Itchy Skin(Pruritus)

1 What is Itchy Skin(Pruritus)?

Itchy skin (Pruritus) is a symptom we have all experienced. Nevertheless, itching can be difficult for a person to describe to others.

While itching symptoms vary, it typically leads to a peculiarly uncomfortable skin sensation. It may feel as if something is crawling on (or in) your skin.

Itching can be diffuse (generalized all over the body) or localized -- all over or confined to a specific spot -- and there are many causes of diffuse and localized itching.

Itching symptoms can be associated with

  • rash,
  • dry skin,
  • cracked skin,
  • flaky skin,
  • flaky scalp,
  • skin redness,
  • bumps on the skin,
  • blisters,
  • spots on the skin.

Itching may be most noticeable at night (nocturnal), during the day, or both. When there are itching symptoms, there can be a leathery or scaly texture to the skin depending on the cause.

Itching can be caused by

Infectious causes of itching include

  • sexually transmitted diseases (STDs),
  • parasites (such as scabies, fleas, bedbugs, pinworms, and lice),
  • viral rashes.

Perhaps the best definition of itching is by the response it evokes -- it is a feeling that makes you want to scratch. Rash or redness can be present with itching from scratching or from the underlying condition.

Medically, itching is known as pruritus. Something that is itchy is said to be pruritic.

2 Symptoms

Itchy skin (Pruritus) symptoms can be associated with:

  • rash,
  • dry skin,
  • cracked skin,
  • flaky skin,
  • flaky scalp,
  • skin redness,
  • bumps on the skin,
  • blisters,
  • Spots on the skin.

Itching may be most noticeable at night (nocturnal), during the day, or both.

When there are itching symptoms, there can be a leathery or scaly texture to the skin depending on the cause.

3 Causes

An itch is often caused by a condition affecting the skin, but it can be a sign of a more serious underlying problem.

In some cases, it may not be possible to identify a specific cause.

Skin conditions

Skin conditions that can cause itching include:

  • dry skin
  • eczema – where the skin is dry, red, flaky and itchy
  • contact dermatitis – inflammation of the skin that occurs when you come into contact with an irritant or allergen
  • urticaria – also known as hives, welts or nettle rash; urticaria is triggered by an allergen and causes a raised, red itchy rash to develop
  • lichen planus – an itchy rash of unknown cause
  • psoriasis – a skin condition that causes red, flaky, crusty patches of skin covered with silvery scales
  • dandruff – a common skin condition that causes dry white or grey flakes of dead skin to appear in the scalp or hair
  • folliculitis – a skin condition caused by inflamed hair follicles
  • prurigo – small blisters (fluid-filled swellings) that are very itchy

Allergies and skin reactions

Itching is sometimes caused by an allergen, irritant or other environmental factor, including:

  • cosmetic ingredients, such as preservatives, fragrances, hair dye and nail varnish hardeners
  • certain metals, such as nickel or cobalt in jewellery
  • rubber – including latex
  • textiles – particularly the dyes and resins that are contained in them
  • some plants – such as chrysanthemums, sunflowers, daffodils, tulips and primula
  • an allergy to certain foods or types of medication (for example, aspirin and a group of medicines called opioids)
  • prickly heat – an itchy rash that appears in hot, humid weather conditions
  • sunburn – skin damage caused by exposure to ultraviolet (UV) rays

Parasites and insects

Itching can be caused by the following pests:

  • the scabies mite, which burrows into the skin and causes a skin condition called scabies
  • head lice, pubic lice or body lice
  • insect bites and stings from bees, wasps, mosquitoes, fleas and bedbugs
  • threadworms – small worm parasites that infect the bowels of humans and can cause an itchy bottom
  • trichomonas vaginalis – a tiny parasite that causes a sexually transmitted infection (STI) called trichomoniasis

Infections

Itching may be a symptom of an infection, such as:

  • chickenpox or another viral infection
  • athlete's foot – a fungal infection that causes itching in between the toes
  • ringworm – a fungal infection that causes a ring-like red rash to develop on the skin and can cause an itchy scalp
  • vaginal thrush or thrush in men – yeast infections that can cause itching in and around the genitals

Other conditions

Itching can be a sign of an underlying condition that may affect the inside of the body without necessarily causing any other obvious symptoms.

