The Neuropathic Itch

Reviewed by: HU Medical Review Board | Last reviewed: December 2022 | Last updated: March 2024

Neuropathic itch is a somewhat common symptom in people who live with neuromyelitis optica spectrum disorder (NMOSD).

NMOSD is a nervous system disorder that primarily affects the spinal cord and optic nerve. It results from the body’s immune system reacting against its own cells and, in turn, the swelling of the spinal cord (acute myelitis) and optic nerve (optic neuritis).

Defining the symptom: what is the neuropathic itch?

A neuropathic itch can be described as an itchy sensation with no other signs of skin issues, such as rash or swelling. The itching can be constant or sporadic. In most cases, neuropathic itch occurs within a few days to a few weeks of an NMOSD attack.1,2

The neuropathic itch usually gets better over a few weeks, though it can last up to a year or longer in some people. The severity of neuropathic itch differs between people, but it can sometimes be severe.1,2,4

Neuropathic itch can result in skin lesions created by repeated scratching or picking of the skin. People who have neuropathic itch usually do not feel the pain linked to skin lesions. This causes them to continue to scratch, causing ulcers and significant skin damage.1,2

What causes this symptom?

Experts disagree on the exact causes of neuropathic itching.5

Neuropathic itch linked to NMOSD may be caused by swelling (inflammation) in the spinal cord or nerves, leading to unusual sensory issues. Neuropathic itching, in particular, may be a sign of damage in the central spinal cord. This area of the spinal cord is where nerves control itchy feelings.1

When something damages these nerves – as with NMOSD – these nerves incorrectly signal the brain that there is an itching sensation.2

Are treatments available for neuropathic itch?

Treatment options for neuropathic itch are limited and include5:

  • Injections of botulinum
  • Topical (on the skin) application of ketamine combined with lidocaine (an anesthetic)
  • Gabapentin, a seizure drug also used for neuropathic pain
  • Some antidepressants
  • These treatments show evidence of improving neuropathic itch in some people. However, they need to be further studied along with potential new treatments.

    As with any itch, you should try your best not to scratch. Scratching can open your skin to infection. And sometimes, it can make the itching worse.5

    The culprit: the underlying cause, NMOSD

    The most important thing about neuropathic itch is diagnosing and treating the underlying cause. Treatment for neuropathic itch begins with treating NMOSD. Sudden attacks of NMOSD are treated with an injection of steroids (also called corticosteroids or glucocorticoids), sometimes with other medical options. These drugs work by reducing inflammation.6,7

    Repeated attacks of NMOSD are treated with drugs that suppress the immune system.1

    How common is the neuropathic itch?

    About 12 to 27 percent of people with NMOSD report having symptoms of a neuropathic itch. Although this symptom is somewhat common, the neuropathic itch may not be recognized as an early one of NMOSD.1

    Other common NMOSD symptoms

    People with NMOSD can experience many other symptoms as well, such as1-3:

  • Blurry vision or loss of vision
  • Weakness
  • Numbness or abnormal sense of touch
  • Painful muscle spasms
  • Uncontrollable vomiting and hiccups
  • Bladder or bowel control problems
  • Pain
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