Pruritus (Itching)

What is pruritus?

Pruritus, commonly referred to as itching, is an unpleasant sensation that triggers the desire to scratch the affected area of the skin. It is a symptom rather than a disease or condition. It can occur in various parts of the body and may range from mild to severe.

Pruritus can be acute, lasting for a short duration, or chronic, persisting for an extended period. It may cause inflamed or rough skin, and scratching can cause bleeding or infection. It can be uncomfortable and frustrating.  Chronic pruritus is an essential feature of atopic dermatitis or eczema.

What causes pruritus?

There are numerous potential causes of pruritus, including:

• Skin Conditions: Many skin disorders can lead to itching, such as eczema, psoriasis, dermatitis, and hives. These conditions often involve inflammation and irritation of the skin. These conditions can disrupt the skin’s protective barrier, leading to itchiness.
• Allergies: Allergic reactions to substances like pollen, pet dander, insect bites, or certain foods can result in itching. According to the Mayo Clinic irritation and allergic reactions are the main cause of pruritus. Wool, chemicals, or soap can irritate the skin and cause rashes. Sometimes the cause is poison ivy or a cosmetic that can cause an allergic reaction.
• Infections: Infections caused by bacteria, fungi, or parasites can lead to itching. For example, fungal infections like athlete’s foot and scabies mites can cause intense itching.
• Dry Skin: Dry skin, especially in cold and dry climates, can become itchy. This is a common issue in the winter months.
• Systemic Diseases: Some underlying systemic diseases, including liver disease, kidney disease, and certain blood disorders and cancers, can manifest with itching as a symptom.
• Medications: Certain medications, particularly opioids and some antibiotics, may cause itching as a side effect.
• Neurological Conditions: Conditions like neuropathy can cause abnormal sensations, including itching. Shingles, a pinched nerve and multiple sclerosis can cause itchy skin.
• Psychological conditions: Anxiety, Obsessive Compulsive Disorder and Depression can cause pruritus.

When should you see a dermatologist?

• Severe Itching: If the itching is severe, persistent, or interferes with your daily life and sleep, or lasts for two weeks and over-the-counter treatments do not provide relief.
• Rash or Skin Changes: When itching is accompanied by a rash, blisters, sores, or any other unusual skin changes.
• Widespread Itching: If the itching affects the whole body.
• Comes on Suddenly: It comes on suddenly and can’t be explained by a simple answer.
• Secondary Symptoms: If itching is accompanied by other symptoms such as fever, fatigue, swelling, or unexplained weight loss.
• History of Allergies or Chronic Conditions: If you have a history of allergies, skin conditions, or chronic diseases like diabetes or liver or kidney disease.
• Medication-Related Itching: If you suspect that a medication you take is the cause contact the prescribing doctor.
• Age: The elderly and people with compromised immune systems often have dry skin which should be evaluated. 

How is pruritis diagnosed?

Dr. Rains will review your medical history. He will ask about your itching and examine your skin. If he thinks it may be related to a medical condition, he may order blood tests. His goal is to treat the itchy skin and remove the cause of the itching. 

How is pruritus treated?

The treatment of pruritus depends on its underlying cause:

1. Topical Treatments: For many skin-related causes, topical creams or ointments containing corticosteroids or antihistamines may provide relief.
2. Moisturizers: Keeping the skin moisturized with creams and ointments can alleviate itching especially in cases of dry skin or eczema.
3. Antihistamines: Oral antihistamines can be effective to relieve itching associated with allergies and allergic reactions.
4. Avoiding Triggers: Identifying and avoiding triggers, such as certain foods or allergens, is essential to prevent itching.
5. Cool Compresses: Applying cool, damp compresses to the itchy area can provide temporary relief.
6. Prescription Medications: In cases of severe itching due to systemic diseases, Dr. Rains or your primary care provider may prescribe medications to manage the underlying condition which may alleviate the pruritus.
7. Phototherapy: In some cases, exposure to ultraviolet light under medical supervision may be used to treat pruritus.
8. Lifestyle Changes: Drinking plenty of water, maintaining good hygiene, and wearing breathable clothing can also help manage itching.

It’s essential to contact Dr. Michael Rains at Beacon Dermatology in Asheville, North Carolina to schedule a consultation to determine the cause of pruritus and receive appropriate treatment. Chronic or severe itching should not be ignored, as it can lead to complications and negatively impact a person’s quality of life.

Dr. Michael Rains is a board-certified dermatologist and the founder of Beacon Dermatology in Asheville, North Carolina. His approach to aesthetic and dermatological treatments are holistically focused on revealing and enhancing a patient’s natural beauty. Dr. Rains is known for his caring and compassionate approach to medicine, listening to his patients’ concerns and goals and ensuring they receive excellent care and education to ensure they can make informed decisions about their treatments.

References

• https://www.mayoclinic.org/diseases-conditions/itchy-skin/symptoms-causes/.
• Ständer S, Steinhoff M. Pathophysiology of pruritus in atopic dermatitis: an overview. Exp Dermatol. 2002 Feb;11(1):12-24. doi: 10.1034/j.1600-0625.2002.110102.x. PMID: 11952824.