# Hell’s Itch: A Case Series of a Debilitating Post-Sunburn Pruritic Syndrome in a Healthy Young Adult

## TL;DR

Hell’s Itch is a rare, intensely itchy condition after sunburn that is difficult to treat, but β-alanine may offer temporary relief.

## Contribution

This case series introduces β-alanine as a potential off-label treatment for Hell’s Itch.

## Key findings

- Three patients with Hell’s Itch reported rapid symptom relief after taking β-alanine.
- Standard treatments like antihistamines and lidocaine were ineffective for the patients.
- Only mild paresthesia was reported as an adverse effect in one patient.

## Abstract

Background and Clinical Significance: Hell’s Itch is a rare, intensely uncomfortable post-sunburn condition with burning pruritus emerging 24–72 h after UV exposure. This condition often goes unrecognized and is frequently misdiagnosed by healthcare providers due to a lack of knowledge and familiarity. Standard antipruritic measures are often ineffective, and patients frequently rely on anecdotal self-management. Case Presentation: Three healthy adult males between 23 and 28 years old experienced multiple episodes of delayed-onset intense pruritus following moderate-to-severe sun exposure. The patients experienced a burning or stinging pain which they described as “fire ants” or “thumbtacks,“ and their symptoms started between 24 and 72 h after sun exposure without any rash or fever symptoms. The patients did not achieve symptom relief from standard treatments which included oral antihistamines and topical lidocaine, NSAIDs, aloe vera, and cold compresses. The patients received β-alanine treatment through pre-workout supplements or pure powder after consulting non-clinical sources. Each patient ingested β-alanine and reported rapid relief (itch 8–10/10 → 1–2/10) lasting 2–3 h. The only adverse effect reported by one patient was mild paresthesia. Conclusions: This case introduces β-alanine as a potential off-label therapy for Hell’s Itch and emphasizes the psychological burden and clinical complexity of the condition. While anecdotal, further study is needed to elucidate the mechanism of action of β-alanine in relieving symptoms of Hell’s Itch, as well as assess safety and efficacy in controlled settings. Increased clinical awareness of Hell’s Itch may reduce patient distress and improve management strategies.