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Itch in a Child

See also Pruritus

Most common causes

Atopic dermatitis

The skin is dry and itchy.
Itching may be generalized or may only occur in eczematous skin areas.
Effective topical treatment with a glucocorticoid ointment and/or a calcineurin inhibitor together with emollients reduces both eczema and itching.
For investigations and treatment, see also Atopic Dermatitis in Children: Clinical Picture, Diagnosis and Treatment

Urticaria

Itchy hives appear on the trunk, extremities and face.
The symptoms usually start abruptly. In children, infections are the most common cause of acute urticaria.
An antihistamine with a dose related to the weight of the child may be used throughout the duration of urticaria.
See also Hives (Urticaria).

Scabies-induced eczema

The eczema is very itchy.
Lesions are papular or papulovesicular.
Furrows are often found if they are sought especially in the palms and soles of the feet.
The eczema lesions easily break leading to incrustation.
Large bullous lesions suggest a secondary bacterial infection.
See also Scabies.

Head lice

Give rise to itching and reddened papules in the scalp.
Diagnosis is based on visible lice and nits in the hair shafts.
See also Head Lice and Pubic Lice

Enterobiasis (pinworms)

Causes perianal itching.
The symptom is particularly cumbersome at night and may disturb the sleep so that the child wakes up every now and then.
See also Pinworm (Enterobiasis).

Streptococcal perianal dermatitis

In addition to itching, intense reddening of the perianal skin as well as pain; picture .
See also Anal Problems in Children.

Chickenpox

The rash is itchy.
Papules and vesicles at many different phases are visible on the skin.
Mild fever may precede the skin eruption.
Itching ceases in about one week as chickenpox resolves.
Menthol spirit solution may be used for cooling of the itchy and hot skin.
See also Chickenpox.

Other causes

Allergy or other hypersensitivity may in its mildest form present only with an itch. In a child with pollen allergy, the itch may be located e.g. in the outer ear canals. Known causes include citrus fruit, fresh strawberries and cocoa.
In the summer an itch may be a symptom of hypersensitivity to light.
Mastocytosis (urticaria pigmentosa) is a rare itchy skin disease.

Treatment

Based on the aetiology
Careful treatment of a possible underlying disease (e.g. atopic dermatitis or scabies)
Emollients for dry skin when needed
Antihistamines have not been shown to be effective for itch related to atopic skin.

References

Metz M, Wahn U, Gieler U et al. Chronic pruritus associated with dermatologic disease in infancy and childhood: update from an interdisciplinary group of dermatologists and pediatricians. Pediatr Allergy Immunol 2013;24(6):527-39. [PubMed]