Itchy Palms at Night and Itchy Soles: What Causes It? A Dermatologist's Guide to Causes With and Without Bumps, From Dry Skin, Scabies and Fungus to Liver Disease, and How to Relieve the Itch
Nocturnal palmar pruritus is itching of the palms, the soles, or both that clearly gets worse from evening to the middle of the night and disturbs sleep. The most common causes are local skin conditions such as dry skin and irritant dermatitis from hand washing, pompholyx (small clear blisters on the palms), scabies, and fungal infection. But if your palms and soles itch with no bumps or rash at all, internal diseases must also be considered, especially cholestasis from liver disease, cholestasis of pregnancy, kidney disease, and diabetes.
The palms and soles have the thickest skin on the body. The outer horny layer can be 0.5–1.5 mm thick, compared with 0.02 mm on the face, and there are no oil glands at all. This skin therefore dries and cracks easily, topical medicines penetrate poorly, and many rashes here look different from the same rash elsewhere, so judging by eye what it is often goes wrong. This article sorts the causes by 'what you can see' so you know which ones you can manage yourself and which should be checked.
What causes itchy palms at night: 3 main groups
The way a dermatologist thinks is to first ask whether there is anything visible on the skin, and then sort into groups.
Itchy, with a visible rash or bumps — dry cracked skin, irritant dermatitis, pompholyx (clear blister rash), contact allergy, fungal infection, and psoriasis of the palms and soles. This group accounts for most people who come to the clinic.
Very itchy, with tiny bumps or scratch marks but no obvious rash, and people at home are itchy too — always think of scabies first, because it is contagious and curable if the whole household is treated correctly.
Itchy but the skin looks normal, with no bumps and no rash — early dry skin, cholestasis from liver disease, intrahepatic cholestasis of pregnancy, chronic kidney disease, diabetic neuropathy, carpal tunnel syndrome, certain medicines, and, less commonly, blood disorders or lymphoma.
If itching without a rash lasts longer than 6 weeks, it is medically classed as chronic pruritus and blood tests should be done to look for an internal cause, rather than keep applying anti-itch medicine.
Why do the palms itch most at night
Many people notice they hardly itch in the daytime but, once in bed, itch so much they have to get up and scratch. Several reasons overlap.
Cortisol is lowest at night. Cortisol is a natural anti-inflammatory. Its level in the blood is lowest around midnight to 2 a.m., so every inflammatory rash itches more late at night.
Skin temperature rises in bed. The body releases heat through the hands and feet before sleep, blood flow to the skin increases, and the warmth directly stimulates itch nerve endings.
The skin loses more water in the evening. Transepidermal water loss is higher from evening into the night. Skin that is already dry becomes drier and itchier, especially in an air-conditioned bedroom with low humidity.
Nothing distracts you. In the daytime the brain is busy with other input and the itch signal is drowned out. In a quiet, dark room the itch is felt more clearly.
Disease-specific reasons. Scabies mites move around and burrow more when the skin is warm at night, while itching from cholestasis has its own rhythm that is often worst in the evening.
This means 'itchy at night' alone cannot identify the disease. It must be read together with the location, the look of the skin, and other symptoms. If the itch is all over the body more than in the hands, read more at What causes itching all over the body at night
Itchy palms with no bumps and no rash: what could it be
This is the question people search for most, and it is the group that needs the most care, because 'normal-looking skin' does not mean there is no disease.
What it looks like: A deep, tingling itch in both palms, or in the palms and soles together, that does not go away when scratched. No bumps, red rash or scaling can be seen. There may be only scratch marks or skin thickened from long-term scratching.
Causes: The most common is early dry skin that has not yet cracked visibly. The internal causes known for 'starting at the palms and soles first' are cholestasis from liver disease and cholestasis of pregnancy. Others are chronic kidney disease, peripheral neuropathy (diabetes, vitamin B12 deficiency), carpal tunnel syndrome, iron deficiency, hyperthyroidism, and certain medicines.