Itching can be a symptom of:

  • haemorrhoids (piles) – enlarged and swollen blood vessels in or around the lower rectum or anus
  • an overactive thyroid or underactive thyroid – where the thyroid gland in the neck produces too much or too little thyroid hormone
  • iron deficiency anaemia – where a lack of iron in the body leads to a reduction in the number of red blood cells
  • polycythaemia – where you have a high concentration of red blood cells in your blood
  • liver-related conditions, such as primary biliary cirrhosis and hepatitis
  • long standing kidney failure
  • in rare cases, certain types of cancer, including liver cancer, pancreatic cancer, leukemia and Hodgkin lymphoma

Occasionally, itching can be linked to a psychological condition such as depression or anxiety.

Pregnancy and the menopause

In women, itching can sometimes be caused by hormonal changes during pregnancy and after the menopause.

Pregnancy

Itching often affects pregnant women and usually disappears after the birth. A number of skin conditions can develop during pregnancy and cause itchy skin. They include:

  • pruritic urticarial papules and plaques of pregnancy (PUPPP) – a common skin condition that causes itchy, red, raised bumps that appear on the thighs and abdomen (tummy)
  • prurigo gestationis – a skin rash that appears as red, itchy dots and mainly affects the arms, legs and torso
  • obstetric cholestasis – a rare disorder that affects the liver during pregnancy and causes itching without a rash

Seek advice from your midwife or GP if you have itching or any unusual skin rashes during your pregnancy.

Menopause

Itching is also a common symptom after the menopause, which is where a woman’s periods stop as a result of natural hormonal changes as she gets older.
Changes in the levels of hormones, such as oestrogen, that occur during the menopause are thought to be responsible for the itching.

4 Making a Diagnosis

Itchy skin (pruritus) will be diagnosed and analyzed by your doctor or dermatologist.

Your doctor will give you a physical examination and will ask you several questions about your symptoms, such as:

  • How long have you had the irritation?
  • Does it come and go?
  • Have you been in contact with any irritating substances?
  • Do you have allergies?
  • Where is the itching most severe?
  • What medications are you taking (or have recently taken)?

You may need to undergo more tests if your doctor can’t determine the cause of your itching from your answers and a physical exam.

Tests include:

Blood test

May indicate an underlying condition

Test of your thyroid function

Can rule out thyroid issues

Skin test

To determine if you’re having an allergic reaction to something

Scraping or biopsy of your skin

Can determine if you have an infection

Once your doctor has pinpointed the cause of your itchiness, you can be treated. If the cause is a disease or infection, your doctor will suggest the best course of treatment for the underlying problem.

When the cause is more superficial, you may receive a prescription for a cream that will help relieve the itching.

5 Treatment

Treatment methods for itchy skin include:

  • Skin care
  • Topical treatments
  • Systemic treatments

Disorders that cause itching are treated. Sometimes other measures can also help relieve itching.

Skin care

Skin care measures can help relieve itching regardless of cause. Baths or showers should be short, no more frequent than necessary, and taken with cool or lukewarm (not hot) water. Using moisturizing soap and skin moisturizers can also help, as can humidifying dry air (for example, in winter) and not wearing tight or wool clothing.

Topical treatments

Topical treatments involve substances that are applied to the skin. Topical treatments are used only if a specific area is affected. Options include lotions or creams that contain menthol and/or camphor, pramoxine, capsaicin, or corticosteroids. To be effective, capsaicin cream should be used for at least 2 weeks. It tends to burn, but the burning decreases over time. Menthol and camphor creams have strong odors but can be soothing, as can tacrolimus, orpimecrolimus creams.

