Itching is an irritating sensation that makes a person scratch his skin. In this article, I have discussed various causes, types, and management of itching.
Pruritus (itching) is the predominant symptom of inflammatory skin disease. It lacks a precise definition and can best be defined indirectly as a sensation that leads to a desire to scratch.
Itching can occur as a symptom of many health conditions. The common causes are,
1) Allergic reactions to foods, insect bites, and pollen.
2) Skin conditions such as eczema, psoriasis, dry skin, pediculosis corporis, scabies, onchocerciasis, ascariasis, and ancylostomiasis,
3) Use of irritating chemicals, cosmetics, and other substances.
4) Intake of drugs like Aspirin, Polymyxin, Morphine, Codeine, Scopolamine, and D-tubocurarine.
5) Malignancies such as lymphoma, leukemia, multiple myeloma, and other rare cancer types,
6) Metabolic and endocrine conditions such as hyperthyroidism, hypothyroidism, diabetes mellitus, chronic renal failure, and obstructive biliary disease.
7) During pregnancy, itching can occur with a skin rash causing pruritic urticarial papules and plaques of pregnancy (PUPP).
8) Psychogenic pruritus, in this condition, a patient may have a false belief of parasitic infestation.
9) Hematologic disorders such as polycythemia vera, paraproteinemia, and iron deficiency anemia.
Itching can present as,
1) Tickle sensation, which is more akin to touch. It often occurs due to mild stimulation moving across the skin and remains associated with behaviors such as smiling, twitching, and goosebumps. This sensation is very transient and quickly relieved.
2) Physiological itch is a short-lived cutaneous response of sufficient intensity to provoke scratching, but it does not result in significant skin irritation.
3) Pathological itch occurs in various primary or secondary skin disorders and several systemic disorders resulting in intense cutaneous discomfort.
4) Alloknesis is an abnormal sensory state in which stimuli that do not cause itching (such as a light touch of clothing) can cause itching.
Itchy skin can affect small areas, such as the scalp, an arm or leg, or the whole body. It can also occur without any noticeable changes on the skin. Itchy skin may also occur associated with,
Spots or blisters.
Leathery or scaly patches.
As you rub or scratch the skin, it gets itchier. The more it itches, the more you scratch. Breaking this itch-scratch cycle can be difficult. Sometimes, itchiness can last for a longer time.
The doctor might do a physical examination and ask questions regarding medical history. When the doctor thinks that itchy skin occurs due to a medical condition, the doctor may recommend basic diagnostic tests to rule out the cause. The diagnostic tests recommended are,
1) Blood Tests:
A complete blood count can provide evidence of an internal condition causing itching.
2) Tests of Thyroid, Liver, and Kidney Function:
Liver or kidney disorders and thyroid abnormalities may also cause itching.
3) Chest X-Rays:
A chest X-ray can show enlarged lymph nodes occurring due to itchy skin.
4) Skin Test:
It helps to determine the allergic reaction to other substances.
Most cases of itching are not severe. To feel better, you can follow some simple steps such as,
1) Applying cold compresses.
2) Using moisturizing lotions.
3) Taking lukewarm or oatmeal baths.
4) Using over-the-counter hydrocortisone creams.
5) Avoid scratching of skin and excess exposure to high heat and humidity.
The other essential step to managing pruritus is identifying and treating the fundamental cause, either dermatological or systemic. Other helpful measures to get rid of itching are as follows.
Clothes and environment: Pruritus is temperature-dependent. Wearing light clothes, maintaining cool room temperature, using light bedclothes, and a cool shower before sleep can alleviate pruritus.
Emollients: Pruritus due to dry skin, especially in the elderly, can be relieved by the use of emollients like soft paraffin, moisturizing cream, oils, etc.
Antipruritics: There is no available effective and specific antipruritic drug. The role of sedative antihistamines to reduce itching in atopic skin is controversial.
Topical antihistamines and corticosteroids should not be used in the absence of visible signs of inflammation.
Topical Capsaicin has been found effective in limited disease.
Tricyclic antidepressants may be helpful in some, especially emotionally distressed patients.
Topical Menthol and Crotamiton have also been used with variables.
