Question

Pruritus - Know More About It!

Dr.Radhika A (Md) · Accepted Answer

Pruritus
Itchy skin is a very uncomfortable condition and causes physical and mental irritation to those who have it. It is a very common problem especially among those who have dry skin.

Definition:
Pruritus is a skin condition where it gets very itchy. The level of itchiness differs among individuals and also varies according to the cause of the condition as well. Due to constant scratching of the affected area, this condition can become worse and can even cause infections.

Pruritus is most commonly caused because of dry skin and that is why it is more common in adults because the skin gets drier as the age of the person increases. When the skin is affected by pruritus, it might get red or it might appear just as normal. When it gets a bit severe, chances of developing bumps and blisters are also high. The mind reacts very quickly when it itches, that is why most of the people end up scratching the itchy area which proves to be harmful in the end. Repeated scratching causes the affected area to thicken, after which it can also start bleeding.

Symptoms:
Generally, itchiness is caused only in some small or specific areas of the body. If there is itching on the whole body, then probably it is because of an allergic reaction. It is important to note that pruritus can happen without any visible changes on the skin but there could be following symptoms as well:

- Redness of the skin. The area will also feel warmer.

- Blisters or bumps. There could be a presence of spots in different areas.

- Dry skin which causes it to crack, giving it a leathery kind of texture.

Pruritus can also last for a long time with more severity. Itching and its severity are dependent on each other. When people feel itchy, they cannot resist scratching and when they scratch, itching and skin condition gets worse. Coming out of this loop is very hard but sometimes, trying to divert the attention somewhere else might help. In many situations, only medications are helpful.

When these conditions last for a period of weeks and do not show any signs of improving, it is best to visit the doctor. It is wise to seek medical attention in the following situations as well:

- When the person is not able to concentrate on their routine activities and cannot help thinking about it.

- When they abruptly feel itchy on any body part.

- When pruritus happens in the whole body instead of a specific part.

- In case there are other symptoms present in the body like drowsiness, weight-loss or weakness, digestion issues or fever.

Causes:
Skin is vital, as well as delicate. It acts as a shield to protect the inside parts of the body. It can save the body from harmful elements like bacteria, viruses etc. with the help of some cells which are part of the human body s immune system. Those cells detect the occurrence of an unwanted condition or a presence of a substance which might harm the body. Those cells are very reactive and act when some harmful substance touches the body, or when the body is having some infection or a disease. When those cells detect such a thing, they cause the affected area to develop inflammation which is what is known by the popular term rash or dermatitis. This inflammation triggers the itching. The severity of the rash varies from one person to the other. Some people have very sensitive skin. They can have rashes which are very painful and red, but some can have just the visibility of rashes but no or very less itching.

Following are some of the popularly known reasons for pruritus:
- The most common cause of pruritus is having a dry skin. This can be found out by checking the affected area carefully. If there are no blisters or bumps or no other change on that part, then probably the reason is dry skin. Dry skin which causes pruritus is also known as xerosis. Most people have dry skin by birth and it gets even drier when they grow up. Other reasons why the skin can become dry could be the exposure to an air-conditioned environment, staying in a heated room for a long time or washing the hands/body too often with soaps and chemical based washes.

- Pruritus can also be a result of other skin conditions. Those can be psoriasis, chickenpox, hives, scabies or dermatitis. Dermatitis is also known as eczema. These kinds of conditions generally have an impact on certain specific areas of the body and also cause other issues like redness, bumps or blisters.

- When the skin is itchy, it could be a signal that something is wrong in the body and there could be a presence of an illness. The illness could be related to the liver, kidney or any other organ. Diseases like kidney malfunction, deficiency of iron, cancer, leukaemia, thyroid and lymphoma could be the reasons. In such cases, not a specific part but the whole body becomes itchy. It is advisable not to go by the physical appearance because the skin might appear to be normal but still, there could be repeated itching on some parts or the whole body.

- It has been seen that diseases related to the nervous system also causes itching. Some examples of issues related to the nervous system are shingles, pinched nerves, diabetes mellitus, sclerosis etc.

- Another major cause of pruritus is an allergic reaction to some object. The range of objects is quite wide. It could be hard chemical based soaps like body wash, hand wash or even dishwashers. Some people also find wool as allergic and causes itching to them. Other objects could be some cosmetics, metals like nickel, or plants like poison ivy. There are certain foods like peanuts which also causes pruritus.

- There are certain medicinal drugs which can have their side effects like some antibiotics, narcotic pain related medicines, antifungal drugs. Reactions from these drugs mostly spread to the whole body and cause the rashes all over.

