Itchy Skin (Pruritus): Symptoms, Causes, Complications, Diagnosis and Treatment

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A woman who has itchy skin

1Overview

Itchy skin is one of the most annoying sensations a person can have. It is also called pruritus, an unpleasant sensation that triggers the desire to scratch.

Many systemic diseases may lead to pruritus. For instance, pruritus can be caused by various diseases hence the names – cholestatic pruritus, hematologic pruritus, renal pruritus, endocrine pruritus, idiopathic generalized pruritus, and pruritus linked to malignancy or cancer.

The diseases related to pruritus are urticarial, psoriasis, mastocytosis, xerosis, atopic dermatitis, arthropod assault, pemphigoid and dermatitis herpertoformis.

Having an itchy skin is uncomfortable and irritating. It makes you want to scratch.
The condition is common in older adults since the skin becomes drier with age. The skin may appear red, rough and may have some blisters or bumps. When there is repeated scratching of the skin, it may lead to infection, bleeding, and thickening of the skin.

Some of the self-care measures can help relieve itching such as using anti-itch products, having cool baths, and moisturizing.

2Symptoms

Pruritus can happen in any part of the body, but it’s more common in certain small areas like the legs, arms, and other parts of the body. The itchiness can happen without any noticeable skin changes. Itching can be accompanied by:

  • Dry and cracked skin
  • Bumps
  • Blisters
  • Spots
  • Severe itching
  • Redness
  • Scaly or leathery texture of the skin

In some cases, the itchiness may last for a long time. It can be severe and intense in some instances. The more you scratch or rub the areas of the skin with pruritus, the more they become itchier. Continued or persistent scratching may harm and damage the skin. When the skin isn’t intact anymore, it may lead to infection and bleeding.

3Causes

Pruritus can be caused by some factors, including:

Dry skin – Dry skin is the number one factor that causes itchiness. When the skin is dry,
it results in itchiness and eventually, scratching. Otherwise called xerosis, dry skin happens during older adulthood and may be the result of environmental factors like prolonged use of air conditioning or heating systems, washing the skin too much, excessive bathing and having certain skin conditions.

Skin conditions and rashes – Some skin conditions such as psoriasis, scabies, lice, dermatitis or eczema, chicken pox, and hives may cause itching.

Internal diseases – Skin itchiness or pruritus can signal an underlying medical condition. Some of the diseases that may lead to the itchy skin include kidney failure, liver disease, thyroid problems, cancers like lymphoma and leukemia and iron deficiency anemia.

Allergic reactions – Some allergic reactions and irritations may lead to itching. When a person is allergic to chemicals, soaps, wool and other irritating substances, itchy skin may occur.

Nerve disorders – Some nerve disorders may affect the nervous system. When these happen, they may lead to itchy skin. The conditions include diabetes mellitus, multiple sclerosis, herpes zoster or shingles, and pinched nerves.

Pregnancy – During pregnancy, some women experience skin itching or pruritus. The itchiest parts are the thighs and the abdomen.

Medicines – Some drugs like antifungals, narcotic pain medicines, and antibiotics may cause reactions. During these reactions, one of the common symptoms includes pruritus or itchy skin.

However, some people are at a higher risk of developing pruritus or itchy skin, including:

4Complications

Itchy skin or pruritus can affect the quality of someone’s life. When the itchiness is prolonged, scratching may heighten the intensity and severity of itch, possibly leading to infection, skin injury or damage, and scarring. In some cases, the itchiness may affect one’s self-esteem, work and school performance and daily activities.

5Diagnosis

During diagnosis, the initial step is to assess the patient by taking his or her medical history. Aside from that, a thorough physical assessment is also important. The taking of a complete medical history can help identify the symptoms that may point to an underlying medical condition and other possible causes of itchiness.

A complete physical examination can pinpoint dermatological causes of pruritus.
These include pemphigoid, eczema, scabies, chickenpox and lichen simplex, among others. The doctor or dermatologists can see through examination of the skin, some lesions that may suggest the diagnosis.

Some of the tests that may help with the diagnosis of pruritus include:

Thyroid, kidney, and liver function tests – Some diseases involving the liver, thyroid, and kidney may cause itchiness. These tests will detect if there are abnormalities in these organs.

