Itchy skin or pruritus is that irritation in the skin that makes a person scratch the region. Pruritus is more commonly seen in old age, as the skin dries up. The itched skin may look normal in some cases, while in some it may become reddish and rough in appearance.
Some develop blisters by itching. The appearance of the itched region may depend on the cause of itching. Too much scratching may lead to raised, bumps on the affected region and this increases the chance of infection and bleeding.
Itchiness may be restricted to some regions like arms or legs or may be generalized over the body. It may remain without any other changes or symptoms on skin.
The intensity of itching may differ from person to person, and may also depend on the cause of itching. Scratching the area may increase the itching in the region, resulting in a cycle of itching and scratching. Too much scratching may lead to skin damage, and this may lead to infection.
Itchy skin may not require medical help unless it:
Persists for more than two weeks
Does not improve with home remedies and self-care
Has sudden onset and cannot be explained by any other cause
Affects the whole body
Some symptoms that require medical attention are tiredness, sudden weight loss, increased or decreased the frequency of urination, fever, and redness of the skin.
Some of the possible causes of itchy skin are:
Dry skin – this is a very common cause of itchiness and is common in old age.
Skin conditions – many skin conditions have itchiness as one of the symptoms.
Systemic diseases – some internal diseases like liver and kidney disease, iron deficiency anemia, and thyroid problems may have to itch as one of the symptoms.
Nerve disorders – multiple sclerosis, diabetes mellitus, and shingles are some of the medical conditions affecting the nervous system, leading to itchy skin.
Allergy and irritation – many chemicals that irritate the skin, and allergens that trigger an allergic reaction may cause skin itching.
Certain medications – certain medications like antibiotics, antifungals and narcotics are known to cause itching.
Pregnancy – many skin conditions are known to worsen during pregnancy. Moreover, itching is a common occurrence during pregnancy.
Prolonged itching and scratching may lead to complications like skin injury, infection, and scarring.
Review of medical history and physical examination are important steps in the diagnosis of the cause of itchy skin. Other tests and investigations depend on the suspected cause of the condition. This includes blood tests, thyroid, liver, and kidney function tests, and imaging studies.
Corticosteroid creams, calcineurin inhibitors, and antidepressants are the medications commonly suggested for the treatment of itchy skin. In the presence of a systemic disease, specific treatment to control the same is the best way to control the symptom.
Phototherapy or light therapy is a treatment method in which skin is exposed to certain wavelengths of UV light which help in relieving itching.
Itchy skin may be caused by several conditions. Some of the causes do not result in any skin changes other than itching. The most common cause of itching is dry skin or xerosis. This often causes itching without formation of rashes on the skin.
Exposure to UV radiation may also cause itching, and this also does not cause any rashes. Stress and anxiety are also implicated in the itchy skin in some people.
Metabolic disorders and hormone dysfunctions, cancer, certain medications, blockage of bile, and diseases of blood also cause itching without any other specific changes in the skin. Many skin conditions cause itchiness.
Some of the common conditions that result in itching are:
Eczema – this condition causes dry, red, itchy skin
Urticaria – it is caused by an allergen and leads to raised, red, itchy rashes.
Lichen planus – this skin condition is characterized by itchy skin, but without a known cause
Psoriasis – this is characterized by red, flaky skin patches, often covered with silvery white scales
Dandruff – dandruff refers to the white or gray flakes that develop on skin or scalp
Folliculitis – inflammation of hair follicles results in itchy skin
Prurigo – itchy, small blisters that form on the skin is known as prurigo
Many types of skin reactions and allergies also lead to itching. This includes cosmetics with chemicals, preservatives, and fragrances. Certain metals present in jewelry like nickel and cobalt lead to skin irritation and skin itching.
Rubber, textiles, and some plants are also known to cause allergies. Allergy to certain food or medication has itchy skin as an important symptom. Hot and humid weather lead to itchy skin, called as prickly heat. Exposure to UV light is also a known cause of itchy skin.
Many parasites and insect bites cause itching, this includes:
Some infections cause itchy skin, including chicken pox, athlete’s foot, ringworm, and vaginal thrush. Chicken pox is a viral infection that causes itching and crusty patches on the skin.
A fungal infection that affects the region between the toes, characterized by severe itching is athlete’s foot. Ring-like, reddish rashes are caused by ringworm infection. Yeast infections often cause itching of genitals.
Itchy skin may be a symptom of an underlying medical condition.
Some of the internal diseases that lead to itchy skin are:
Some psychological conditions like depression or anxiety
Hormonal changes during pregnancy and menopause may result in itchy skin. The risk of many skin conditions increases with pregnancy. This includes pruritic urticarial papules, prurigo gestation, and obstetric cholestasis.
These skin conditions are associated with itchy skin. Itching is a common symptom of menopause in many women. This may be caused by the changes in the level of hormones including estrogen.
3 Diagnosis and Treatment
Review of medical history and physical examination suggest the diagnostic tests required for identifying the actual cause of itchy skin. Some of the causes of itchiness are obvious on physical examination, like sunburn and dry skin.
Other causes like systemic diseases and infections may require additional tests to confirm the diagnosis. Biopsy of skin sample from the affected region is helpful in identifying the condition. Some skin conditions and ailments have characteristic rashes that indicate the underlying cause of the symptom.
Blood tests are used to identify the internal conditions and infections that result in itching. It is also useful in identifying iron deficiency that leads to pruritus. As itching may be caused by internal conditions like liver and kidney disease, and thyroid dysfunction, tests to check for the functioning of these organs are also recommended.
Cold applications, creams, and lotions are some of the topical treatments useful in relieving the itch. Applying cold in the affected area interrupts the signals of itching and reduces the symptom.
Cold can be applied in the form of cool water from a running tap, or by placing a moist cloth over the itchy skin. Cool showers and ice packs are also effective in alleviating itching.
Certain itch-relief bath products are available over-the-counter which help in reducing the itching sensation. Hot water baths should be avoided as it can increase itching.
Camphor, menthol, phenol, pramoxine, benzocaine, and diphenhydramine can be used on the affected skin to numb the nerves, reducing the sensation. Hydrocortisone-containing creams and lotions are also used to alleviate itching. Calcineurin inhibitors like tacrolimus and pimecrolimus are also suggested for controlling the condition.
Antihistamines are the conventional oral treatment for controlling the itch. Diphenhydramine and chlorpheniramine are commonly used antihistamines. Antidepressants like selective serotonin reuptake inhibitors may also be of help in reducing itching.
Treating the underlying disease is the best treatment method for controlling the symptom. Thus treating kidney disease, iron deficiency, and thyroid problems reduce itching. This may be combined with other itch-control methods for better effect.
Light therapy or phototherapy is a method in which the skin is exposed to UV radiations for controlling itching. Several sessions of exposure may be required to resolve or reduce itching.
Dry skin care is very important in reducing itching. This can be prevented by taking lukewarm showers, applying moisturizer immediately after drying off after a shower, using moisturizing soap and other products, and using heavier creams during winter months.
Preventing the underlying cause of itching indirectly prevents itchy skin. Thus using sunscreen helps to prevent itching caused by sunburn. Keeping the skin well hydrated using moisturizers prevents itching caused by dryness of skin.
Preventing infections and parasite infestations help to keep itching at bay. Itching caused by some conditions like cancers and kidney disease cannot be prevented.
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