Severity and urgency: If it lasts a few days and improves with moisturizer, it is mostly harmless. But if the itch continues beyond 2–6 weeks, or comes with yellow eyes, dark urine, pale stools, weight loss, low-grade fever or night sweats, the cause needs to be investigated, and a pregnant woman with itchy palms and soles and no rash must see a doctor within a few days.
When to see a doctor: Itching without a rash for more than 2 weeks despite regular moisturizer, itching that prevents sleep, other whole-body symptoms, or pregnancy. The doctor examines the skin closely (sometimes scabies or fungal lesions are too small to see with the naked eye) and arranges blood tests as appropriate.
Itchy palms from dry skin and irritant dermatitis (frequent hand washing, alcohol gel, dish soap)
What it looks like: Dry, tight palms and backs of the hands, fine scaling, deeper palm lines, later small cracks at the fingertips and knuckles. Itchy and stinging on contact with water or alcohol gel. Usually both hands, with the dominant hand worse.
Causes: Damage to the outer skin layer from washing hands more than 10–20 times a day, alkaline soaps, dish detergent, laundry powder, very hot water, and wearing rubber gloves for long periods so the hands become sweaty. Common in nurses, housekeepers, hairdressers, cooks and mothers of small children. Medically it is called irritant contact dermatitis, the most common hand rash.
Severity and urgency: Not dangerous, but if left until the skin cracks deeply it is painful, can become infected with bacteria, and damaged skin becomes more easily allergic to other substances. Most cases improve in 2–4 weeks if the triggers are truly avoided.
When to see a doctor: No improvement after 2 weeks of proper moisturizing, cracks that weep, or clear blisters starting to appear. To tell dry skin from disease, see What causes peeling hands
Itchy palms with small clear bumps beside the fingers (pompholyx, a clear blister rash)
What it looks like: Itching or burning comes first for 1–2 days, then clear blisters 1–2 mm across form deep under the skin, looking like 'sago pearls' on the sides of the fingers, palms and soles. They do not burst easily because the skin is thick. After 1–3 weeks the blisters dry and peel in rings, then come back. Often very itchy at night and in hot weather.
Causes: It is a type of eczema (dyshidrotic eczema). It is common in people with a history of atopic allergy, heavy hand sweating, stress, nickel or cobalt allergy, and sometimes as a reaction to a fungal infection of the feet. The old name 'dyshidrosis' means abnormal sweat glands, but it is in fact not caused by the sweat glands.
Severity and urgency: Not contagious and not dangerous, but very itchy and it can recur for years. If the blisters turn cloudy with pus, or there is pain, swelling and redness, it means a secondary infection.
When to see a doctor: The first episode, more than 3–4 episodes a year, or pus-filled blisters. Read more at Clear blisters on the palms and soles: pompholyx and Small clear bumps on the hands: 8 causes
Itchy between the fingers and wrists at night, and people at home are itchy too (scabies)
What it looks like: Severe itching at night that wakes you to scratch, with small red bumps 1–3 mm across and sometimes gray wavy lines 2–10 mm long, which are the mite burrows. Favorite sites are between the fingers, the sides of the fingers, the inner wrists, elbows, armpits, around the navel, waist, buttocks and genitals. In adults it rarely appears on the face, but in infants it appears very clearly on the palms and soles and may look like blisters or pustules.
Causes: The Sarcoptes scabiei mite burrows under the outer layer of skin. It spreads through prolonged skin-to-skin contact, such as sleeping in the same bed, hugging a child, caring for an older person, or sharing blankets. With a first infection, itching starts 2–6 weeks after exposure. If you have had it before, itching starts quickly, within 1–4 days.
Severity and urgency: Not life-threatening in most people, but it spreads very easily to the household, and scratching can lead to bacterial infection. In older people or those with weak immunity it can become crusted scabies, with tens of thousands to millions of mites, which is extremely contagious.
When to see a doctor: Itching at night together with household members or close contacts itching too, or bumps between the fingers and on the wrists. This should be confirmed with a skin magnifier (dermoscopy) or a skin scraping to look for mites, and everyone in the household must be treated at the same time. For whole-household treatment, see Scabies: which night itch is scabies
Itchy on one palm, itchy on both soles (fungus of the hands and feet)
What it looks like: Both soles peel with fine white scale along the skin lines, itching sometimes and sometimes not, white soggy skin between the toes, and only one palm peeling with similar dry scale. Doctors call this pattern 'two feet–one hand syndrome', an important clue to fungus, because allergic rashes or dry skin usually affect both hands equally. Fungal infection of the toenails is often present too.
