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Itchy Legs

What is an itchy leg?

Itching is defined as having the desire or sensation to scratch [1]. The medical term used for itching is pruritus. It may occur as a symptom of various disorders such as skin disease, dry skin and cancer [2].

Itchy legs are a common annoying and embarrassing problem to most people. It is one of the most disturbing and uncomfortable sensations felt by the skin, aside from pain. Its occurrence varies based on its duration and intensity. It may start as a mild itch, then, progress later on, to a severe itch lasting for several weeks [3].

 

Itchy legs

Picture 1: Itchy Leg

Source: johnhartfitness.com

The Skin

Human skin is designed to serve as a barrier or protection against various foreign objects in the environment. Due to this reason, the skin is responsible for sensations of the objects external to it. Usually, the sensations that skin have are harmless. However, there are also other sensations that cause discomfort and disturbance of the skin.  [4]

Most of the time, people scratch certain parts of the body to remove the feeling of itchiness. When the itchiness becomes intolerable, scratching may result to the injury of the skin. This occurrence is also termed as the itch-scratch cycle. [5]

 

Pathophysiology

Itchy legs may occur without the presence of underlying cause or disease. Though this is the case, it may still cause disturbance and discomfort to the person who is experiencing it. Itchiness which is more severe can affect a person’s daily functioning.  [1]

Itchy skin may be due to internal or external factors affecting the skin. First, the itching sensation arises when the itch receptors of the skin detects presence of irritants on its surface [1]. These irritants cause the release of histamine which results to the itchy sensation [5]. The scratching reflex is elicited in order to relieve the itching and remove the irritant [1].

On the other hand, itching may also result from what is happening inside the skin. In this case, itching results when the somatosensory cortex in the brain is activated. This certain part of the brain is associated with tactile stimulations. As the end-result, nerve cells carry the information towards the brain for the scratch-reflex. [5]

Skin itching is usually accompanied by spots, blisters, bumps, redness, and skin dryness. [5]

 

Itchy Legs Causes

1. Poor Hygiene

  • When there is an accumulation of sweat and dust in the skin, these will be broken down by the bacteria. As a result, it will cause nerve- ending irritation on the skin and with this, itchiness follows. [6]

2. Skin Dryness

There are many factors which contribute to skin dryness. This may be due to:

  • Excessive cleaning or too much use of soap 
  • Shaving: When the shaving gel or aftershave that is being used has high alcohol content, it results to drying of skin and other allergic reactions.
  • Sweating
  • Genetic Predisposition
  • Old Age: Senile Xerosis
  • Dehydration
  • Malnutrition: Deficient intake of fatty acids
  • Diseases: The diseases that contribute to the occurrence of dry skin involve conditions wherein there is decreased oil production by the skin. The diseases causing skin dryness include Sicca Syndrome , Sjogren syndrome, hypothyroidism [5, 6]

3. Infection/Insect bites

  • Folliculitis: This refers to the infection of the hair follicles caused by the bacteria, Staphylococcus aureus. It appears as acne-looking small reddish bumps. These small bumps tend to appear in areas such as upper thigh, face, thighs, or other parts of the body. Along with the appearance of the acne-looking bumps, itchiness or burning pain occurs.

Picture 2 :  Staphylococcal Folliculitis (red bumps with white centers (occationally)

Source: atlasdermatologico.com.br

  • Jock Itch: Also known as Tinea cruris, is an infection caused by fungi located at the upper portion of the thigh and at the groin region. It appears as a papular rash that has brownish or reddish colors, affecting the genitals, buttocks, and inner thighs. It usually occurs in athletes and people who sweat excessively.

Picture 3 :  Jock itch (Tinea cruris) on the thigh (inner side)

Source: atlasdermatologico.com.br

  • Insect bites: When the skin is bitten by insects, the area surrounding the bite will itch. Examples are mosquitoes and louse bites. [1, 5]

4. Skin condition/diseases

  • Leg Acne/Chicken Skin: Medically termed as Keratosis Pilaris, is a skin condition wherein there is thickening of the hair follicles at the thighs or other parts of the body. It manifests as bumps which are small, reddish or brownish in color. This condition is triggered by heat and friction caused by clothes.
  • Scabies: This is caused by the parasites called Mites or Sarcoptes Scabei which comes from pets such as cat or dog. It can be easily transmitted through contact with other people. Sexual contact is also a mode of its transmission.
  • Contaneous Larva Migrans: This is a skin disease which causes intense itching red eruption. It comes from the parasitic hookworms in the feces of cats and dogs.