Corticosteroid creams can help relieve itching and often clear up the rash and other skin abnormalities in disorders such as

Corticosteroids should usually not be used when the skin is infected, when an infestation is present, when no rash or skin abnormalities are present, or when the cause is systemic.

Creams and lotions that contain the antihistamine diphenhydramine or the anesthetic benzocaine usually should not be used because they can sensitize the skin and cause more itching.
Ultraviolet light shone on the skin (phototherapy) may help relieve itching when other treatments are unsuccessful.

Systemic treatments

Systemic treatments are drugs that are taken internally, usually by mouth. They are used if itching is widespread or if topical treatments are ineffective.

Antihistamines, particularly hydroxyzine, are used most often. Some antihistamines, such as cyproheptadine, diphenhydramine, and hydroxyzine, cause drowsiness. They help relieve itching and, when used before bedtime, aid in sleep.

However, these drugs are usually not given during the day to older people, who are at higher risk of falling because of drowsiness. Cetirizine and loratadine cause less drowsiness but rarely can have this effect in older people.

Fexofenadine causes less drowsiness but sometimes causes a headache. Doxepin makes people very drowsy and is effective, so it can be taken at bedtime if itching is severe.

Cholestyramine is used to treat itching caused by gallbladder or liver disorders, chronic kidney disease, or polycythemia vera. However, cholestyramine has an unpleasant taste, causes constipation, and can decrease absorption of other drugs.

Naltrexone can be used to treat itching caused by gallbladder or liver disorders but may increase pain if pain is present.

Gabapentin can help relieve itching caused by chronic kidney disease but can cause drowsiness.

6 Prevention

There are several methods to prevent itchy skin (pruritus), which include:

  • Keep your scratches clean: Scratching is unavoidable, especially for children. So keep both the affected area and fingernails as clean as possible to lower irritation and infection risks.
  • Play it cool: Apply a cold compress to the affected area to protect your skin and help prevent scratching.
  • Avoid sleep scratching: Scratching at night can both interrupt your sleep pattern and make your itch worse. If you can’t resist scratching, try wearing gloves.
  • Stay loose: Loose-fitting cotton clothing is the way to go when you’re feeling itchy and scratchy.
  • Cover up: In areas where poison ivy, poison oak, or poison sumac might be prevalent, protect your skin by wearing long pants and long-sleeve shirts.
  • Bug off: To discourage insects from snacking on you, find an insect repellent that feels comfortable on your skin.
  • Wear sunscreen: The best way to stop sunburn itch is to avoid sunburn in the first place. Find a sunscreen that’s comfortable on your skin, and reapply as directed.

7 Alternative and Homeopathic Remedies

Several alternative remedies exist for itchy skin (Pruritus).

Have an itch that no amount of scratching can relieve? It is one of the most irritating problems to have because the more you scratch, the more it itches. Even though an itch is our body’s defense mechanism against an unpleasant contact with some irritant, constant itching can cause a break in the skin and lead to infections. But you can try these home remedies for itch relief.

Coconut oil

Whether due to dry skin or an insect bite, whatever the cause of the itch, coconut oil can work wonders. The best way to use it is to rub a little coconut oil directly onto the affected area. If you suffer from a widespread itch all over the body especially during the winter, soak in a bathtub of lukewarm water; then just pat yourself dry and apply the oil all over.

Petroleum jelly

If your skin is of the sensitive type, the best remedy is petroleum jelly. It does not contain any harmful chemicals and by its very nature, has a soothing action on the skin. Therefore, it not just relieves your itch, but it also ensures the skin irritation becomes less. Best of all, it is safe as well as inexpensive and so you don’t have to worry about how often you apply it.

Lemon

With a rich content of vitamin C and bleaching properties, lemons are one of the best remedies for itchy skin. The volatile oil in lemon has the ability to numb sensations and is also good against inflammation. Simply cut a lemon in two and squeeze out a little juice over the itchy area; allow to air dry and you’ll soon find some relief.