Causes: A dermatophyte fungus, the same group that causes ringworm. It spreads from your own feet to the hand you use to scratch or pick at the feet. Risk factors are wearing closed shoes all day, damp feet, walking barefoot in shared bathrooms, and diabetes.
Severity and urgency: Not dangerous, but it does not clear by itself and can spread. The most common thing that makes it worse is applying steroid cream or anti-itch cream mixed with steroid, which makes the fungus grow faster and changes the look of the rash so it is hard to diagnose (tinea incognito).
When to see a doctor: Peeling on one hand only, no improvement after 2–4 weeks of treatment, or thick yellow nails as well. The doctor scrapes the scale for a fungal test (KOH), which gives a result in a few minutes. Read more at What causes peeling feet and Ringworm: why steroid cream makes it spread
Itchy palms after touching certain things (contact allergy rash)
What it looks like: A red, itchy rash with small blisters or thickened cracked skin, appearing where the skin touched a substance, for example fingertips that handle garlic or onion, a hairdresser's fingertips that handle hair dye, palms that wear rubber gloves, or the line where a ring or watch touches. The rash usually appears 24–72 hours after contact, so it is hard to work out what caused it.
Causes: A delayed-type allergy to a specific substance (allergic contact dermatitis). Common culprits are nickel, rubber accelerators in gloves (thiurams, carbamates), paraphenylenediamine in hair dye, fragrance, preservatives in liquid soaps and creams (methylisothiazolinone), and chromate in cement.
Severity and urgency: Not contagious, but if contact with the substance continues the rash becomes chronic and can spread up the arms. People whose work means handling the substance every day may be unable to keep working if they do not know what they are allergic to.
When to see a doctor: A hand rash lasting more than 3 months, or one that returns every time you go back to work. You should have an allergy skin test with patches (patch test) to identify the allergen clearly. For details see Contact dermatitis
Thick, cracked, itchy palms and soles (psoriasis of the palms and soles)
What it looks like: Thick pinkish-red patches with clear edges and thick silvery-white scale, usually on both sides symmetrically, with deep painful cracks. One type has sterile yellow pustules 2–4 mm across in the middle of the palms or soles that turn into brown spots (palmoplantar pustulosis). The itch can range from slight to severe.
Causes: An immune disease that speeds up skin production. Rashes on the hands are triggered repeatedly by pressure and friction. The pustular type is clearly linked to smoking. There may also be rashes on the elbows, knees or scalp, or pitted nails.
Severity and urgency: Not contagious, but a rash on the palms and soles affects quality of life greatly because the hands and feet are used every day, and it is often more resistant to topical medicine than rashes elsewhere.
When to see a doctor: A thick, cracked rash that persists, does not improve with ordinary topical medicine, or comes with finger joint pain. Read more at Psoriasis: early signs and treatment
Itchy palms and soles from liver disease (cholestasis)
What it looks like: A deep itch in the palms and soles first, then spreading all over the body, worst from evening to the middle of the night. The skin looks normal or has only scratch marks. Some people itch for months to years before their eyes turn yellow. Accompanying symptoms to ask about are yellow eyes, yellow skin, dark tea-colored urine, pale clay-like stools, and fatigue.
Causes: Narrowing or blockage of the bile ducts, so bile substances and certain itch-causing substances (such as lysophosphatidic acid) build up in the blood. The diseases include primary biliary cholangitis, which is most common in women aged 40–60, bile duct stones, hepatitis B or C, liver inflammation from medicines or herbal products, and masses pressing on the bile ducts.
Severity and urgency: The itch is a sign of a disease whose cause must be found, not a skin disease. If there are yellow eyes together with pain in the upper right abdomen or fever with chills, go to hospital immediately.