- Other general causes of itching are fungal infections or things like bedbugs, lice or other worms. An example of a fungal infection is athlete s foot in which the area between the toes or the area around it gets affects and starts to itch.

- In females, during pregnancy, the skin can get itchy. Especially the abdominal area gets very itchy but even thighs can become like that. If a female who already has dermatitis becomes pregnant, the chances of dermatitis getting worse are very high.

How is it diagnosed?
To diagnose the presence of pruritus is straightforward because it simply means itching in the body. But to detect the cause of the itching can be a bit tricky. It can be a time-consuming process and requires a physical examination by the doctor or a skin specialist. The doctor would also ask about the medical history of the patient to check if the person is allergic to some specific substances or drugs. The doctor might also ask for one or few of the following tests:

- Blood tests: Lot of information can be gathered from a blood sample. The blood count can point in the right direction to detect the underlying cause of pruritus. It could be deficiency or iron or some other internal issue.

- Kidney function test: They are important to verify how well the kidneys are doing their work. Any disorders can immediately be detected with the help of kidney function. If there is a chronic kidney disease, it damages the kidneys very severely and disables them from filtering the toxins. This condition is also known as Uremia. When a person has Uremia, their itching increases in the night time and mostly affects the back, abdominal area and the arms.

- Thyroid test: It is used to find out if the person has got hyperthyroidism or any other thyroid abnormalities.

- Liver tests: They are helpful in checking the health of the liver.

- Chest X-rays: This test is useful in recognising the presence of any lung related diseases or issues like enlarged lymph nodes.

Prevention:
To avoid getting pruritus, it is important to keep the skin healthy and keep it away from risky substances. Following suggestions will help in the prevention of pruritus:

- Keeping the skin moisturized always is very crucial. Avoiding it from getting dry will improve its overall health as well. Use of moisturizing lotions and creams is highly advisable.

- When there is sunshine, use of sunscreen is also highly worthwhile. It does not matter whether the person is inside or outside. The rays of the sun reach indoors as well which is why sunscreen is beneficial.

- If the skin is sensitive or prone to pruritus, then soaps should be avoided. There are soap free options available in the market. If the soaps must be used, then using mild ones is advisable.

- Showering with hot water should be avoided and using warm water instead is suggested. Hot water makes the skin drier.

- Whenever possible, use cotton instead of synthetic clothes. Woolen clothes might not have many alternatives, but a cotton cloth can be worn inside them to avoid their direct contact with the skin.

- When the person is spending much time in the heated or air-conditioned room, then using a dehumidifier or keeping a bowl of water might help a little bit.

- When the skin is irritated, it might be very difficult to resist itching, but keeping a washcloth soaked in cold water can help in giving some relief. It will bring the inflammation down and prevent the person from scratching the already sensitive area.

- When the person is going outside where the presence of insects or mosquitoes could be there, then keeping themselves covered is wise. Using a mosquito repellent indoors will also be very helpful.

- If the person is allergic to substances like nickel, then use of artificial jewellery should be strictly avoided. Instead, they should use alternatives like pure gold or pure silver.

Treatment:
The treatment of pruritus depends on the underlying cause of this problem. If the reason is simply dry skin, then moisturizing alone will solve the issue. For other causes, the treatments are as follows:

- Skin conditions like eczema or hives can be treated with the help of corticosteroids, but these should be used only if the skin specialists approve of them. Sometimes, doctors also prescribe antihistamines.

- If the itching is caused because of some allergy, then anti-allergy drugs like Benadryl, Allegra etc. can help as well.

- Fungal infections are mostly treated with drugs that are available over-the-counter. There are a few anti-fungal creams available with the pharmacies that can be used. For that, the person should be sure that the infection is fungal which only the doctor can confirm. They might also prescribe oral drugs like Lamisil or Terbinafine.

- A popular drug that doctors prescribe is hydrocortisone. Since it is a low potency steroid, it should only be used if it is prescribed by the doctor.

- In case the cause of pruritus is an internal body condition, then treatment will be provided to heal that, and the treatments could vary.

- Light or phototherapies are also used to control the itching.

Complications:
Apart from mental discomfort, pruritus can also cause infections in case people cannot help scratching their skin. If pruritus is left untreated, it might not get healed and remain there.

Myths:
People often believe that the presence of pruritus is only because of some allergy. It is not always the case. Allergies are just one reason for having this condition. There could be internal body condition as well which might lead to pruritus. Also, when the skin becomes red and hives are developed, many people relate those scenarios with superstitions which are scientifically and medically not valid.

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Pruritus - Know More About It!