Skin Sensitivity: Painful Reactions to Water and Nighttime Itching - Dermatology

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Skin experiences heat and stinging upon contact with water / Skin becomes unbearably itchy at night?


Hello, doctor! I would like to inquire about two skin issues that have started occurring in the past week or two.
The first issue is that my skin feels hot and stings when it comes into contact with water (especially noticeable in my limbs while showering).
I researched online and found that this symptom resembles contact dermatitis, but I'm not entirely sure.
At the same time, I am experiencing another symptom: my skin becomes extremely itchy at night while I sleep (particularly in my limbs), to the point that I wake up from the itching.
There are no significant visible abnormalities on the skin's surface, just small red spots from where I've scratched.
I have a history of atopic dermatitis/eczema and initially thought this was just seasonal allergies or dry skin (applying lotion has not helped), but the previous symptoms did not include the stinging sensation when in contact with water.
Therefore, I am reaching out to seek your clarification.

Xiao Mu, 20~29 year old female. Ask Date: 2023/02/01

Dr. Wu Yuxin reply Dermatology


Based on your description, it is most likely that excessive skin dryness has exacerbated your atopic dermatitis.
The lotion you usually use may not be sufficient at this time; you might need to switch to a cream or a more intensive moisturizer.
However, I recommend that you first consult a dermatologist to assess your condition and determine if further treatment is necessary.

Reply Date: 2023/02/01

More Info


Understanding skin sensitivity, particularly in the context of painful reactions to water and nighttime itching, can be quite complex, especially for individuals with a history of atopic dermatitis or eczema. Your symptoms of experiencing a burning and painful sensation when your skin comes into contact with water, along with intense itching at night, are concerning and warrant a closer examination.

Firstly, the burning sensation when your skin touches water could be attributed to several factors. One possibility is that your skin has become excessively dry, which is common in individuals with atopic dermatitis. When the skin is dry, it can lose its natural barrier function, leading to increased sensitivity and discomfort when exposed to water. This is particularly true if you are experiencing this sensation during bathing, as hot water can exacerbate dryness and irritation. It may be beneficial to switch to lukewarm water and limit the duration of your baths or showers to help mitigate these symptoms.

Another potential cause for your symptoms could be a condition known as aquagenic urticaria, which is a rare form of physical urticaria that causes hives or a burning sensation upon contact with water, regardless of its temperature. However, this condition is quite rare, and it would be essential to consult a dermatologist for a proper diagnosis.

The intense itching you experience at night, especially if it disrupts your sleep, is also a common issue for those with atopic dermatitis. This condition often leads to a cycle of itching and scratching, which can further damage the skin and lead to secondary infections. The fact that you notice small red spots from scratching indicates that your skin barrier is compromised, which is typical in eczema patients. It is crucial to manage the itch to prevent this cycle.
You mentioned that moisturizing with lotion has not been effective. It may be time to consider using a thicker emollient, such as a cream or ointment, which can provide a better barrier and retain moisture more effectively than lotions. Look for products that contain ingredients like ceramides, glycerin, or hyaluronic acid, which can help restore the skin barrier. Additionally, applying moisturizers immediately after bathing can help lock in moisture.

Given your history of atopic dermatitis, it is also important to consider potential triggers that may exacerbate your symptoms. These can include environmental factors such as allergens, irritants, or even stress. Keeping a symptom diary may help identify specific triggers that worsen your condition.

Lastly, if your symptoms persist or worsen, it is crucial to seek professional medical advice. A dermatologist can provide a thorough examination and may recommend treatments such as topical corticosteroids or other medications to help manage inflammation and itching. In some cases, they may also suggest allergy testing to rule out any specific allergens that could be contributing to your symptoms.

In summary, your symptoms of painful reactions to water and nighttime itching could be linked to dry skin, atopic dermatitis, or potentially other conditions. A multifaceted approach involving proper skin care, identification of triggers, and professional medical guidance will be essential in managing your symptoms effectively.

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