Itchy legs-creeping eruption

Picture 4: Itchy red eruptions in Contaneous Larva Migrans

Source: ihealthblogger.com

  • Herpes gladiatorum (Wrestler’s Herpes): It can be obtained in sporting clubs, through skin-to-skin contact.
  • Acne: This usually appears as reddish-colored bumps with white or black heads, commonly located at the thighs or buttocks.
  • Gravitational Eczema (Stasis Dermatitis): This condition involves skin irritation caused by increased venous return in the capillaries, resulting to elevated pressure in these areas.

Picture 5: Gravitational Eczema (Stasis Dermatitis)

Source:healthhype.com

  • Swimmer’s Itch: This is an acute immune reaction of the skin caused by parasitic schistosomes. [1, 5]

5. Leg Itch caused by Exercise (Running)

  • Unfit Runners: When an inactive person suddenly decides to begin vigorous exercises such as running, an intense itch, specifically on the legs, may occur. This happens because the small arteries cannot dilate immediately causing decrease of oxygen levels in that area. As a result, the low oxygenation level irritates the adjacent nerves leading to itchiness.
  • Cholinergic Urticaria: This is described as hives causing intense leg itch. It usually appears on the thighs, arms, or upper trunk. It occurs in a duration of 30 minutes to 1-2 hours. This is common in patients who have allergic reactions to their own perspiration. This condition happens due to the body’s reaction to physical stimuli such as heat, sunlight, clothe friction to the skin, water, spicy foods, vibration, cold climate, exercise, and emotional stress.

Picture 6 : Cholinergic (physical) urticaria on lower leg

Image source: Flickr.com

  • Exercise-Induced Anaphylaxis:  This is an allergic reaction that is triggered by exercise. In this condition, intense leg itching is felt together with fatigue, dizziness, facial swelling, breathing difficulties, warmth, and fainting. All of these may occur within 30 minutes of doing exercises. [1, 6]

6. Leg Itch occurring after shower

  • Excessive use of soaps and hot showers which may result to drying of skin
  • Cholinergic urticaria
  • Psychological causes
  • Polycythemia Vera [6]

7. Itchy Pants Syndrome

  • Also known as Pants Paresthesia Syndrome, it is a condition wherein the pants causes irritation of the skin in the form of allergic dermatitis. This manifests as intense itching felt at the thighs. Also, the condition may be due to wearing unwashed pants. [1, 5]

8. Drug Intake

  • Taking some drugs may cause the release of Histamine. This leads to triggering itchy sensation. Examples are Chloroquine and Opioids. [5]

9. Internal Diseases

There are certain diseases, which may be internal or hereditary, that may cause itchiness and rashes on the legs. Examples are :

  • Hyperparathyroidism
  • Liver disorders
  • Iron Deficiency Anemia
  • Cancer: Hodgkin’s Lymphoma
  • Uramic Pruritus [5]

10. Nervous Disorders

Some conditions which affect the nervous system can also cause itching. These are:

  • Diabetes Mellitus
  • Herpes Zoster
  • Multiple Sclerosis
  • Restless Leg Syndrome (Willis-Ekbom Disease) [5]

11. Pregnancy

  • Leg itching is common to pregnant women due to poor circulation at the legs. [5]

 

How to get rid of itchy legs

The first step to treating itchy legs is finding its underlying cause. Then, when it is identified, the doctor can now treat the underlying cause as well as the itchy legs [7]. The treatment of itchy legs includes the following:

1. Proper Hygiene

  • Having regular showers is advised to eliminate itching caused by skin bacteria.
  • Make sure to take showers before and after exercises.
  • Use of lukewarm water and mild soaps prevents drying of skin.
  • For persistent rashes caused by bacteria, anti-bacterial soaps or ointments are recommended. [4, 6]