Blood test – A complete blood count (CBC) can help provide evidence of an internal medical condition that may lead to itching like iron deficiency anemia.

Chest X-ray – X-rays can help detect signs of underlying medical conditions liked by itchy skin, including enlarged or inflamed lymph nodes.

The other tests to help diagnose the cause of itchiness include:

  • Erythrocyte sedimentation rate
  • HIV serology
  • Creatinine

6Treatment

Treating itchiness or pruritus depends on the underlying medical condition. Here are the most common treatment options for itchy skin.

Medications

Corticosteroids – Corticosteroid creams are usually prescribed to treat itchy skin, particularly as there are lesions and rashes. If the skin is red and itchy, the doctor may prescribe these creams to be applied to the affected areas.

In some cases, if the skin is dry, the doctor may recommend covering the itchy area with damp cotton soaked in water. This will help lock in the moisture and let the skin absorb the cream. Also, it provides a cooling effect on the skin, providing relief from itch.

Antidepressants – In some cases, selective reuptake inhibitors like Zoloft and Prozac, can help reduce many kinds of pruritus or itchy skin.

Calcineurin inhibitors – These medicines like Protopic and Elidel can help reduce itching.

However, if the underlying medical condition has been identified, the condition will be treated accordingly. When the condition is resolved, the skin itching or pruritus will go away on its own.

Other itch relief procedures may also be recommended such as:

Phototherapy or light therapy – This procedure involves exposing the affected area of the skin to ultraviolet light. After many sessions, the patient may experience itch relief.

Home remedies for pruritus or itchy skin:

  • Use a good and high-quality moisturizing cream to the affected areas of the skin. Some of these potent moisturizers for the skin are Eucerin, CeraVe, Cetaphil, Aveeno, and others).
  • Avoid situations or items that may trigger pruritus such as the use of perfumes, detergents, and soaps, exposure to heat or cold temperatures, wearing jewelry items and being exposed to irritating chemicals.
  • Apply anti-itch creams or lotions on the area. There are many creams that can be used to provide temporary relief to itch. Some creams are used like capsaicin, calamine lotion, and topical anesthetics.
  • Avoid scratching the itchy area. Scratching may make the area itchier and the cycle goes on. Also, scratching may lead to irritation of the skin and the lesion may bleed. To prevent wounds, trim the nails or wear gloves at night.
  • Apply a cool compress to the affected area or you can apply wet compress or dressings to prevent scratching and provide itch relief.
  • Reduce stress because it can worsen itching.
  • Take a shower with lukewarm water or you can add baking soda or fine oatmeal to reduce itching. Some products contain colloidal oatmeal to provide itch relief like Aveeno. After bathing, make sure to immediately apply moisturizers to lock in the moisture into the skin.
  • You can take over-the-counter allergy medicines but these need the prescription of a licensed doctor. These medicines are helpful in relieving itchiness at night.

7Prognosis

The prognosis of pruritus or itchy skin depends on the underlying illness causing it. In some cases, like eczema and skin conditions, the prognosis is positive since these are just mild conditions. On the other hand, for more serious medical conditions such as renal failure, liver disease, and some cancers, the prognosis is poor.

The treatment of pruritus and its efficacy also depends on the underlying cause. Renal pruritus, for instance, is an independent marker for mortality at three years for patients undergoing dialysis. Meanwhile, patients with severe generalized pruritus and Hodgkin’s disease may also have a poor prognosis.

On the other hand, patients with allergies like asthma, eczema and food allergies may have a positive prognosis, provided that they do not experience anaphylaxis, a condition that can be life-threatening.

Anaphylaxis happens when the airways become inflamed and swollen due to an allergic reaction. When this happens, the airways may be blocked, leading to the lack of oxygen supply to important organs in the body such as the brain and the heart.

For mild conditions, the use of corticosteroids and oral allergy medications may immediately provide relief from itch and pruritus. The dermatologist or doctor may prescribe the medicines that can provide temporary relief. The best way for skin conditions to improve is to make sure it was hydrated and moisturized all the time. Dry skin may lead to itchiness and pruritus.