When to see a doctor: Itchy palms and soles with no rash for more than 2 weeks, especially in middle-aged women, regular alcohol drinkers, people with viral hepatitis, or people who started a new medicine or herbal product in the past 1–3 months. The initial test is a blood test of liver function, especially ALP, GGT and bilirubin.
Pregnant and itchy palms and soles at night (cholestasis of pregnancy)
What it looks like: Intense itching of the palms and soles with no rash, usually starting in the third trimester, after about 28–30 weeks of pregnancy, worst at night, and it may spread over the whole body. A minority have mild jaundice.
Causes: Intrahepatic cholestasis of pregnancy, caused by very high estrogen and progesterone late in pregnancy together with genetics. It occurs in about 0.3–5% of pregnancies, varying by ethnic group, and is more common in twin pregnancies, pregnancies after IVF, and in women who had it in a previous pregnancy.
Severity and urgency: It is not dangerous to the mother and the itch resolves within 2–4 weeks after delivery, but the baby has a higher risk of preterm birth, meconium in the amniotic fluid, and stillbirth, especially when blood bile acids exceed 100 micromol/L. This is the most urgent itch in this article.
When to see a doctor: A pregnant woman with itchy palms and soles and no rash must tell her obstetrician within 1–2 days for a blood test of serum bile acids and liver function. A bile acid level of 10 micromol/L or more together with itching meets the criteria. The medicine obstetricians use is ursodeoxycholic acid at about 10–15 mg/kg/day, which helps reduce the itch, and the doctor plans the timing of delivery according to the bile acid level. Do not buy anti-itch pills yourself during pregnancy. Itchy rashes with bumps in pregnancy are a different group of diseases, see Skin changes during pregnancy
Itchy soles at night with burning and numbness: is it diabetes
What it looks like: A tingling, burning itch like ants biting or pins pricking at both soles, starting at the toes and spreading up in a 'sock' pattern, worse at night when the blanket touches the feet. Later numbness begins and sensitivity to pain, heat and cold decreases. In the hands it follows the feet in a 'glove' pattern.
Causes: Small fiber neuropathy. The most common cause is poorly controlled diabetes, followed by vitamin B12 deficiency (especially in people who have taken metformin for many years or follow a strict vegetarian diet), heavy alcohol use, and some chemotherapy drugs. In addition, diabetes makes the skin drier and makes fungal infection of the feet more likely.
Severity and urgency: Not acutely dangerous, but it is a sign that the nerves are starting to deteriorate. A numb foot can develop wounds without being noticed, and infection can spread. Anti-itch medicine rarely works for this kind of itch because the cause lies in the nerves.
When to see a doctor: Itching and burning of both soles for more than 2–4 weeks, or beginning numbness. Fasting blood sugar (FBS), HbA1c and vitamin B12 level should be checked. If you already have diabetes, your feet should be examined every year. Read more at Skin diseases in diabetes
What kind of itch is kidney disease
What it looks like: Itching can be all over, most often the back, arms and legs, but itchy palms and soles also occur. It is usually equal on both sides, worst at night and after dialysis, with very dry skin. The skin looks normal or has only scratch marks and firm bumps from chronic scratching.
Causes: Itching from chronic kidney disease (chronic kidney disease–associated pruritus, or uremic pruritus) comes from build-up of waste products, dry skin, high phosphate and parathyroid hormone, and abnormal functioning of the itch nerves. It occurs in about 40% of dialysis patients and usually appears when the kidneys are already at stage 4–5.
Severity and urgency: Someone whose kidneys are almost normal should not itch from the kidneys, so if you have never had kidney disease, itching alone does not mean kidney failure. But if you also have diabetes, high blood pressure, swelling, foamy urine or reduced urine, you should be tested.
When to see a doctor: Check kidney function (BUN, creatinine and eGFR) when itching without a rash lasts more than 6 weeks. Kidney patients who itch should tell their kidney doctor, because adjusting dialysis, controlling phosphate, and specific medicines such as low-dose gabapentin 100 mg after dialysis can help. Do not adjust medicines yourself, because many medicines need a lower dose in people with reduced kidney function.
