Itch (Pruritus)

What is Itch?

Itchy skin is an irritating and bothersome sensation that causes you to want to scratch. This can be caused or worsened by dry skin. It is common in older adults, as the skin tends to become drier as we age. Sometimes, itchiness can last a while, can be intense, and impact the quality of life measures. If you chronically rub or scratch the area, it may kickstart an itch scratch cycle where scratching to relieve itching actually worsens itching and inflammation.

Common Symptoms of Itchy Skin

• Redness
• Bumps or blisters
• Leathery or scaly skin
• Dry, cracked skin
• Lack of sleep

Causes of Itchy Skin

There are many different causes of a severe itch, which may include:

Skin conditions: Including dry skin, eczema, scabies, burns, psoriasis, scars, hives, insect bites, atopic dermatitis and more.

Irritation and allergic reactions: Chemicals, soaps, wool, cosmetics, and certain drugs, among others, can all lead to irritation of the skin or allergic reactions.

Nerve disorders: Certain conditions that affect the nervous system such as degenerative spine disease, diabetes mellitus, or multiple sclerosis may cause itching.

Internal diseases: In some cases, itchy skin can be a symptom of any serious underlying disease including malignancies, cholestatic liver disease, kidney disease, blood disease, or serious infections.

Who is a Good Candidate for Itch Treatment?

Individuals with itchy skin that does not seem to go away should see a dermatologist to be evaluated. During your consultation with one of our dermatologists, we will examine your skin, and you will be able to discuss your symptoms. The provider will create a treatment plan to help control or eliminate your itch.

Pruritus Diagnosed

Diagnosing pruritus (itchy skin) involves a thorough evaluation to determine the root cause of the symptoms. Because pruritus can be caused by a wide variety of underlying issues, from skin conditions to underlying systemic diseases, your dermatologist will begin with a comprehensive medical history and physical exam. During this visit, be prepared to discuss when the generalized itching started, what seems to trigger it, and whether you’ve noticed any accompanying symptoms such as rash, fatigue, or night sweats.

Depending on your symptoms and history, additional tests may be ordered, which can include:

• Blood tests: To evaluate for underlying systemic conditions such as liver disease, kidney dysfunction, thyroid disorders, diabetes, anemia, or infections.
• Liver and kidney function tests: These assess how well your organs are working and whether autoimmune diseases like chronic hepatitis or renal insufficiency may be contributing to your itch.
• Thyroid function tests: An overactive, underactive or thyroid disease can be a hidden source of persistent itching.
• Chest X-rays or imaging studies: Used to check for signs of malignancy, enlarged lymph nodes, or systemic illness that may cause generalized pruritus.
• Skin biopsy: If a rash or lesion is present, a small sample of skin may be taken to help identify specific skin diseases such as eczema, psoriasis, or cutaneous T-cell lymphoma.
• Allergy testing: If an allergic reaction is suspected, patch testing or other allergy testing may be recommended.

If no underlying condition is found, the neuropathic itch may be diagnosed as idiopathic pruritus, meaning it has no identifiable cause. However, it may also be categorized as part of a chronic skin condition such as senile pruritus, which is common in older adults.

Chronic Pruritus Treatments

If itching persists despite at-home remedies, treatment options may include:

Corticosteroid Creams: To treat red and itchy skin, a medicated cream or ointment may be prescribed.

Other Creams and ointments: Other creams and ointments such as calcineurin inhibitors or topical anesthetics may help to relieve symptoms.

Oral medications: Antihistamines (levocetirizine, fexofenadine, hydroxyzine, doxepin, etc) gabapentin, and antidepressants called selective serotonin reuptake inhibitors (Zoloft or Prozac) may help to ease chronic itch.

Phototherapy: This involves exposing the affected skin to a specific type of light. Multiple sessions are usually needed to get itching under control.

What to Expect During Generalized Pruritus Treatment

In order to determine the cause for your itchy skin, a physical exam as well as blood tests evaluating your blood count, liver, thyroid, and kidney function, and chest X-rays may be performed. Treatment options focus on finding the cause of the itch and removing it.

Itch FAQs

What to Expect Following Itch Treatment

Following itch treatment, patients should see an improvement in their symptoms. In most cases, the itch will go away after some time. Your dermatologist will provide you with tips on how to keep your itch at bay.

Some quick tips for temporary, at-home itch relief, include avoiding items or situations that cause you to itch, using creams, lotions, or gels that soothe the skin, moisturizing daily, avoiding scratching, reducing your stress, using a humidifier, and trying over-the-counter-allergy medications.

Schedule a Consultation

If you are bothered by itchy skin, contact our office today to schedule a consultation. Our dermatology specialists are highly skilled in diagnosing and treating all forms of skin issues for a healthy and happy you!