2. Avoid having dry skin

  • Hydrate the body with increased fluid intake
  • Refrain from having direct exposures to wind and sunlight
  • Use moisturizing and anti-itch creams
  • Avoid use of strong scented soaps
  • Use shaving gel or shaving creams with less or no amount of alcohol in it
  • Avoid using hot showers to prevent drying of skin
  • If possible, use a humidifier in the house to prevent drying of skin. [1, 5, 6]

3. Choose proper clothing

  • Avoid wearing restrictive clothing especially around the legs.
  • Use clothes which are comfortable and light. Clothes made from cotton are recommended.
  • Choose underwear or sportswear with fabric that does not irritate the skin. 
  • Always wash the clothes before wearing them.
  • Avoid fabrics made from as synthetics and wool [1, 4, 7]

4. Modify activities

  • Some patients may be advised to refrain from vigorous activities and exercises.
  • Do not exercise in a weather which is hot or humid
  • People who are diagnosed with Exercise-induced anaphylaxis are advised to wear medic-alert bracelets and should never exercise without company.
  • For people who would like to resume doing vigorous activities, such as exercising, after a long period of being inactive, make sure to have proper training.
  • If the cause of itching is Restless Leg Syndrome, stretching exercise and massage may aid in preventing its occurrence.
  • For pregnant women, it is helpful to take short walks everyday to enhance blood circulation. In this way, itchy legs could be prevented.
  • In patients with gravitational eczema, avoid long periods of standing. [1, 4, 5]

5. Lifestyle changes

  • Avoid consumption of alcohol or caffeine [6]

6. Other tips to get rid of itchy legs

  • Refrain from scratching the itchy area
  • Use cool washcloth or cold compress to relieve itching
  • Utilize sunscreens to avoid sunburns and other skin damage [6]

 

Pharmacologic Therapy

Pharmacologic treatment for itchy legs varies depending on their condition. According to the Health Services at Columbia University, it is recommended to seek medical advice if self-treatment or home remedies do not soothe the itchy legs [8]. Here are certain medications which are used to treat itchy legs:

1. Corticosteroids

  • This is given to control itching by applying it topically (on the skin). Most doctors advise applying the cream on the affected area together with clean cool washcloth to enhance its absorption.  [9]

2. Antihistamines

  • Diphenhydramine: This is usually given to patients to cure allergic reactions such as rashes, hives, sneezing, cough, motion sickness, and runny nose. It also aids in treating patients with sleeping problems and Parkinson’s Disease. [10]

3. Topical anesthetics

  • Anesthetics such as benzocaine and lidocaine are given for temporary relief of itching. [9]

4. Antifungal medications

  • This is indicated for itchiness caused by fungal infections such as in the case of Jock Itch or Tinea Cruris. [6]

5. Antibiotics

  • For itchy leg brought about by bacterial infections such as Staphylococcus aureus in Folliculitis, antibiotics are prescribed. [5]

6. Epinephrine

  • For patients with itchy leg caused by severe allergic reaction such as in Exercise-Induced Anaphylaxis, an Intramuscular injection of Epinephrine or Adrenaline is given. [1]

 

Points to Consider

Itchy Legs is a common problem that causes discomfort and disturbance. In preventing and treating this condition, determining the underlying cause is important. When home remedies or self-treatment does not relieve the itching, it is best to seek help from the doctor. This is to ensure proper diagnosis and prompt treatment.

 

References:

1. http://www.healthhype.com/itchy-legs-causes-and-treatment.html

2. http://en.wikipedia.org/wiki/Itch

3. http://www.webmd.com/skin-problems-and-treatments/guide/skin-conditions-pruritus

4. http://berryripe.com/itchy-legs/

5. http://www.ihealthblogger.com/2013/03/Itchy-Legs-Causes-Symptoms-Treatment-Prevention.html

6. http://janmodric.hubpages.com/hub/10-Causes-of-Itchy-Legs

7. http://www.webmd.com/skin-problems-and-treatments/guide/skin-conditions-pruritus

8. http://www.livestrong.com/article/293512-itchy-leg-skin/

9. http://www.mayoclinic.com/health/itchy-skin/DS00847/DSECTION=treatments-and-drugs

10. http://www.livestrong.com/article/77882-medications-stop-skin-itching/

 



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