Tingling hands, waking at night and having to shake your hands (carpal tunnel syndrome)
What it looks like: Numbness, tingling or a strange itchy feeling in the thumb, index finger, middle finger and half of the ring finger, but not the little finger. It often wakes you at 2–4 a.m. so that you shake your hand or dangle it beside the bed, and it improves. It occurs after using the hands for prolonged twisting, gripping or holding a phone.
Causes: The median nerve is compressed in the carpal tunnel at the wrist (carpal tunnel syndrome). It is common in women aged 40–60, pregnant women, people who use the wrist repeatedly at work, and people with diabetes or underactive thyroid. During sleep the wrist is often held bent, so pressure in the tunnel rises and symptoms are worst at night.
Severity and urgency: It is not a skin disease and topical medicine does not help. If left until the muscle at the base of the thumb wastes, the hand will be permanently weak.
When to see a doctor: An 'itch' that is really tingling along those fingers should be seen by an orthopedist or neurologist for a nerve conduction test. Treatment starts with a wrist splint at night.
Itching from medicines, blood disorders and thyroid, and what kind of itch is cancer
This group is much less common than the others, but it is the reason doctors must take a detailed history when itching comes without a rash.
What it looks like: Itching all over or starting at the hands and feet, with normal-looking skin. Some types have distinctive features, such as an itchy, stinging feeling 10–30 minutes right after a bath with no rash (aquagenic pruritus), which can be a symptom of the thick-blood disorder polycythemia vera.
Causes: Medicines such as opioid painkillers, the antimalarials chloroquine and hydroxychloroquine, some blood pressure medicines, and the oral chemotherapy capecitabine, which causes red, painful palms and soles (hand-foot syndrome). Blood disorders such as iron deficiency and thick blood. Hyperthyroidism, which usually comes with palpitations, tremor and weight loss. And lymphoma, especially Hodgkin type, in which itching occurs in about 10–30% of patients, and for some it comes months before a lump is found.
Severity and urgency: The itch that should raise the question of cancer is chronic itching without a rash together with 'B symptoms': recurrent fever with no cause, drenching night sweats that soak the clothes, weight loss of more than 10% in 6 months, or enlarged lymph nodes felt in the neck, armpits or groin. Without these symptoms the chance of cancer is very low.
When to see a doctor: Itching within 1–8 weeks of starting a new medicine: bring every medicine to show the doctor, and never stop your regular medicines yourself. If itching comes with B symptoms, see an internal medicine doctor for blood tests (CBC, ferritin, TSH) and a physical exam for lymph nodes.
Itchy palms and the belief that money is coming: is it true
In Thailand there is an old belief that an itchy left or right palm means you will receive or lose money. This is a cultural belief with no medical evidence behind it. The problem is that this belief leads many people to overlook symptoms that have lasted for months. Medically, an itchy palm is itching of one area of skin, which can have the causes explained above. If it itches for just a few minutes and goes away by itself, there is no need to worry, but if it itches every night until you cannot sleep, the real cause should be found.
What do itchy palms on both sides versus one side tell you
Location and symmetry are clues you can use in practice before seeing a doctor.
Both palms itchy equally, skin looks normal — think of dry skin, liver disease, cholestasis of pregnancy, kidney disease, medicines, or peripheral neuropathy.
A rash on both hands, with scale or clear blisters — irritant dermatitis, pompholyx, atopic eczema, or psoriasis.
One hand together with both soles — think of fungus first.
The dominant hand, or the place that holds a particular object — irritant dermatitis or contact allergy rash.
Between the fingers, wrists, and people at home itchy too — scabies.
Tingling from the thumb to the ring finger, waking in the night — carpal tunnel syndrome.
What tests are done when itchy palms and soles do not go away
Testing depends on what is seen on the skin. A dermatologist does not order every blood test for everyone but chooses according to the clues.
Skin examination with a magnifier (dermoscopy) to look for scabies burrows, fungal scale, or the features of psoriasis.
Scraping scale for a fungal test (KOH), with a result in 10–15 minutes.
Skin scraping for scabies mites or eggs from a burrow between the fingers.
