Itchy skin at night: common causes, self-care and when to see a GP

Several things can combine at night. There are fewer distractions, skin tends to be warm under bedding, and for some conditions the itch is characteristically worse after dark. The NHS says itching in scabies is intense, especially at night. In dry skin, eczema and hives, scratching during sleep can also damage the skin and keep the cycle going. Whatever the cause, the practical aims are the same: calm the skin, protect it from scratching and find out whether there is an underlying cause.

The NHS suggests the following steps, which may also help stop itchy skin returning and avoid skin damage from scratching.

A pharmacist can tell you what the best products are for itchy skin, including medicines called antihistamines that may help with some causes, and lotions and creams such as menthol creams that help by cooling the skin. Tell the pharmacist where your skin is itchy and any other symptoms. The NHS pregnancy advice adds that some types of antihistamine can also help you sleep if itchy skin is keeping you awake at night, but ask a pharmacist, GP or midwife what is suitable.

• Pat or tap the skin instead of scratching it, and hold something cool such as a damp towel against it.

• Have cool or lukewarm baths or showers and avoid long soaks.

• Use an unperfumed moisturiser or emollient regularly.

• Keep nails clean, short and smooth.

• Wear loose cotton or silk clothing; avoid tight clothes and wool or synthetic fabrics.

• Use laundry liquid or powder for sensitive skin, and avoid perfumed soaps, deodorants and moisturisers.

• Ask a pharmacist about antihistamines, which may help with some causes, or menthol creams that cool the skin.

The NHS itchy skin page groups possible causes. It stresses that you should not try to diagnose yourself and should see a GP if worried.

The NHS describes scabies as an itchy rash caused by mites, spread through close skin contact, which anyone can get. The symptoms are intense itching, especially at night, and a raised rash or spots that may look red and are harder to see on brown or black skin, but can be felt. The rash is common between the fingers, around the wrists, under the arms and around the waist, groin and bottom, and in older people and young children can affect the head, neck, palms and soles. It can take up to 8 weeks for the rash to appear after infection.

A pharmacist can recommend a cream or lotion applied over the whole body, repeated 7 days later. Everyone in the home needs treating at the same time, even without symptoms, and anyone with sexual contact in the past 8 weeks. The NHS says to wash bedding and clothing at 60C or higher on the first day of treatment, and that itching can continue for a few weeks after the mites are killed. See a GP if the child is under 2, the skin may be infected, there is a crusted flaky rash, or itching persists 2 to 4 weeks after treatment.

The British Association of Dermatologists (BAD) agrees that itching is the main symptom of scabies and is often worse at night. It says the itch can affect the whole body apart from the head and neck, that several people in a family or friendship group may become itchy at around the same time, and that not everyone with scabies has the itch and rash. Treatment must be applied to all areas of the skin, not only the itchy parts, and BAD says it is best applied at night.

The NHS describes atopic eczema as a common skin condition causing itchy skin that can become dry, cracked, crusty, scaly or thickened, often on the elbows, knees and hands, with flare-ups and better periods. It cannot be cured, but treatment can help manage the symptoms. Itching from dry skin is often eased by regular emollients, which the NHS includes in its own self-care list for itchy skin.

The NHS advises seeing a GP if itchy skin is affecting your daily life, does not get better with self care or keeps coming back, is caused by a new rash, lump or swelling you are worried about, is all over your body, is severe or happens during pregnancy. A GP will look at your skin and ask about your symptoms, might arrange a blood test to help find the cause, may prescribe creams, lotions or tablets depending on the cause, and may refer you to a dermatologist.

Generalised itching without a rash can be linked to thyroid, liver or kidney conditions, or to low iron, so blood tests are a sensible next step when there is no obvious skin cause. Yellowing of the skin or eyes, dark urine or pale stools with itching need prompt assessment.