Itching (pruritus)

0


What is it about ?

Pruritus is a tickling, itchy sensation that makes you want to scratch.

  • The itching can be limited to a specific place on the body (the cause is usually localized) or all over the body.
  • Itching can appear with or without skin lesions. Skin damage can also be caused by scratching.

Causes of pruritus

Itching can have many causes: skin disorders, from medications, from systemic conditions or some psychological reasons.

Skin disorders
Medications

Medicines can trigger itching by different mechanisms:

  • an allergic reaction;
  • dry skin;
  • increased sensitivity to the sun;
  • liver damage.

In principle, any medicine can cause itching. More often than not, the link between the medication and the itching is quickly evident, but sometimes it does not appear for a long time.

Medications that are often responsible for itching are:

  • certain antibiotics;
  • medicines that lower cholesterol (cholesterol lowering drugs);
  • certain medicines which lower blood pressure (antihypertensives) known as converting enzyme inhibitors (ACEIs);
  • a gout medicine (allopurinol);
  • a large number of cancer drugs;
  • strong pain relievers such as morphine.
Systemic disorders

Systemic disease can be itchy without necessarily causing damage to the skin. Some examples :

  • kidney disease;
    • Itching is caused by a high concentration of waste products (urea) that the kidney cannot get rid of.
    • This problem is common in people on kidney dialysis.
  • liver disease;
    • Itching is caused by the buildup of bile acids that the liver cannot get rid of.
    • Typical examples are cholestasis of pregnancy (decrease or stop of bile secretion), hepatitis or cirrhosis of the liver following deterioration of the bile ducts.
  • cancer ;
    • Itching is common, especially in cancers of the blood such as lymphomas.
  • thyroid disease;
  • other conditions such as diabetes, a HIV infection, a multiple sclerosis (MS) or a Parkinson disease.

Itching is present in 2% of normal pregnancies with no underlying condition.

Psychological causes

Itching may also be due to a psychiatric condition, such as depression, a bipolar disorder or psychosis.

They can also be the consequence of the vicious itching-scratching cycle, known as neurodermatitis. As a result of repeated scratching, the skin becomes thicker and darker, which further aggravates the itching and maintains the vicious cycle.

How to recognize them?

You get a tickling sensation in a specific part of the skin or all over your body and you feel like scratching all the time. Sometimes you have skin lesions, but this is not always the case.
Itching can have many causes, but you can often get a feel for where it is.

How is the diagnosis made?

Discussion and clinical examination

The doctor tries to identify the cause of the itching based on the following information:

  • the’aspect : plaques, blisters, presence or absence of eczema, redness,…;
  • the’place : localized itching or all over the body.

Certain types and causes of itching typically occur in certain areas of the body. Some examples :

The doctor will ask you questions about possible allergies to various products, the medications you are taking and any known skin problems in your family. He will check if you have any other physical symptoms.

Other examinations

If he suspects a systemic cause, the doctor will have blood tests and may order imaging tests, such as a x-ray or a ultrasound. A yeast infection is sometimes diagnosed with a skin dandruff (dander) examination.

If the diagnosis is not entirely clear and / or specialized treatment is required, the doctor will refer you to a specialist for further examinations and treatment.

What can you do ?

General measures
  • Even though it’s very difficult, try not to scratch the itchy areas of your skin.
  • Apply a cold compress or menthol cream to the skin to relieve the feeling of heat and itching.
Measures against dry skin

The itching is very often due to the dry skin. If you have it:

  • Regularly coat your skin with moisturizers, which you can find in pharmacies.
  • Limit baths, as they dry out the skin even more.
  • Wash your skin with lukewarm water, and avoid hot water.
  • Limit the use of soap. Preferably use a shower oil. Systematically apply a moisturizer after your toilet.
  • After showering, dry your skin by dabbing it with a towel instead of rubbing it.
  • Use hypoallergenic fragrance-free products for skin care. Consult your pharmacist.
  • Avoid clothing that irritates the skin (wool and other rough materials).
  • Avoid the sun and high temperatures.
Measures against lice, fleas and scabies
  • Treat head lice with the wet comb method.
  • Scabies and lice require hygienic measures: wash clothes and bed linen.
  • If you have fleas in the home, treat your pets and the whole house with flea control.

What can your doctor do?

Above all, itching should be treated. Although the cause of the itching is not clearly established, most people are relieved by treatment for this symptom.

Creams and ointments
  • If your itching is associated with skin lesions, your doctor may prescribe creams or ointments. These are often cortisone-based.
    • Cortisone ointments are available in different strengths. The doctor will make his choice based on the type of skin lesion and its location.
    • Likewise, a trial treatment with cortisone ointment may provide relief when the cause of your itching is unknown.
  • There are still other types of itchy ointments, such as calcineurin inhibitor creams or menthol cooling creams.
Medications

Your doctor may also prescribe oral medications for you.

  • Antiallergics can be helpful, especially with hives or dermographism. They can also decrease itching due to other causes.
  • In some cases, the doctor may prescribe certain types of antidepressants or light therapy.
  • Oral cortisone may also be considered for short treatment of severe cases.
  • When faced with a skin fungus and scabies, the doctor will prescribe special ointments and creams.
    • There are also oral medications for the treatment of yeast infection.

Finally, in the presence of general underlying conditions, treatment depends on the cause of the itching. The doctor will prescribe additional examinations or appropriate medication. Sometimes he will refer you to a specialist.

Want to know more?

Sources