Patch test for chronic hand rashes suspected to be caused by an allergen. Reading the result takes 2–4 days.
Blood tests when itching without a rash lasts more than 6 weeks: complete blood count (CBC), iron stores (ferritin), liver function (ALP, GGT, bilirubin, AST, ALT), kidney function (BUN, creatinine), sugar (FBS, HbA1c), thyroid (TSH), and, depending on risk, hepatitis B and C or HIV.
Pregnant women: blood bile acids and liver function.
Basic home measures for night-time itchy palms
These measures help you sleep while waiting to see a doctor and are the foundation of treatment for every kind of hand rash, but they do not treat scabies, fungus, or internal disease.
Cold compress for 10–15 minutes with a cloth soaked in cold water or a cold pack wrapped in cloth. Cold quickly dampens the itch signal. Do not soak in very warm water, because it feels good briefly but dries the skin and the itch returns stronger.
Apply a thick moisturizer right after every hand wash, within 3 minutes while the hands are still damp. Choose a fragrance-free formula. If the palms are thick and cracked, use a cream with urea 10–20% or lactic acid, which helps dissolve thick horny skin and draws water into the skin.
Before bed, apply a thick layer of cream and wear cotton gloves overnight. This helps the cream penetrate thick skin better and prevents scratching while asleep.
Keep nails short and file them smooth. Scratching inflames the skin more, and inflamed skin itches more, a cycle that must be broken.
Change how you wash your hands. Use mild or non-foaming soap and room-temperature water, pat dry including between the fingers, and wear gloves when washing dishes or doing laundry, with a cotton glove underneath if you must wear them longer than 15–20 minutes.
Keep the bedroom cool but not too dry. A comfortably cool room temperature reduces night itching. If the air conditioner runs all night the skin will dry, so apply extra cream before bed.
A cooling lotion with menthol 0.5–1% or pramoxine 1% can be added during bad itching. It can be used on skin that is not broken.
What not to do is buy strong steroid cream or a steroid-antifungal combination cream and apply it yourself for a long time, because if it is fungus or scabies it will spread and be harder to diagnose, and do not apply alcohol, wintergreen oil or medicated balm on cracked skin.
Medicines doctors actually use, by cause
Treatment of itchy palms depends entirely on the cause. Antihistamines alone help little in almost every group. Below is the approach dermatologists use, so that you understand what to expect and the criteria for whether it is working.
1. Irritant dermatitis, contact allergy and pompholyx
High-potency topical steroids. Because palm skin is thick, weak creams do not penetrate. Commonly used are mometasone furoate 0.1% or betamethasone valerate 0.1% once or twice a day for 2–4 weeks. For very thick rashes the doctor may use clobetasol propionate 0.05%, the strongest, generally for no more than 2 consecutive weeks, then reduce to every other day or weekends only.
Non-steroid topical medicines such as tacrolimus 0.1%, used during long-term control to reduce steroid use.
Working means the itch clearly decreases within 1 week and the rash flattens within 2–4 weeks. Not working means no improvement after 4 weeks, which calls for reviewing the diagnosis, doing a patch test, or finding what you are still in contact with.
For severe chronic hand rashes that resist topical medicine, the doctor may consider oral immune-suppressing medicine or targeted ultraviolet light treatment of the hands, which must be assessed individually.
2. Scabies
Permethrin 5% cream applied over the whole body from the neck down to the toes, including under the nails, between the fingers and the genitals, left for 8–14 hours and then washed off. Repeat once more after 7 days.
Alternatives in adults are benzyl benzoate 25% or the oral medicine ivermectin 200 micrograms/kg as a single dose, repeated after 7–14 days. Ivermectin is not used in pregnant women or in children under 15 kg.
Everyone in the household must be treated at the same time on the same day, even if not yet itchy, and bedsheets, towels and clothes used in the previous 3 days should be washed in water hotter than 60 degrees Celsius or sealed in a bag for 72 hours.
Working means no new bumps after the second application, but the itch can persist for another 2–4 weeks even though the mites are dead. During this period a mild steroid cream and antihistamines can help. If new bumps continue after 4 weeks, it means treatment was incomplete or you were re-infected by someone at home.
