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Pruritus

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Pruritus



Introduction 

Itching is an unpleasant sensation that compels a person to scratch the affected area. The medical name for itching is pruritus.

Itching can affect any area of the body. It can either be:



generalised – where itching occurs over the whole body



localised – where itching only occurs in a particular area



Sometimes, there may be a rash or spot where the itching occurs.

Mild, short-lived itching is common, but the problem can occasionally be severe and very frustrating to live with.

Common causes of itching

Itching can be caused by a number of different conditions, including:



skin conditions – such as eczema



allergies or skin reactions



parasitic infestations – such as scabies



insect bites and stings



fungal infections – such as athlete’s foot or vaginal thrush



hormonal changes during pregnancy or the menopause



systemic conditions (one that affects the whole body) – such as liver or kidney problems, or an overactive thyroid gland



 

Things you can do

If you experience troublesome itching, there are some things you can do that may help relieve it and prevent damage caused by scratching, including:



patting or tapping the itchy area, rather than scratching it



holding a cold compress, such as damp flannel, over the affected area to cool it down



bathing or showering in cool or lukewarm water



using unperfumed personal hygiene products



avoiding clothes that irritate your skin, such as wool or man-made fabrics



using a moisturiser or emollient if your skin is dry or flaky



There are also medicines, such as antihistamines and steroid creams, that are available over the counter from pharmacies that may help relieve itching caused by certain skin conditions.

 

When to see your GP

Many cases of itching will get better over a short period of time. However, you should visit your GP if your itch is:



severe



lasts for a long time



keeps coming back



associated with other symptoms – such as redness and swelling orjaundice (yellowing of the skin and whites of the eyes)



You should also visit your GP if your entire body itches and there is no obvious cause. It could be a symptom of a more serious condition.

Your GP will ask you about your symptoms – for example, if you have noticed whether anything makes your itch worse, or if your itch comes and goes. They will also examine your skin to look for any visible symptoms.

In some cases, they may take a skin scraping or a swab so it can be tested to help identify the cause of your itching. A blood test may also be carried out to look for underlying problems, such as thyroid or kidney disease.

Depending on what is found to be causing your itch, you may be referred to a hospital specialist for a further assessment and specific treatment. 

Causes of itching 

An itch is often caused by a condition affecting the skin, but it can be a sign of a more serious underlying problem.

In some cases, it may not be possible to identify a specific cause.

Skin conditions

Skin conditions that can cause itching include:



dry skin



eczema – where the skin is dry, red, flaky and itchy



contact dermatitis – inflammation of the skin that occurs when you come into contact with an irritant or allergen (see below)



urticaria – also known as hives, welts or nettle rash; urticaria is triggered by an allergen and causes a raised, red itchy rash to develop



lichen planus – an itchy rash of unknown cause



psoriasis – a skin condition that causes red, flaky, crusty patches of skin covered with silvery scales



dandruff –  a common skin condition that causes dry white or grey flakes of dead skin to appear in the scalp or hair



folliculitis – a skin condition caused by inflamed hair follicles



prurigo – small blisters (fluid-filled swellings) that are very itchy  



 

Allergies and skin reactions

Itching is sometimes caused by an allergen, irritant or other environmental factor, including:



cosmetic ingredients, such as preservatives, fragrances, hair dye and nail varnish hardeners



certain metals, such as nickel or cobalt in jewellery



rubber – including latex



textiles – particularly the dyes and resins that are contained in them



some plants – such as chrysanthemums, sunflowers, daffodils, tulips and primula



an allergy to certain foods or types of medication (for example, aspirin and a group of medicines called opioids)



prickly heat – an itchy rash that appears in hot, humid weather conditions



sunburn – skin damage caused by exposure to ultraviolet (UV) rays



 

Parasites and insects

Itching can be caused by the following pests:



the scabies mite, which burrows into the skin and causes a skin condition called scabies



head lice, pubic lice or body lice



insect bites and stings from bees, wasps, mosquitoes, fleas and bedbugs



threadworms – small worm parasites that infect the bowels of humans and can cause an itchy bottom



trichomonas vaginalis – a tiny parasite that causes a sexually transmitted infection (STI) called trichomoniasis



 

Infections

Itching may be a symptom of an infection, such as:



chickenpox or another viral infection



athlete's foot – a fungal infection that causes itching in between the toes



ringworm – a fungal infection that causes a ring-like red rash to develop on the skin and can cause an itchy scalp



vaginal thrush or thrush in men – yeast infections that can cause itching in and around the genitals



 

Other conditions

Itching can be a sign of an underlying condition that may affect the inside of the body without necessarily causing any other obvious symptoms.

