Definition of Pruritus (Itchy skin (pruritus))
Itchy skin is an uncomfortable, irritating sensation that makes you want to scratch. Also known as pruritus (proo-RIE-tus), itchy skin may be the result of a rash or another condition, such as psoriasis or dermatitis. Or itchy skin may be a symptom of a disease, such as liver disease or kidney failure.
Depending on the cause of your itchy skin, it may appear normal. Or it may be red or rough or have bumps or blisters.
Long-term relief requires identifying and treating the cause of itchy skin. Itchy skin treatments include medications, wet dressings and light therapy. Self-care measures, including using anti-itch products and taking cool baths, also can help.
Symptoms of Pruritus (Itchy skin (pruritus))
You may have itchy skin over certain small areas, such as on an arm or leg, or your whole body may itch. Itchy skin can occur without any other noticeable changes on the skin. Or it may be associated with:
- Bumps, spots or blisters
- Dry, cracked skin
- Leathery or scaly texture to the skin
Sometimes itchiness lasts a long time and can be intense. As you rub or scratch the area, it gets itchier. And the more it itches, the more you scratch. Breaking this itch-scratch cycle can be difficult, but continued scratching can damage your skin or cause infection.
When to see a doctor
See your doctor or a skin disease specialist (dermatologist) if the itching:
- Lasts more than two weeks and doesn’t improve with self-care measures
- Is severe and distracts you from your daily routines or prevents you from sleeping
- Can’t be easily explained
- Affects your whole body
- Is accompanied by other symptoms, such as extreme tiredness, weight loss, changes in bowel habits or urinary frequency, fever, or redness of the skin
Possible causes of itchy skin include:
- Dry skin. If you don’t see a crop of bright, red bumps or some other dramatic change in the itchy area, dry skin (xerosis) is a likely cause. Dry skin usually results from environmental factors such as hot or cold weather with low humidity, long-term use of air conditioning or central heating, and washing or bathing too much.
- Skin conditions and rashes. Many skin conditions itch, including eczema (dermatitis), psoriasis, scabies, lice, chickenpox and hives. The itching usually affects specific areas and is accompanied by other signs, such as red, irritated skin or bumps and blisters.
- Internal diseases. These include liver disease, malabsorption of wheat (celiac disease), kidney failure, iron deficiency anemia, thyroid problems and cancers, including leukemia and lymphoma. The itching usually affects the whole body. The skin may look otherwise normal except for the repeatedly scratched areas.
- Nerve disorders. Conditions that affect the nervous system — such as multiple sclerosis, diabetes mellitus, pinched nerves and shingles (herpes zoster) — can cause itching.
- Irritation and allergic reactions. Wool, chemicals, soaps and other substances can irritate the skin and cause itching. Sometimes the substance, such as poison ivy or cosmetics, causes an allergic reaction. Food allergies also may cause skin to itch.
- Drugs. Reactions to drugs, such as antibiotics, antifungal drugs or narcotic pain medications, can cause widespread rashes and itching.
- Pregnancy. During pregnancy, some women experience itchy skin, especially on the abdomen, thighs, breasts and arms. Also, itchy skin conditions, such as dermatitis, can worsen during pregnancy.
Complications of Pruritus (Itchy skin (pruritus))
Itching skin can affect the quality of your life. Prolonged itching and scratching may increase the intensity of the itch, possibly leading to:
- Skin injury
Preparing for your appointment
You’re likely to start by seeing your family doctor or primary care doctor. In some cases, you may be referred to a specialist in skin diseases (dermatologist).
Here is information to help you get ready for your appointment and to know what to expect from your doctor.
What you can do
Write down your signs and symptoms, when they occurred, and how long they lasted. Also, make a list of all medications, including vitamins, herbs and over-the-counter drugs, you’re taking. Or take the original bottles and a written list of the dosages and directions.
Write down questions to ask your doctor. For itchy skin, questions you may want to ask include:
- What is likely causing my symptoms?
- Are tests needed to confirm the diagnosis?
- What are other possible causes for my symptoms?
- Is my condition likely temporary or chronic?
- What is the best course of action?
- I have other health problems. How can I manage them together?
- What are the alternatives to the primary approach you’re suggesting?
- Do I need prescription medication, or can I use over-the-counter medications to treat the condition?
- What results can I expect?
- Can I wait to see if the condition goes away without treatment?
Don’t hesitate to ask any other questions you have.
