{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T12:50:00Z","timestamp":1761655800147,"version":"build-2065373602"},"reference-count":10,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T00:00:00Z","timestamp":1761609600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and Clinical Significance: Hell\u2019s Itch is a rare, intensely uncomfortable post-sunburn condition with burning pruritus emerging 24\u201372 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 \u201cfire ants\u201d or \u201cthumbtacks,\u201c 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 \u03b2-alanine treatment through pre-workout supplements or pure powder after consulting non-clinical sources. Each patient ingested \u03b2-alanine and reported rapid relief (itch 8\u201310\/10 \u2192 1\u20132\/10) lasting 2\u20133 h. The only adverse effect reported by one patient was mild paresthesia. Conclusions: This case introduces \u03b2-alanine as a potential off-label therapy for Hell\u2019s 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 \u03b2-alanine in relieving symptoms of Hell\u2019s Itch, as well as assess safety and efficacy in controlled settings. Increased clinical awareness of Hell\u2019s Itch may reduce patient distress and improve management strategies.<\/jats:p>","DOI":"10.3390\/reports8040217","type":"journal-article","created":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T11:47:19Z","timestamp":1761652039000},"page":"217","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hell\u2019s Itch: A Case Series of a Debilitating Post-Sunburn Pruritic Syndrome in a Healthy Young Adult"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-1015-7526","authenticated-orcid":false,"given":"Precious Ochuwa","family":"Imokhai","sequence":"first","affiliation":[{"name":"Montana College of Osteopathic Medicine, Rocky Vista University, Billings, MT 59106, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"DeVries","sequence":"additional","affiliation":[{"name":"College of Medicine, Rocky Vista University, Parker, CO 80134, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katelin","family":"Ball","sequence":"additional","affiliation":[{"name":"Department of Research and Scholarly Activity, Rocky Vista University, Ivins, UT 84738, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3031-8006","authenticated-orcid":false,"given":"Brandon","family":"Muse","sequence":"additional","affiliation":[{"name":"Department of Research and Scholarly Activity, Rocky Vista University, Ivins, UT 84738, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7456-3074","authenticated-orcid":false,"given":"Benjamin","family":"Brooks","sequence":"additional","affiliation":[{"name":"Department of Research and Scholarly Activity, Rocky Vista University, Ivins, UT 84738, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2499","DOI":"10.1016\/j.jid.2021.03.015","article-title":"Mechanisms of Broad\u2013Band UVB Irradiation\u2013Induced Itch in Mice","volume":"141","author":"Cao","year":"2021","journal-title":"J. Investig. Dermatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.jaci.2023.05.004","article-title":"Basic Mechanisms of Itch","volume":"152","author":"Misery","year":"2023","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.jaad.2021.07.078","article-title":"Itch: Pathogenesis and Treatment","volume":"86","author":"Sutaria","year":"2022","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_4","unstructured":"U.S. Food and Drug Administration (2025, July 01). ITCH\u2013X. FDA Drug Label, Available online: https:\/\/www.accessdata.fda.gov\/scripts\/cdrh\/cfdocs\/cfrl\/rl.cfm."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"114942","DOI":"10.1016\/j.celrep.2024.114942","article-title":"High\u2013Affinity Agonists Reveal Recognition Motifs for the MRGPRD GPCR","volume":"43","author":"Wang","year":"2024","journal-title":"Cell Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"taaa204","DOI":"10.1093\/jtm\/taaa204","article-title":"Hell\u2019s Itch Could Be Caused by Neurogenic Inflammation: Proposed Pathophysiology and Treatment Options","volume":"28","author":"Wyckmans","year":"2021","journal-title":"J. Travel. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2114","DOI":"10.1001\/jama.2024.4899","article-title":"Chronic Pruritus: A Review","volume":"331","author":"Butler","year":"2024","journal-title":"JAMA"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1016\/j.burns.2011.12.003","article-title":"Post Burn Pruritus\u2014A Review of Current Treatment Options","volume":"38","author":"Zachariah","year":"2012","journal-title":"Burns"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1007\/s40265-017-0746-9","article-title":"Chronic Pruritus: Current and Emerging Treatment Options","volume":"77","author":"Pereira","year":"2017","journal-title":"Drugs"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Toyama, S., Tominaga, M., and Takamori, K. (2022). Treatment Options for Troublesome Itch. Pharmaceuticals, 15.","DOI":"10.3390\/ph15081022"}],"container-title":["Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2571-841X\/8\/4\/217\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T12:44:58Z","timestamp":1761655498000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2571-841X\/8\/4\/217"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,28]]},"references-count":10,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["reports8040217"],"URL":"https:\/\/doi.org\/10.3390\/reports8040217","relation":{},"ISSN":["2571-841X"],"issn-type":[{"value":"2571-841X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,28]]}}}