Alcohol Withdrawal Symptoms - Itching

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KEY TAKEAWAYS

Intense itching is a rare but acutely-felt symptom of Alcohol Withdrawal Syndrome—a collection of side effects that occur when excessive or prolonged alcohol consumption ends abruptly, or is significantly reduced.

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What Are The Symptoms Of Alcohol Withdrawal-Induced Itching?

Itching due to alcohol withdrawal varies from mild to severe and presents in one or more of the following ways:

  • Itchy skin. Similar to a rash or a reaction caused by a bug bite, itchy skin is often described as an irritating feeling that provokes the desire to scratch.
  • Burning and tingling. In some cases, itching from alcohol withdrawal is also accompanied by a burning sensation and tingling.
  • A crawling sensation. At times, alcohol withdrawal-induced itching is characterised as a feeling of insects crawling under or on the skin [1].
  • Skin damage. Redness, swelling, blotchiness, and dryness are also symptoms of itching due to alcohol withdrawal.

Why Does Alcohol Withdrawal Cause Itching?

Protracted drinking and/or extreme amounts of alcohol impact several organs, including the body’s largest organ: the skin [2].

Possible causes of alcohol withdrawal syndrome triggering itching include:

1.        Malnutrition

It’s also one of the most serious side effects of alcohol use disorder[3].

While alcohol is rich in calories, it's devoid of essential nutrients. These include:

  • Vitamins
  • Minerals
  • Fat
  • Protein

Furthermore, heavy drinking decreases hunger, which contributes to nutritional deficiencies.

An increase in alcohol consumption has also been linked to a decrease in the quality of one’s diet [4].

Additionally, alcohol hinders the absorption of nutrients that are particularly important to skin health and contribute to itchy skin.

These nutrients include zinc, niacin, and Vitamin A/Retinol. The effects of alcohol-related malnutrition on the skin include [5]:

  • Itchy skin, or pruritus
  • Blotchy complexion
  • Skin structure
  • Premature ageing
  • Flakiness
  • Acne
  • Inflammation
  • Rashes
  • Redness and flushing
  • Rosacea

2.      Dehydration

Alcohol withdrawal itching is also caused by dehydration, another common side effect in the alcohol detox process [6].

Alcohol acts as a diuretic.

It increases urination, and interferes with hydration, which directly affects the skin and contributes to itching [7].

The symptoms of dehydrated skin are:

  • Scaly skin
  • Itching
  • Dullness
  • Puffiness

3.      Immune Response To Alcohol

Another contributing factor to itchy skin from alcohol abuse and alcohol withdrawal is the immune system’s reaction to drinking.

A 2021 article published in the International Journal of Molecular Sciences shows that histamines are released to metabolise alcohol [8].

Histamines often provoke itching, as well as redness.

4.      Chronic Liver Disease

One of the symptoms of liver disease—a complication that's prevalent in alcohol abuse—is itching.

Liver disease is associated with an increased production in bile salts.

These accumulate under the skin and stimulate itchiness [9].

5.      Underlying Health Conditions

Several underlying health conditions have been linked to alcohol withdrawal-induced itchiness [10].

These include:

  • Eczema
  • Psoriasis
  • Anemia
  • Kidney disease
  • Diabetes
  • Psychiatric conditions, such as anxiety

6.      Alcoholic Hallucinosis/Tactile Hallucinations

Itching, or a general feeling of itchiness, is a common symptom of tactile hallucinations and is often described as bugs crawling in or under the skin.

This manifestation of tactile hallucinations is known as “formication” [14].

Unlike visual or auditory hallucinations—the sense of seeing or hearing things that are not there—tactile hallucinations are impressions of things that do not exist.

Tactile hallucinations are one of the most severe symptoms of alcohol withdrawal [15].

They're frequently present during the third phase, and the most acute form of alcohol withdrawal, delirium tremens (DTs).

Experts refer to tactile hallucinations as part of alcoholic hallucinosis—an uncommon consequence of chronic alcohol abuse [16].

Other symptoms of tactile hallucinations include stinging, or the sense of “something” that needs to get out [17].

7.      Alcoholic Neuropathy

One of the warning signs of alcoholic neuropathy is itching, as well as skin infections and sensitivity to touch [18].

Alcoholic neuropathy is a serious condition caused by alcohol abuse.

Due to alcohol’s effect on several nutrients that are key to appropriate nerve function—such as folate, thiamine, Vitamin E, and Vitamins B6 and B12—alcoholic neuropathy often presents as skin sensitivity, burning, and itchiness (also known as neuropathic itch). Such itchiness is intensified by scratching.

8.      Alcohol Intolerance

Itching caused by alcohol detoxification is also caused by an intolerance to alcohol itself [19].

In these cases, the body doesn’t have the ability to break down alcohol.

Flushing and itching are two symptoms of alcohol intolerance.

What Is Alcohol’s Connection To Itching?

Severe itching is an alcohol withdrawal symptom of the third phase, and it occurs after 48-96 hours after drinking the last drop of alcohol.  

This stage requires maximum medical care. 

Alcohol Withdrawal Itching

Alcohol addiction and alcohol dependence acts on the body’s central nervous system (CNS) [20].

The central nervous system is in charge of several central bodily functions, from heartbeat and blood pressure to body temperature and movement.

