Two years ago, Johnny Hays was taking a late afternoon swim with his wife at Perry Lake in northeast Kansas. He normally wears a long-sleeve shirt in the sun, but his wife convinced him to swim without one that day. The pair spent less than an hour in the water, and the UV index wasn’t particularly high. Hays’ skin didn’t look red or feel sunburned afterward either, he said.
A few days later, however, he experienced a sudden pain on his back so excruciating it “put [him] on the ground.” He didn’t know it then, but what he was experiencing was a rare but debilitating reaction to sun exposure known as “Hell’s Itch.”
“Just after 48 hours, I started feeling a little pinch on my back — and that’s all it felt like,” Hays, who says he was not wearing sunscreen that day, told HuffPost. “Like something was biting me. I’m like, what the hell is that?”
Quickly, that biting sensation spread across his back and shoulders, and the pain intensified.
“Within 60 seconds, it went from feeling like one little prick on my back to full-blown hot knives or needles being stabbed randomly throughout my back,” said Hays, who has posted about the experience on his @johnnyhaysoutdoors TikTok account.
Hays started panicking, figuring there must be something “severely wrong,” he said. At first, he didn’t connect the pain to the sun exposure because he didn’t have a sunburn. During a Google search, Hays found a Reddit thread about Hell’s Itch, which described his symptoms exactly.
Within 60 seconds, it went from feeling like one little prick on my back to full-blown hot knives.
- Johnny Hays
While not a clinical term, Hell’s Itch is the nickname for this dermatologic phenomenon characterized by “uncontrollable itch with intense stabbing pains,” according to a case report in the Journal of the European Academy of Dermatology and Venereology. It typically shows up one to three days after a sunburn or sun exposure, and is often triggered by an inciting event such as water exposure or application of a topical cream.
“People get this deep, burning itch that scratching does nothing to relieve,” explained board-certified emergency room physician Dr. Jordan Wagner, known as “Doctor ER” on YouTube. “It feels like fire ants biting beneath the skin. It can be intense enough to keep you up at night and genuinely wear on you emotionally, not just physically.”
Indeed, a 2023 survey of 100 people with self-reported Hell’s Itch found that 44% had experienced suicidal thoughts due to the condition.
While there isn’t much scientific literature on Hell’s Itch, it has been the subject of discussion in many online forums like the one Hays came across that day.
Cole Leighton, a film school student at Loyola Marymount University, has experienced Hell’s Itch twice, most recently in August 2025 after a day at the beach, which he has talked about on TikTok. Leighton, who said he was not wearing sunscreen that day, told HuffPost it was “far and away the worst pain [he’s] ever experienced.”
“It literally it feels like torture,” he told HuffPost. “The best way I would describe it is that it feels like you’re getting tickled from the inside out and it just doesn’t stop.”
What Causes Hell’s Itch?
This condition is understudied and not well-understood at this time. There are no universally accepted diagnostic criteria, nor is there a definitive explanation for why Hell’s Itch occurs, Wagner said. The leading theories suggest it may have to do with “abnormal signaling between the sun-damaged skin and the nervous system,” Wagner explained.
“UV exposure causes inflammation in the skin, which may sensitize the nerve fibers that carry itch and pain signals,” he continued. “Researchers have proposed several possible pathways involving neurogenic inflammation, nerve growth factor and receptors known as TRPV1 and TRPV4. These receptors help the body detect pain, itch and changes in temperature.”
According to Wagner, this might help explain why the sensation is much more intense than a typical itch and why symptoms often appear after a shower or applying a topical product to the affected area.
“These mechanisms are plausible and supported by related laboratory research, but they have not been conclusively proven in patients with Hell’s Itch,” Wagner added.
How To Alleviate The Agony Of Hell’s Itch
Anecdotally, some common effective remedies discussed in internet forums include taking ibuprofen and an antihistamine like Benadryl, taking a very hot shower, blowing a hair dryer on the affected area, applying peppermint oil or taking beta-alanine, a non-essential amino acid commonly found in pre-workout supplements. People report that traditional sunburn remedies, like using aloe vera or other lotions, often make the pain and discomfort worse.
As Wagner cautioned: “Over-the-counter antihistamines or pain relievers may take the edge off for some people, but they aren’t right for everyone. Check with a pharmacist or doctor first, especially if you’re pregnant, giving medication to a child, have an underlying medical condition or already take other medications.”
With Hell’s Itch, you’ll often find that remedies that help alleviate one person’s symptoms can greatly aggravate another’s. So it does require a bit of trial and error.
Hays learned this firsthand. Desperate for relief, he tried applying peppermint oil since he had read that it helped many folks online. Unfortunately, it made things “10 times worse” for him, he said.
“I ran to the shower to wash it off, and I was in the shower on my hands and knees yelling for about I say half an hour,” Hays said.
That’s when he inadvertently discovered the one thing that did actually give him some relief: a “really, really hot shower.”
“And at first, it would be excruciating. It hurt so bad. But once I got past the first 30 or 45 seconds of it, the pain would very quickly dissipate, and I would have some relief for the first time in days,” Hays said. “Wow. And that effect would last up to an hour, even two hours.”
The first time Leighton experienced Hell’s Itch, the urgent care he visited gave him an anti-itching cream, which only made his symptoms worse, he said. The next time he got Hell’s Itch, he saw folks recommending beta-alanine on Reddit. He ordered some C4 energy drinks on DoorDash, which contain beta-alanine, drank one and noticed immediate relief. When he felt the pain coming back, he drank another, he said.
One case study paper published in 2025 referred to beta-alanine as a “potential rapid-acting treatment for symptom relief,” but noted that “its efficacy remains anecdotal,” so controlled clinical trials are needed. The paper’s authors did note that while the mechanism of action here is unclear, beta-alanine is “known to activate sensory neuron receptors involved in pain and pruritus [itching].”
Pre-workout powders and energy drinks often contain considerable amounts of caffeine among other active ingredients. So be sure to read the labels carefully and consult with a healthcare professional before consuming them, especially if you have heart problems, high blood pressure or other health conditions.
Wagner recommended staying hydrated and applying a cool compress to the area — just don’t put ice directly on the skin. Avoid the sun, scratching the area and using “heavily fragranced or unproven products,” he advised.
“Pay attention to what helps versus what aggravates it and adjust from there,” Wagner said.
Symptoms tend to improve within a few days, but the sunburn itself can take longer to heal, Wagner noted. But if your symptoms are severe, worsening or not improving with basic care, seek professional medical care.
“It’s worth getting evaluated rather than assuming it’s Hell’s Itch and waiting it out,” Wagner said. “Extensive blistering, fever, vomiting, confusion, fainting, dehydration, signs of infection, eye symptoms or difficulty breathing require prompt medical attention.”
The best treatment, however, is prevention, said Wagner.
“Use broad-spectrum sunscreen with an SPF of at least 30, reapply it as directed, and combine it with shade and protective clothing,” he said. “A sunburn may feel like a short-term problem, but it represents real UV damage that accumulates over time and increases the risk of premature skin aging and skin cancer.”