Itching can be a symptom of:



haemorrhoids (piles) – enlarged and swollen blood vessels in or around the lower rectum or anus



an overactive thyroid or underactive thyroid – where the thyroid gland in the neck produces too much or too little thyroid hormone



iron deficiency anaemia – where a lack of iron in the body leads to a reduction in the number of red blood cells



polycythaemia – where you have a high concentration of red blood cells in your blood



liver-related conditions, such as primary biliary cirrhosis and hepatitis



long standing kidney failure



in rare cases, certain types of cancer, including liver cancer,pancreatic cancer, leukaemia and Hodgkin lymphoma

Occasionally, itching can be linked to a psychological condition such as depression or anxiety.

Pregnancy and the menopause

In women, itching can sometimes be caused by hormonal changes during pregnancy and after the menopause.

Pregnancy

Itching often affects pregnant women and usually disappears after the birth. A number of skin conditions can develop during pregnancy and cause itchy skin. They include:



pruritic urticarial papules and plaques of pregnancy (PUPPP) – a common skin condition that causes itchy, red, raised bumps that appear on the thighs and abdomen (tummy)



prurigo gestationis – a skin rash that appears as red, itchy dots and mainly affects the arms, legs and torso



obstetric cholestasis – a rare disorder that affects the liver during pregnancy and causes itching without a rash



Seek advice from your midwife or GP if you have itching or any unusual skin rashes during your pregnancy.

 

Menopause

Itching is also a common symptom after the menopause, which is where a woman’s periods stop as a result of natural hormonal changes as she gets older.

Changes in the levels of hormones, such as oestrogen, that occur during the menopause are thought to be responsible for the itching.

 

 

Treating itching

The treatment for itching will largely depend on the cause.

However, there are some things you can try – and treatments your GP or pharmacist can offer – that may help relieve an itch and reduce the risk of skin damage caused by scratching.

General tips



keep your nails clean, short and smooth



try patting or tapping the itchy area, rather than scratching it



wear cotton gloves at night to prevent damage from scratching in your sleep



hold a cold compress, such as damp flannel, over the affected area to cool it down



avoid spicy foods, alcohol and caffeine, as these can affect the blood flow in your skin and make itching worse



 

Bathing



use cool or lukewarm water, rather than hot water



keep baths to less than 20 minutes



try to reduce how often you have a bath or shower if possible



avoid using perfumed soap, shower gel or deodorants – unperfumed substitutes are often available from pharmacists



use unperfumed moisturising lotions and emollients after bathing or showering to help prevent your skin becoming too dry



dab or pat your skin dry, rather than rubbing it



 

Clothing and fabrics



avoid clothes that irritate your skin, such as wool and some man-made fabrics



wear cotton or silk whenever possible



avoid tight-fitting clothes



use mild laundry detergent that is less likely to irritate your skin



use cool, light, loose bedclothes



 

Medication

Some lotions, creams and medications available over the counter from pharmacies or on a prescription from your GP can help reduce itchiness.

Common treatments recommended include:



an oily moisturiser or emollient if your skin is dry or flaky



creams containing menthol to cool your skin or anti-itch ingredients such as crotamiton



mild steroid cream (usually for only a few days) for small, inflamed areas – hydrocortisone cream is available from pharmacies over the counter, or your GP can prescribe a steroid cream for you



antihistamine tablets to help control allergic reactions – check with your pharmacist or GP before using these because they are not suitable for everyone



Some antihistamine tablets can make you feel drowsy. This may be helpful if taken at night to help you sleep, but it's important not to drive, use power tools or operate heavy machinery after taking them.

If you have itching in hairy areas such as your scalp, lotions are available specifically for these areas, so you don't have to use sticky creams.

There are also some more powerful medications, such asantidepressants, which may be recommended if the above treatments don't help and your itch is particularly long-lasting.


Pruritus ani