3. Fungus of the hands and feet
Topical terbinafine 1% once or twice a day for 2–4 weeks, or clotrimazole 1% / ketoconazole 2% twice a day for 4 weeks, applied 2 cm beyond the edge of the rash and continued for another 1–2 weeks after the rash clears.
For thick moccasin-type soles, or when both the hands and nails are involved, topical medicine does not penetrate. The doctor uses an oral medicine such as terbinafine 250 mg once a day for 2–6 weeks or itraconazole according to the doctor's plan, and may check liver function before starting.
The feet must be treated at the same time, otherwise the hand is re-infected from the feet. Working means the scale is gone and the KOH test finds no fungus.
4. Cholestasis from liver disease
Treat the underlying cause first, for example removing the stone, stopping the medicine or herbal product responsible, or treating viral hepatitis.
Itch-relieving medicines used by internal medicine liver doctors include cholestyramine 4 g, one sachet at a time, starting once or twice a day and adjustable up to 16 g/day. It must be taken at least 1 hour before or 4–6 hours after other medicines because it binds them. If it does not work, the doctor may use rifampicin 150–300 mg/day with blood tests to monitor the liver, or naltrexone and sertraline in turn.
Non-sedating antihistamines hardly help itching from cholestasis.
5. Kidney disease and peripheral neuropathy
Control blood sugar, control phosphate, give vitamin B12 when deficient, and moisturize regularly.
Medicines that act on the nerves, such as gabapentin or pregabalin, are started at a low dose at bedtime. The doctor must adjust the dose to kidney function, because people with reduced kidney function are more prone to side effects of drowsiness and dizziness.
How far do antihistamines go
Sedating antihistamines such as chlorpheniramine 4 mg or hydroxyzine 10–25 mg before bed help you sleep for a short time but do not treat the cause. Older people must be careful because they cause confusion, difficulty passing urine, and a risk of falls in the night.
Non-sedating antihistamines such as cetirizine 10 mg or loratadine 10 mg once a day work well for hives but help very little with dry skin, hand rashes and itching from internal disease. If the itch comes with raised red welts that appear and fade within 24 hours, read more at What causes hives
The choice of medicine, its strength and how long to use it are for the doctor to decide after an examination, especially any oral medicine, and for pregnant women, breastfeeding women, children, and people with liver or kidney disease.
When to see a doctor immediately or within a few days
Pregnant with itchy palms and soles and no rash, especially in the third trimester — tell your obstetrician within 1–2 days.
Itching with yellow eyes, yellow skin, tea-colored urine or pale stools — see a doctor within a few days. If there is also fever with chills or pain in the upper right abdomen, go to hospital immediately.
Itching with fever, night sweats, weight loss of more than 10%, or enlarged lymph nodes.
Household members itchy at the same time — suspect scabies, and the whole household must be treated.
A hand rash that cracks into pus-filled sores, with swelling, redness and heat, or a red line spreading up the arm — bacterial infection.
Itching with no rash for more than 6 weeks or a hand rash that does not improve after 2–4 weeks of proper care.
Numb feet, wounds on the feet appearing without you noticing, or weakening hands that drop things.
In brief
Itchy palms at night are mostly caused by local skin conditions: dry skin and irritant dermatitis, pompholyx, contact allergy rash, scabies and fungus, in which a rash or bumps can be seen.
Itching is worse at night than in the day because cortisol is at its lowest, the skin is warmer, the skin loses more water, and nothing distracts you.
Itchy palms and soles with no rash call for thinking of cholestasis from liver disease, cholestasis of pregnancy, kidney disease, diabetic neuropathy and medicines.
Night-time itching between the fingers and at the wrists with household members itchy too is scabies until proven otherwise. Apply permethrin 5% to the whole household and repeat after 7 days.
Thick palms make weak medicines ineffective. Hand rashes usually need a high-potency steroid for 2–4 weeks together with urea cream, and fungus must be ruled out before applying it.
What to do right away if you are pregnant and your palms and soles itch: tell your obstetrician to have bile acids tested within 1–2 days.