What to expect from your doctor
Your doctor is likely to begin with your medical history and to ask you some questions, such as:
- When did you begin experiencing symptoms?
- What did your skin look like when your symptoms started?
- Have your symptoms changed?
- What, if anything, appears to worsen your symptoms?
- What, if anything, appears to improve your symptoms?
- What at-home treatments have you tried?
- What prescription and over-the-counter medications are you taking?
- Have you traveled recently?
- What is your typical diet?
- Are you in contact with possible irritants, such as pets or certain metals, at home or at work?
Tests and diagnosis
Tracking down the cause of your itch can take time and involve a physical exam and a careful history. If your doctor suspects your itchy skin is the result of an underlying medical condition, he or she may perform tests, including:
- Blood test. A complete blood count can provide evidence of an internal condition causing your itch, such as iron deficiency.
- Chemistry profile. This test is used to determine if you have a liver or kidney disorder.
- Thyroid function test. Thyroid abnormalities, such as hyperthyroidism, may cause itching.
- Chest X-rays. Signs of underlying disease that are associated with itchy skin, such as enlarged lymph nodes, can be seen by using radiography.
Treatments and drugs
Once a cause is identified, treatments for itchy skin may include:
- Corticosteroid creams. Applied topically, these may control itching. Your doctor may recommend applying the medicated cream to affected areas, then covering these areas with damp cotton material that has been soaked in water or other solutions. The moisture in the wet dressings helps the skin absorb the cream.
- Calcineurin inhibitors. Certain drugs, such as tacrolimus (Protopic) and pimecrolimus (Elidel), can be used instead of corticosteroid creams in some cases, especially if the itchy area isn’t large.
- Oral antihistamines. Your doctor may recommend anti-allergy medications to ease your itch. This group of medications includes over-the-counter drugs that don’t make you sleepy, such as cetirizine (Zyrtec) and loratadine (Claritin), or those that make you sleepy, such as diphenhydramine (Benadryl). The ones that make you sleepy can be particularly helpful at night if your itchy skin keeps you awake.
- Antidepressants. Selective serotonin-reuptake inhibitors, such as fluoxetine (Prozac) and sertraline (Zoloft), may help reduce various types of skin itching.
Treating the underlying disease
If an internal disease is found — whether it’s kidney disease, iron deficiency or a thyroid problem — treating that disease often relieves the itch. Other itch-relief methods also may be recommended.
Light therapy (phototherapy)
Phototherapy involves exposing your skin to certain wavelengths of ultraviolet light. Multiple sessions are usually scheduled until the itching is under control.
Lifestyle and home remedies
For temporary relief of itching, try these self-care measures:
- Use a high-quality moisturizing cream on your skin. Apply this cream at least once or twice daily, concentrating on the areas where itching is most severe. Examples include Cetaphil, Eucerin, CeraVe and others.
Apply an anti-itch cream or lotion to the affected area. Short-term use of nonprescription hydrocortisone cream containing at least 1 percent hydrocortisone can temporarily relieve the itch. So can menthol, camphor or calamine.
Topical anesthetics, such as lidocaine or benzocaine, may be helpful. However, benzocaine has been linked to a rare but serious, sometimes deadly condition known as methemoglobinemia, which decreases the amount of oxygen that the blood can carry. Don’t use benzocaine in children younger than age 2 without supervision from a health care professional. If you’re an adult, never use more than the recommended dose of benzocaine, and consider talking with your doctor.
- Avoid scratching whenever possible. Cover the itchy area if you can’t keep from scratching it. Trim nails and wear gloves at night.
- Apply cool, wet compresses. Covering the affected area with bandages and dressings can help protect the skin and prevent scratching.
- Take a lukewarm bath. Sprinkle the bath water with baking soda, uncooked oatmeal or colloidal oatmeal — a finely ground oatmeal that is made for the bathtub (Aveeno, others).
- Wear smooth-textured, loose cotton clothing. This will help you avoid irritation.
- Choose mild soaps without dyes or perfumes. Be sure to rinse the soap completely off your body. And after washing, apply a moisturizer to protect your skin.
- Use a mild, unscented laundry detergent when washing clothes, towels and bedding. Try using the extra-rinse cycle on your washing machine.
- Avoid substances that irritate your skin or that cause an allergic reaction. These can include nickel, jewelry, perfume or skin 9999products with fragrance, cleaning products, and cosmetics.
- Reduce stress. Stress can worsen itching. Counseling, behavior modification therapy, meditation and yoga are some ways of relieving stress.