is no rash or bumps in the area that is itchy, other than the redness from your scratching. This means it is caused, like most of our other MS symptoms, by demyelination of the nerves of our central nervous system.

However, itching tends to be paroxysmal, meaning it comes and goes pretty quickly. The good news is that these types of symptoms usually do not signal a relapse, but are probably just due to a transmission of nerve impulses across sites where they do not normally occur and where there has been previous damage.

Characteristics of Itching in Multiple Sclerosis

Itching as a symptom of MS has been found to have the following characteristics, although not everyone experiences all of them:

Paroxysmal: The itching starts and stops abruptly.

Frequent: The itching episodes happen as often as six times per day –- sometimes even more.

Short duration: It lasts a couple of seconds to a couple of minutes.

Nocturnal: The itching often occurs at night, waking the person from sleep.

Connected to other symptoms: In some patients, trigeminal neuralgia follows the itching. In some others, the itching follows pain or sensory disturbances such as dysesthesias. There seems to also be a connection with L'hermitte's sign, an electric-shock type of sensation that runs down the spine when the head is bent forward.

Symmetric: The itching can happen on the face, torso, arms and legs (basically anywhere on the body) and usually happens on both sides of the body, meaning both arms would be affected or both sides of the face. Occasionally, though, the itching may be on only one side.

Triggers: Some patients find that itching is triggered by heat, such as being outside on a warm day or taking a hot bath. It is often triggered by movement.

Treatment of Itching in Multiple Sclerosis

If itching is impairing your daily functioning or quality of life, or if it is leading to self-injury (like a skin infection or scarring) from compulsive scratching seeking out treatment is important. Often, behavioral treatments are helpful, as are simple measures like covering up the itchy area with clothing.

While no studies have been conducted on neuropathic itching, several things have been shown to help. Anticonvulsants like Tegretol (carbamazepine) and Neurontin (gabapentin) and antidepressants like Paxil (paroxetine), Remeron (mirtazapine), and Elavil (amitriptyline) are sometimes used for this symptom.

Lyrica (pregabalin) may also be helpful. Once treated, the itching often doesn’t return.

Other Causes of Itching in Multiple Sclerosis

Sometimes, it is not your MS that is causing itching but another medical condition or even one of your MS medications. This is why it's a good idea to see your neurologist or primary care physician if your itching persists or worsens with home remedies.

Rarely, some of the disease-modifying therapies (including Copaxone, Tysabri, Avonex,) may cause itching, which can signal an allergic reaction. Often this reaction is accompanied by hives or redness, which signals that it is not typical MS neuropathic itching. This could be serious and you need to call your doc right away.

In addition, Tecfidera (dimethyl fumarate), another disease-modifying therapy, may cause itching as a side effect, along with flushing and stomach upset.

A Word From Verywell

Itching in MS can be extremely frustrating, especially since Benadryl, steroids, or any topical products that you use are unlikely to provide any relief. If you have MS and have itching, see your doctor for some medicine or strategies that can help.

Sources:

Oaklander AL. Neuropathic Itch. Semin Cutan Med Surg. 2011 Jun;30(2):87-92.

Yosipovitch G, Samuel LS. Neuropathic and psychogenic itch. Dermatol Ther. 2008 Jan-Feb;21(1):32-41.

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