Frequently asked questions about itchy palms at night
What causes itching on the palms
The most common cause is dry skin and irritant dermatitis from frequent hand washing, alcohol gel and cleaning products. Next are pompholyx (clear blister rash of the palms), contact allergy rash, fungus and scabies, most of which have a rash, scale or bumps that can be seen. If the palms itch while the skin looks normal, especially if both palms and soles itch, internal causes must be considered, such as cholestasis from liver disease, cholestasis of pregnancy, kidney disease, diabetes and certain medicines. If you moisturize regularly for 2 weeks and still itch, or the itch continues beyond 6 weeks, see a doctor for a skin examination and blood tests as appropriate.
Why do my hands tingle and itch at night?
At night the hormone cortisol, which helps reduce inflammation, falls to its lowest, the body releases heat through the hands and feet so the skin warms, the skin loses more water, and nothing else draws your attention. Itching from dry skin, inflammatory rashes and cholestasis is therefore most noticeable at this time. Scabies itches most at night because the mites move more when the skin is warm. But if the feeling is 'tingling' from the thumb to the ring finger that wakes you in the night so that you shake your hand, it is usually carpal tunnel syndrome, not a skin disease, and should be told apart because the treatment is different.
What kind of itch is diabetes
Diabetes can cause itching in 3 ways. The first is dry skin all over, especially the legs and feet. The second is easy fungal infection, such as of the toe webs, soles, groin and under the breasts, which itches together with scale or a red rash. The third is peripheral neuropathy, which feels like a tingling, burning itch, like pins pricking at both soles, worse at night, then gradually becoming numb. Itching alone cannot diagnose diabetes. Fasting blood sugar after 8 hours without food (FBS) or HbA1c must be tested. An FBS of 126 mg/dL or higher, or an HbA1c of 6.5% or higher, meets the criteria for diabetes.
What kind of itch is kidney disease
Itching from kidney disease usually occurs when the kidneys are already badly affected, that is stage 4–5 or on dialysis. It itches equally on both sides, most often on the back, arms, legs, and palms and soles, worst at night, with very dry skin and no obvious rash apart from scratch marks. About 40% of dialysis patients have itching. If you have never had kidney disease, itching alone does not indicate kidney failure, but if you also have diabetes, high blood pressure, swollen legs, or foamy or reduced urine, kidney function (creatinine and eGFR) and urine should be tested.
What kind of itch is cancer
Itching that warrants a cancer work-up is very rare. The features to watch for are chronic whole-body itching for more than 6 weeks with no rash and no other cause found, together with recurrent fever, drenching night sweats, weight loss of more than 10% in 6 months, or enlarged lymph nodes felt in the neck, armpits or groin, which fit lymphoma, especially Hodgkin type. Another pattern is a stinging itch after bathing with no rash, seen in thick-blood disorders, and itching with yellow eyes in cancers that block the bile duct. Without these accompanying symptoms the chance that the itch comes from cancer is very low. The doctor starts with basic blood tests and a physical examination.
Itchy palms with no bumps: what should I do
Start with skin care. Apply a thick fragrance-free moisturizer or urea 10–20% cream after every hand wash, use a cold compress for 10–15 minutes when itchy, wear cotton gloves at night, keep nails short, and use a mild soap. If it is dry skin, it should clearly improve within 1–2 weeks. If it does not improve, or both palms and soles itch, or you are pregnant, have yellow eyes or dark urine, or have diabetes or kidney disease, see a doctor for tests of liver function, kidney function, sugar, thyroid and a complete blood count. Do not buy strong steroid cream and apply it for a long time, because if it is fungus or scabies it will spread more.
The information in this article is general knowledge to support the decision to see a doctor. It is not a diagnosis or a prescription for any individual. The choice of medicine, dose and duration must always be assessed by a doctor. If you are pregnant, breastfeeding, or have liver or kidney disease, tell your doctor before starting any medicine.
Read more about dry skin at Dry cracked skin (xerosis), and other skin diseases written by our dermatologists at Skin disease article hub
Written by Dr. Patara Voravutinon, Dermatologist · Last reviewed 27 September 2026
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