Baking soda

An itch restricted to a small area can be managed with baking soda. All you need to do is add 1 part of water to three parts of baking soda to make a paste; then apply this paste to the itchy area. However, don’t use this remedy if the skin is broken. If the itch is spread all over the body, add a cup of baking soda into a tub full of lukewarm water and soak in it for half an hour; then dry in air.

Tulsi or Holy basil

Tulsi leaves are rich in thymol, eugenol and camphor and these have the ability to reduce irritation of the skin. Just wash a few leaves and rub them over the affected area. Or prepare a tea by boiling a few leaves in water in a covered utensil; then dip a cotton ball or cloth into the tea and apply to the itchy skin.

Apple cider vinegar

Many people use vinegar on the scalp for dandruff; by the same logic, it works well for itchy skin, too. It has a good antiseptic and antifungal action and this makes it a good anti-itching agent. Dip a cotton ball or cloth in a little apple cider vinegar and dab on the itchy area. Or if you feel a general itchy sensation all over the body, add a cupful into your bath water.

Aloe vera

With all its moisturizing action, aloe vera is one of the most effective skin soothing agents. When you rub the gel over an itchy spot, it helps reduce the skin irritation in that area and provides quick relief from itching. Just break a leaf from the plant, cut it lengthwise using a knife and using a spoon, scoop out the jelly-like substance inside. Apply a little of this gel to the itchy area and leave it on for a few minutes.

When you suffer from itchy skin, try these home remedies instead of scratching yourself and you will find the itch soon subsides on its own. However, if you find that the use of these substances is not giving you relief, you may need to find out what is causing the itch.

Allergy to certain clothing made of synthetic material or a food allergy may sometimes set off symptoms of itching. But if there is a change in colour of the itchy area or if you find the skin developing scars or a shiny surface or if the itching is so severe it intrudes on your sleep, please ensure you see a doctor to get a professional opinion and the right treatment.

8 Lifestyle and Coping

Following lifestyle modifications are necessary in order to cope with itchy skin (Pruritus):

  • Limit the number of baths you take - use lukewarm water and very little or no soap, and don't spend too long in the water eg. no more than 20 minutes
  • Instead of soap, you can use a moisturising liquid (emollient), such as aqueous cream, Oilatum or Diprobase, prescribed by your doctor or nurse
  • Avoid perfumed or scented moisturisers as these can dry the skin and cause more itching
  • Pat your skin dry with a towel rather than rubbing
  • Drying the skin thoroughly reduces the chance of chaffing and fungal infection
  • Moisturise your skin straight after you bathe - apply the moisturiser in the same direction as your hair grows
  • Avoid scented or lanolin based lotions
  • Use odourless and colourless moisturiser such as epaderm and hydromol, which you can get from the chemist and apply it 4 times a day
  • Wear cotton and linen, rather than wool or man made materials which can irritate the skin
  • Keep your bedclothes light
  • Try to keep an even, cool temperature in your room, as getting hot can make itching worse
  • Use an electric razor rather than wet shaving
  • Drink plenty - preferably water (2 to 3 litres a day)
  • Keep your nails short to reduce the risk of scratching your skin
  • Avoid highly perfumed washing products for clothing and bedding

Instead of scratching

  • It can sometimes help to gently pinch an area of skin close to the itch
  • Rub, tap or press the area
  • Put a cool pack on the skin
  • Gently apply more moisturiser

Contact your doctor or nurse if you

  • Notice the itching gets worse
  • See the itchy area getting more red and sore
  • See any pus coming from the skin or it smells
  • Are unable to sleep because of the itching

9 Risks and Complications

There are several complications associated with itchy skin (Pruritus).

Repeated skin scratching due to constant desire to itch can lead to:

  • Skin Injury
  • Infections
  • Scarring
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