Opioid receptor antagonists like Naloxone have shown some promise.
Specific therapies like parathyroidectomy, ultraviolet B (UVB) for chronic renal failure, and cholestyramine and UVB for pruritus secondary to liver disease have been found useful.
A doctor's consultation is needed when the itching,
1) Lasts more than two weeks and does not improve with self-care measures,
2) Remains severe, causing a disturbance in the daily routine,
3) comes suddenly and frequently without any apparent cause,
4) Affects the whole body,
5) Accompanied by other signs and symptoms such as weight loss, fever, or night sweats.
If the itching persists for three months despite treatment, see a dermatologist to know the underlying cause and to rule out other conditions.
Itchy skin lasting for more than six weeks can affect the quality of life. It may disturb your sleep or cause anxiety and depression. Prolonged itching and scratching can increase the intensity of the itch, possibly leading to skin injury, infection, and scarring.
If you have any diseases that cause itching, treating the condition may help. You may need other treatments according to the causative agents. Contact your healthcare provider if the itching remains severe with no apparent cause and does not disappear after a few weeks.
Itching can be due to many reasons, which may include-
- Allergic reactions to food, insect bites, pollen, and medicines.
- Skin conditions such as eczema, psoriasis, and dry skin.
- Irritating chemicals and other substances.
- Parasites such as pinworms, scabies, head and body lice.
- Liver, kidney, or thyroid diseases.
- Some types of cancer and their treatment.
- The disease that affects the nervous system such as diabetes and shingles.
In most cases, itching is not due to any underlying diseases. In those cases, the following measures can help in the healing-
- Applying cold compresses.
- Using moisturizing lotions.
- Taking a lukewarm bath.
- Using over-the-counter hydrocortisone cream or antihistamines.
- Avoid scratching, wearing irritating fabrics, and exposure to heat and humidity.
In some cases, the skin may feel itchier at night because of a lack of outside distractions. The natural cycle of certain hormones, molecules, and chemicals in the body at night can cause itchiness. The natural causes include-
- The circadian rhythm of the body influences the fluctuations of the hormones.
- Menopause and pregnancy can cause changes in the level of the estrogen hormone and result in skin dryness and itchiness.
- Rarely the itchiness may be due to more severe conditions like psoriasis, fungal skin infections, skin cancer, thyroid conditions, HIV, iron deficiency anemia, severe depression, or anxiety.
Itching or pruritus is one of the symptoms of chronic liver disease, but not everyone with liver disease develops it. The accumulation of bile salts under the skin during liver diseases can cause itching. Itching caused by liver disease will not improve and needs treatment.
Itching without rashes can be due to the following reasons -
- Dry skin.
- Early infections of certain bug bites.
- The side-effects of certain medications.
- Stress, anxiety, and depression.
- Hormonal fluctuations.
- Underlying health conditions such as diabetes, stroke, shingles, etc.
Itching is common in people with advanced chronic kidney disease (CKD). This condition is called uraemic pruritis. It is due to excessive urea in the blood. This usually happens when both the kidneys stop working. The itching can be on and off or continuous. It may affect the whole body or limited area.
Anxiety disorders can cause itchy skin and vice versa. One can exaggerate the other. Each can be treated effectively, but it’s essential to determine the cause of itching because the treatment has an entirely different approach in each case.
Infections that may cause itching all over the body includes-
- Fungal rashes.
- Mites, including bed bugs.
- Pinworm infections.
Itching in the lower legs can be due to -
- High blood sugar can cause extremely dry skin.
- Poor blood circulation.
- Nerve damage (neuropathy).
- Nephropathy (kidney disease).
Itching in the private parts of both males and females can be due to
- Lichen sclerosus.
- Skin irritation from sweating.
- Skin irritation from tight clothing.
- Skin irritation from personal care products.
In females, it can be due to
- Yeast infection.
- Bacterial vaginosis.
- Trichomoniasis and other sexually transmitted diseases.
In males, it can be due to
- Jock itch.
In itching due to chemical irritants, the irritation will decrease if the irritant is removed. Other causes may require specific treatment. It will include steroid creams, antifungal creams, and antibiotics.
Last reviewed at:
01 Jun 2022 - 4 min read
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