The central nervous system also regulates the five senses: seeing, hearing, smelling, tasting, and feeling.

Alcohol suppresses these activities. Excitability and sensitivity, for example, become subdued under the influence of alcohol.

Vision blurs, and tactile feelings, such as touch and pain, decrease.

Once alcohol consumption ends, or is drastically curbed, the central nervous system must recalibrate.

The central nervous system, in the absence of alcohol, becomes sensitive. This sensitivity extends to several vital organs, including the skin. Itching, burning, tingling, dryness—all are byproducts of alcohol’s effect on the skin.

Additionally, heavy alcohol use impacts key neurotransmitters, or brain chemicals, that in some cases ultimately leads to itching.

A 2018 published in The Journal of Clinical and Experimental Hepatology shows that alcohol disrupts the balance of Gabba-Amino Butyric Acid (GABA) and glutamate [21].

Suddenly quitting drinking, or significantly reducing alcohol consumption, causes an increase in glutamate activity.

This results in excitotoxicity, which occasionally presents as severe itching.

What Else Contributes To Itching From Alcohol Withdrawal?

The detox process from drinking alcohol varies from person to person [22].

Age, genetics, and overall health play a role in the severity of alcohol withdrawal symptoms.

Several other factors contribute to the intensity of alcohol withdrawal and the itching that occurs in some people. 

These include:

  • The amount of alcohol consumed.
  • The type of alcohol consumed. Beer and wine, for example, have a lower alcohol content by volume (ABV) than hard alcohol.
  • The duration of excessive drinking.
  • The use of other drugs/substances.
  • Co-occurring medical complications such as anemia.
  • Vitamin deficiencies.

How Is Itching Prevented During Alcohol Detox?

Several precautions to reduce alcohol withdrawal-induced itching are available [23].

In addition to adopting healthy strategies for coping with stress and enlisting the support of others, these include:

  • Vitamin supplements
  • Healthy eating
  • Hydration
  • Rest
  • Body lotions and other treatments, such as eczema cream, that are targeted at soothing itchy, dehydrated skin and dryness

Is Itching From Alcohol Withdrawal Permanent?

In some cases of alcoholic neuropathy, the damage caused to the nerves endures [24].

However, in most cases, itching, as well as other side effects of alcohol withdrawal, subside within two to seven days.

The exception to this is delirium tremens, which requires hospitalisation and, oftentimes, alcohol addiction treatment.

Does Itching Cause Lasting Skin Damage?

Whether itching causes permanent skin damage varies.

Scratching, for instance, plays a role in scarring.

Abstinence from alcohol, coupled with hydration, skin treatments, and a nutritious diet, helps diminish long term skin damage.

What Is The Treatment For Alcohol Withdrawal Itching?

If alcohol withdrawal itching is caused by delirium tremens, immediate medical care is required.

Delirium tremens, as noted, is the most acute form of alcohol withdrawal and is deemed an emergency that needs to be handled by medical professionals.

Because of the potentially fatal aspects of delirium tremens, hospitalisation and medical detox is often necessary.

Medical staff will work to ensure the patient remains calm until the DTs have subsided or passed.

Following this, substance abuse treatment is recommended to help the patient stop drinking.

If alcohol withdrawal itching is due to nutritional deficiencies, a healthy eating regime will aid in the replenishment of nutrients. Nutritional supplements, vitamins, and minerals also assist with skin healing. These include:

  • Zinc [25]
  • Vitamin A
  • Vitamin B12

Itching caused by dehydration is alleviated with hydration.

Other skin conditions, such as flaking and dryness, are also often treated with Epsom salt baths.

Epsom salts, or magnesium sulfate, help to soothe and soften rough, itchy skin.

Who Is At Risk For Alcohol Withdrawal Itching?

People who drink alcohol excessively or for an extensive amount of time are at a high risk of alcohol withdrawal-induced itching.

Additionally, those who have undergone previous alcohol detoxes are at a greater risk for more acute withdrawal symptoms, including severe itching.

This condition is known as alcohol kindling [26].

Alcohol kindling occurs after multiple relapses and attempts to stop drinking and is frequently telling of a drinking problem.

Withdrawal symptoms dramatically increase in intensity during alcohol kindling. The possibility of alcohol kindling emphasizes the need to seek treatment for alcohol addiction.

When To Seek Help

Itchiness due to alcohol withdrawal is often indicative of a larger problem with alcohol.

Treatment options for those who are dependent on alcohol are readily available, from inpatient programmes to intensive outpatient programmes.

Seeking help is the first step towards recovery—and, ultimately, healing.

Last Updated: August 3, 2022

About the author

Peter Szczepanski

Peter has been on the GPhC register for 29 years. He holds a Clinical Diploma in Advanced Clinical Practice and he is a Clinical Lead in Alcohol and Substance Misuse for Abbeycare Gloucester and works as the Clinical Lead in Alcohol and Substance Use in Worcestershire. Peter also co-authored the new 6th edition of Drugs In Use by Linda Dodds, writing Chapter 15 on Alcohol Related Liver Disease. Find Peter on Respiratory Academy, Aston University graduates, University of Birmingham, Q, Pharmaceutical Journal, the Dudley Pharmaceutical Committee, Dudley Council, Twitter, and LinkedIn.