What is pruritus?
The word “pruritus” refers to itchiness. This symptom can occur in isolation, or can be the result of another condition. The most common cause of pruritus is dry skin. Skin disease, pregnancy, and medications can also cause pruritus. On very rare occasions, pruritus can be due to cancer. If itching lasts six or more weeks, pruritus is considered chronic.
Who gets pruritus?
Certain groups of people are more susceptible to pruritus, including:
- The elderly
- Atopic patients (seasonal allergies, hay fever, asthma, and eczema)
- People with diseases, including diabetes, HIV infection/AIDS and various types of cancer
- Pregnant women
- Patients with kidney failure on dialysis
Diagnosis and Tests
How is pruritus diagnosed?
Your doctor will likely examine your skin. In order for a complete skin exam to take place, you may have to undress. If your itching has been severe, you might also have scratch marks or red skin. The doctor might ask many questions, including:
- When did the itching start?
- Did you make any changes in personal care products (soaps, lotions, etc.) before you started itching?
- Have you had other symptoms, such as weight loss, feeling very tired, night sweats, or increased thirst?
- Did you start taking any new medications?
- Did you touch something specific, such as a plant or a new pet? (This is a likely cause if the itch is confined to one location).
What tests are done in diagnosing pruritus?
Tests are done to determine the cause of the itching. The itching might be the primary problem, or might be a symptom of another condition. Tests may include:
- Allergy tests, which can indicate if you are having a reaction to something in your environment.
- Blood tests, which can reveal vitamin and mineral deficiencies or problems with the liver, kidneys, or thyroid.
- Imaging tests (such as a chest X-ray), which can reveal abnormalities associated with cancer.
- Skin biopsy, which can help identify skin conditions resulting in pruritus. This test involves taking a small sample of skin and examining it under a microscope.
Management and Treatment
How is pruritus treated?
The cause and severity of the itching determines the course of treatment.
If a drug reaction is suspected, switching to a different medication may help reduce the pruritus. If the itching is due to an underlying condition, the condition must be treated. Examples of conditions causing pruritus include kidney, liver, or gallbladder problems and blood diseases.
Your doctor might suggest self-care treatments, such as:
- Skin creams and lotions that moisturize your skin, preventing dryness. These should be applied following a bath or shower, while the skin is still damp.
- Regular use of sunscreen to prevent skin damage and sunburns.
- Use of a mild bath soap and laundry detergent that will not irritate your skin.
- Bathing in warm—not hot—water. This can relieve itching and avoid drying out your skin.
- Avoidance of certain fabrics, such as wool and synthetics, which can make your skin itch. Switch to cotton clothing and bed sheets.
- Keeping the thermostat in your house down and using a humidifier. Warm, dry air can make your skin dry.
- Placing a cool washcloth or some ice over the area that itches. This is can provide relief from itching and is less damaging than scratching.
Your doctor may also prescribe medication to treat pruritus, including:
- Topical steroids or oral steroids.
- Topical non-steroid creams, such as cooling gels, anti-itching medicines, or capsaicin.
- Antidepressant medications.
- Immunosuppressant medications, such as cyclosporine A.
In some cases, non-medical therapies are suggested, including:
- Light therapy.
- Transcutaneous electrical nerve stimulation therapy, known as TENS units.
How can I prevent pruritus?
Practicing healthy skincare habits can help prevent pruritus. This includes eating a healthy diet and protecting your skin from excessive damage. Drinking plenty of water, moisturizing to prevent dry skin, using warm (rather than hot) water for washing, and applying adequate sunscreen are also good habits for your skin.
When should I contact my healthcare provider about pruritus?
Contact your healthcare provider if:
- You have itchiness that lasts longer than a couple of weeks.
- The itchiness interferes with your sleep.
- The recommended suggestions are not working.
- Skin damaged from scratching might be infected. Signs of infection include red or swollen skin, pus, or fever.
Also contact your healthcare provider if you have developed concerning new symptoms, including:
- Weight loss or gain.
- Changes in bodily functions (urination or bowel movements).
- Mood changes.