Your concern

Itching with nothing to see

When the skin is normal, itching must be investigated elsewhere: it is a different visit.

It is an uncomfortable situation: the skin itches, sometimes a great deal, but in the mirror there is nothing to show. The only visible things are the marks of scratching — linear excoriations, crusts — which are consequences, not the cause, and must be distinguished from primary lesions.

The first and commonest explanation remains cutaneous: very dry skin itches before showing obvious signs, because a compromised barrier makes nerve endings more reactive. This is the case resolved by working on cleansing and emollients, and it is worth excluding first because it is simple.

When, however, itching is generalised, persistent for weeks and without dryness to justify it, the reasoning moves beyond pure dermatology. Diffuse itching without lesions can accompany general conditions — thyroid, haematological, hepatic, renal — or medication recently started. It is not an alarm: in most cases the explanation stays mundane. But it is why this visit includes targeted blood tests rather than stopping at a cream, and why it is worth having rather than living with the symptom for months.

Telling scratch marks from true lesions

This is the visit's first task, and the one the patient cannot do alone. Linear excoriations, small crusts and thickened areas are what scratching produces: they are the consequence of the symptom, not its origin, and reading them as «the rash» leads you astray. When no primary lesion lies beneath those marks, the picture is classified as itching on normal skin — a category of its own, with its own diagnostic pathway including general investigations. It is not a longer visit out of excessive caution: it is that the answer, in these cases, is often not in the skin.

How it shows

Diffuse itching without visible eruptions
Only scratch marks: linear excoriations, crusts
Persistence for weeks, often worse in the evening
Absence of marked dryness to justify it
Sometimes onset after starting a new medication
Impact on sleep and concentration

How we proceed

1Dermatological visit: search for primary lesions beneath the scratch marks
2Assessment of the state of the skin barrier
3Review of medication taken and timing of onset
4Targeted blood tests when itching is diffuse and persistent
5Symptomatic therapy and a pathway for the identified cause

Available treatments

Dermatology visit
Targeted investigations
Symptomatic therapy
Scheduled follow-up

Book a visit

Our specialists will evaluate your case and define the most suitable treatment plan.

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Siena · Firenze

Where to find us

Skinfarm Siena →342 795 0356

Skinfarm Florence · Dermatology →350 862 2658

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Frequently asked questions

Will the doctor tell me it is nerves?+

Itching without lesions is not by definition psychogenic, and dismissing it that way is a time-wasting error. Stress can amplify the perception of the symptom, as it does with pain, but before attributing the picture to it, cutaneous and general causes must be excluded. The point of this visit is precisely that: doing the checks rather than giving a convenient explanation.

What tests are needed?+

It depends on the picture, which is why no identical panel is prescribed for everyone. In diffuse, persistent itching without a cutaneous explanation, some general parameters are typically assessed — thyroid function, blood count, liver and kidney function, iron status — chosen according to age, associated symptoms and current medication. The list is built at the visit, after hearing the history.

I started a new medication: could that be it?+

It is one of the first things to check, and it is frequently missed because itching can appear some time after the therapy started, breaking the mental link. Bringing a complete list of what you take, supplements included, with approximate start dates, is one of the most useful things a patient can prepare beforehand.