Pruritus: Causes, Symptoms, Diagnosis, Treatment and Complications

Pruritus is a skin condition in which you want to scratch your skin due to its intense itching. As people age, their skin tends to become drier, which greatly contributes to itchy skin.

Your skin may appear normal, strange, irritated, rough, or bumpy, depending on what is making you scratch. Scratching frequently could result in larger, elevated skin areas that could bleed or get infected.

Activities that promote self-care include moisturizing, using mild cleansers, and taking brief baths. You must find and address the source of your itchy skin for long-lasting relief. Treatments that are frequently used include medicated lotions, wet dressings, and oral anti-itch medications.

Causes Of Pruritus

The following list of factors can result in itchy skin:

• Skin problems. Examples include xerosis, dermatitis, psoriasis, scabies, parasites, burns, scars, insect bites, and hives.
• Internal diseases. Whole-body itching could be a sign of an underlying condition such as liver disease, renal disease, anemia, diabetes, thyroid issues, or even some malignancies.
• Psychiatric disorders. Anxiety, OCD, and sadness are a few examples.
• Allergies and irritation. Wool, chemicals, detergents, and other items can irritate the skin and result in rashes and irritation. An allergic reaction can occasionally be brought on by a chemical, such as cosmetics or poison ivy. Additionally, adverse reactions to several medications, including those used to alleviate pain (opioids), can result in itchy skin.
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Symptoms Of Pruritus

Small patches of skin, such as the scalp, arm, or leg, can become itchy. The entire body could also be covered. Itchy skin might develop even in the absence of other obvious skin changes. It could also include:

• Skin inflammation
• Scratch patterns
• Bumps, blemishes, or blisters
• Cracked, parched skin
• Patches with leather or scales

Sometimes the itching is severe and lasts for a long time. The region becomes itchier as you rub or scratch it. And the more you scratch, the itchier it is. It can be difficult to control this itch cycle.

Diagnosis Of Pruritus

Beginning with a physical examination and inquiries about your medical history, the cause of your itching skin might be identified. You might undergo tests, such as the following ones if your doctor suspects a medical problem is responsible for your itchy skin:

• Blood test. A complete blood count can show whether anemia, for example, is the fundamental problem causing the itch.
• Tests for the kidneys and liver function. Itching can be brought on by liver, renal, and thyroid diseases, including hyperthyroidism.
• A chest X-ray. If you have swollen lymph nodes, which can be associated with itchy skin, a chest X-ray can reveal this.

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Treatment Of Pruritus

The goal of treating itchy skin is to eliminate its root cause. In the event that over-the-counter medications and other treatments don't help you manage your symptoms, consult with your doctor. It can be difficult to control itchy skin symptoms, and long-term therapy may be necessary. Options include

• Ointments and creams containing corticosteroids. Your medical professional can advise using a medicated lotion or ointment on the affected regions of your skin if it is irritated and a sensation of itching is present. Then you can use a wet cotton cloth to cover the affected skin. In addition to cooling the skin, moisture helps in the cream's absorption.
• Your doctor may advise following this bedtime regimen if you have chronic or severe itching: Apply triamcinolone after taking a 20-minute bath in lukewarm water only. Apply 025% to 0.1% of an ointment onto wet skin. As a result, the drug can absorb moisture more easily. . For several evenings, repeat this ritual before you go to sleep.
• Additional creams and ointments. You can also use calcineurin inhibitors on your skin, such as tacrolimus (Protopic) and pimecrolimus (Elidel). Alternately, topical anesthetics, capsaicin cream, or doxepin cream might provide some comfort.
• Oral medication. Selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants, may be useful in reducing some types of chronic itching. Examples of SSRIs include sertraline and fluoxetine.
• Tricyclic antidepressants, such as Doxepin, are an alternative. Some of these medications may not start to really benefit you for 8 to 12 weeks after starting treatment.
• (Phototherapy) Light therapy. Your skin will be exposed to a specific type of light during phototherapy. For some people who cannot take oral medications, this may be a useful alternative. A few phototherapy sessions will probably be required before the itching is under control.

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What are the common causes of skin itching?

Answer: Common skin conditions causing itching include skin conditions like eczema/atopic dermatitis, psoriasis, contact dermatitis, scabies, and fungal infections like tinea/ringworm and candida. Systemic disorders causing pruritus include cholestasis, viral hepatitis and cirrhosis, uremic pruritus in CKD, iron deficiency anemia, aquagenic pruritus in polycythemia vera, thyroid dysfunction, and in psychiatric disorders like OCD.

How can I recognize the symptoms of an itchy rash?

