This paper is in the following e-collection/theme issue:

Research Letter (75) Infodemiology and Infoveillance (1270) Skin Cancer and Melanoma Prevention (110) Dermatology Health Services Research (47) Infoveillance, Infodemiology, Digital Disease Surveillance, Infodemic Management (1010) Teledermatology (58)

Published on in Vol 6 (2023)

Preprints (earlier versions) of this paper are available at https://preprints.jmir.org/preprint/48669, first published .
Hell’s Itch: A Unique Reaction to UV Exposure

Hell’s Itch: A Unique Reaction to UV Exposure

Hell’s Itch: A Unique Reaction to UV Exposure

Authors of this article:

Katelin J Ball1 Author Orcid Image ;   Brandon W Muse1 Author Orcid Image ;   Bailey Cook1 Author Orcid Image ;   Alyssa P Quinn1 Author Orcid Image ;   Benjamin D Brooks1 Author Orcid Image
Article Authors Cited by Tweetations (4) Metrics

    Research Letter

    College of Osteopathic Medicine, Rocky Vista University, Ivins, UT, United States

    Corresponding Author:

    Benjamin D Brooks, PhD

    College of Osteopathic Medicine

    Rocky Vista University

    255 E Center St

    Ivins, UT, 84738

    United States

    Phone: 1 435 222 1236

    Fax:1 720 874 2452

    Email: bbrooks@rvu.edu


    We present a survey-based exploration of Hell’s Itch, a severe dermatologic reaction often mistaken for sunburn, that reveals distinct symptoms including intense pain, unrelenting itching, paresthesia, and even suicidal ideation, differentiating it from a typical sunburn.

    JMIR Dermatol 2023;6:e48669

    doi:10.2196/48669

    Keywords

    Hell’s Itch; social media; sunburn; sun; survey; skin; dermatology; dermatological; itch; itchiness; itchy; symptoms; experience; ultraviolet; UV; dermatologist; teledermatology; hair; nails; scratch 


    Hell’s Itch is an inciting dermatologic reaction that can occur after sun exposure and is often characterized by symptoms such as intense pain, itching, paresthesia, and suicidal ideation. A patient with Hell’s Itch described their experience as follows: “Dozens of white-hot sewing needles being repeatedly stabbed into my upper back. The pain is unrelenting and unbearable... It drives you completely insane.” Patient accounts like this distinguish Hell’s Itch from a typical sunburn.

    One in 3 people in the United States experience a sunburn annually [1]. Sunburn is characterized by cutaneous erythema appearing 24 to 72 hours following sun exposure. The cause of sunburn is excessive exposure to UV radiation, commonly causing acute, transient inflammation in the skin [2]. Symptoms depend on sunburn severity and may include blistering, peeling, and pruritus due to peeling [2]. Like sunburn, Hell’s Itch is a manifestation of cutaneous damage after unprotected UV exposure. However, Hell’s Itch exhibits key differences in presentation. Hell’s Itch is reported as an acute, uncontrollable itch that causes stabbing pain when scratched [3]. In addition, Hell’s Itch results from a key inciting event such as topical cream application or water exposure.

    Hell’s Itch is commonly misdiagnosed as sunburn. Misdiagnosis leads patients to seek medical advice from alternative sources such as social media. There are social media platforms with groups comprising up to 4000 members who share experiences and anecdotal treatment remedies.

    Here, we explore the differences in symptomatology between Hell’s Itch and a typical sunburn using a patient survey.


    Hell’s Itch is not well characterized in the scientific literature, with only 3 published case reports to date [3-5]. Without objective diagnostic criteria available to establish a diagnosis of Hell’s Itch, our survey relied on subjective, self-reported data as the source to identify the distinguishing symptoms. We surveyed patients in social media groups with approximately 5500 total members to identify common symptoms, the incidence of symptoms, and symptom severity rated from 0 (none) to 10 (worst imaginable). Study inclusion criteria included adults aged ≥18 years with at least 1 episode of Hell’s Itch.


    A total of 100 people with self-diagnosed Hell’s Itch completed the survey. The defining differences between the symptoms of Hell’s Itch and sunburn identified in the survey included unrelenting pruritus, intense pain, difficulty sleeping, paresthesia, and suicidal ideation (Table 1). Hell’s Itch symptoms commonly occurred after sun exposure and were often triggered by inciting events like water exposure (eg, showering, bathing, swimming, humidity, or sweating) or application of a topical cream (88/100, 88%).

    Table 1. Hell’s Itch survey results (N=100).
    SymptomPrevalence (%)Average symptom severity ratinga
    Pruritis989.17
    Pain908.42
    Difficulty sleeping878.62
    Paresthesia or tingling777.61
    Suicidal ideation446.93
    Peeling skin336.20
    Numbness135.13
    Other328.94

    aSymptom severity was rated from 0 (none) to 10 (worst imaginable).


    The incidence rate of Hell’s Itch is currently unknown as it is commonly misdiagnosed as a sunburn. Our survey characterizes the prevalence and severity of key symptoms differentiating Hell’s Itch from a typical sunburn—intense pain, itching, paresthesia, and even suicidal ideation—which are distinctive symptoms absent with sunburn. However, the survey may be limited in its strength because it relied on patients self-diagnosing their condition. Future efforts should move beyond convenience samples and include studies to characterize pathophysiology, risk factors, and effective treatments.

    Conflicts of Interest

    None declared.

    1. Young AR, Tewari A. Sunburn. UpToDate. 2022. URL: https://medilib.ir/uptodate/show/6624 [accessed 2023-02-09]
    2. Rhodes LE, Lim HW. The acute effects of ultraviolet radiation on the skin. In: Lim HW, Honigsmann H, Hawk JL, editors. Photodermatology. London, United Kingdom. CRC Press; 2007;75.
    3. Wilder-Smith AJ. Hell's Itch due to sunburn. J Travel Med. Jan 01, 2019;26(1):tay124. [CrossRef] [Medline]
    4. Toljan K. Another report of Hell's Itch due to sunburn. J Travel Med. Nov 09, 2020;27(7):taaa182. [CrossRef] [Medline]
    5. Wyckmans MM. Hell's Itch could be caused by neurogenic inflammation: proposed pathophysiology and treatment options. J Travel Med. Jan 06, 2021;28(1):taaa204. [CrossRef] [Medline]

    Edited by R Dellavalle; submitted 02.05.23; peer-reviewed by A Nigh, L Alhanshali; comments to author 26.07.23; revised version received 04.09.23; accepted 15.09.23; published 24.10.23.

    Copyright

    ©Katelin J Ball, Brandon W Muse, Bailey Cook, Alyssa P Quinn, Benjamin D Brooks. Originally published in JMIR Dermatology (http://derma.jmir.org), 24.10.2023.

    This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Dermatology, is properly cited. The complete bibliographic information, a link to the original publication on http://derma.jmir.org, as well as this copyright and license information must be included.