The symptoms of an itchy rash include persistent urge to scratch, often worse at night. Skin in affected areas looks red and inflamed. There may be papules, vesicles or plaques or in some cases scaling or crusting of skin may appear. Lichenification is skin thickening which appears due to repeated scratching over time. Distribution patterns of some rashes are characteristic like eczema commonly affects flexural areas like the elbows and knees, while scabies often involves the web spaces of fingers. Along with itch,rash may be accompanied by pain, burning, oozing or signs of secondary infection.

Complications Of Pruritus

Your quality of life may be impacted by severe itching that persists for longer than six weeks and it is known as chronic pruritus. Sleep disruption, anxiety, or despair could result from it. Scratching and itching over an extended period of time can make the itch worse and raise the risk of skin damage, infection, and scarring.

Frequently Asked Questions

Q: What is Pruritis?

Answer: It's the intense itching on the skin.

Q: What is chronic Pruritis?

Answer: Pruritis which gets prolonged for a over a a period of 6 weeks is known as chronic.

Q: How can I know if I have Pruritus?

Answer: Physical examination done by a doctor is the only sure-shot way to know if someone has pruritus. 

Q: What deficiency causes Pruritus?

Answer: Iron deficiency.

Q. What is the medical term for itching?

Answer: Pruritus is the medical term for itching commonly used in medical practice

Q. Is pruritus different from general itching?

Answer: Itching and pruritus both describe the urge to scratch, but they differ in severity and context. Itching is mild, temporary, and caused by simple irritants like mosquito bites, dry skin, or heat rash. Itching is short-lived and harmless and usually goes away on its own. Whereas pruritus is persistent and intense itching that occurs due to eczema, allergic reactions, scabies, liver/ renal failure and in various underlying medical conditions. Pruritus is long-lasting or recurrent and needs further evaluation.

Q. What does a pruritic rash typically look like?

Answer: A pruritic rash may appear as red, inflamed patches, small bumps (papules), blisters (vesicles), or scaly areas. The rash can be localized or spread over the body. An itchy rash can also have thickened skin (lichenification), crusting, or even secondary infection over time. The location and pattern of the rash often help identify its cause e.g, eczema in the elbow or knee folds or scabies in the finger web spaces.

Q. How do doctors diagnose persistent itching?

Answer: Doctors diagnose persistent itching by first taking a detailed history, asking about duration of itching, what triggers it, any medications, allergies, and other symptoms like rash, jaundice or fatigue. They then do a physical examination of the skin to look for rashes, bumps, blisters, dryness, or signs of infection, and note the pattern and location of lesions. Most skin conditions are diagnosed with history and physical examination. In unclear cases, doctors may do skin scraping and culture, like in suspected fungal infections or skin biopsy in chronic cases. Sometimes allergy tests are done to diagnose allergic conditions. Some cases require blood tests to check liver, kidney or thyroid function, if any systemic disease is suspected.

Q. What are the best treatments for severe skin itching?

Answer: Severe skin itching should be evaluated by a doctor to check for underlying conditions, and treatment aims at treating the cause and relieving symptoms. For inflamed or itchy skin, topical corticosteroid creams or ointments, e.g, Triamcinolone 0.25% to 0.1% ointment, are to be applied on moist skin to improve absorption. Other topical creams include calcineurin inhibitors like tacrolimus (Protopic) and pimecrolimus (Elidel); Tricyclic antidepressants like Doxepin cream can also be used. Oral medications such as antihistamines, SSRIs like sertraline and fluoxetine, TCAs like Doxepin are also used if creams are not enough, though oral medications may take several weeks to work. Phototherapy is another option for persistent cases. Along with medications, keeping the skin moisturized, avoiding triggers, and gentle skin care are important.

Q. Can liver disease or other internal conditions cause chronic itching?

Answer: Yes, various systemic diseases can cause pruritus. In liver diseases like cholestasis, hepatitis, cirrhosis, primary biliary cholangitis, and primary sclerosing cholangitis, there is bile salt accumulation in the blood, which deposits in the skin and stimulates itch receptors and leads to chronic itching. In chronic kidney disease, uremic toxins, high levels of phosphate and calcium, and skin dryness activate itch pathways. In polycythemia vera, high red cell mass increases histamine release from basophils and mast cells, which trigger itching, especially after warm showers. Other conditions that can cause pruritus are iron deficiency anemia, hyperthyroidism, hypothyroidism, and diabetes.

Q. What are effective remedies for allergic itching?

Answer: In Allergic itching, the main cause is the release of histamine, which triggers itching, redness, and swelling. Treatment focuses on blocking histamine’s effects using oral antihistamines like cetirizine or loratadine. Topical corticosteroid creams are also used, and they help reduce inflammation in affected areas. Moisturizers keep the skin soft and prevent dryness, because dryness can worsen itching. Most importantly, patients should identify and avoid allergens or triggers such as certain foods, dust, animal dander, or chemicals to prevent recurrence of symptoms.

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