Itchy skin may be a symptom of a skin or systemic disease. Well-known conditions that cause intense itching are scabies, lice, insect bites, urticaria, allergic or contact dermatitis, lichen planus, miliaria and dermatitis herpetiformis.
Causes of itchy skin
When itchy skin is permanent without any rash on the skin, and may be caused by dry skin (especially in older people), systemic disease and reaction to medications. Systemic diseases that cause generalized pruritus include cholestatic diseases, uremia, polycythemia, and hematologic malignancies. Itchy skin can also occur in the last months of pregnancy. Barbiturates, salicylates, morphine and cocaine can also cause itchy skin. Less pronounced causes of itching may include thyroid dysfunction, diabetes, anemia and cancer of internal organs. Very rarely, itching is caused by mental trauma.
Itchy skin possible with dry skin, so this cause of itching must be excluded first. Usually, along with itching, when examining the skin, a number of changes are detected, primarily traces of scratching. Itchy skin can also be a manifestation of various diseases of internal organs, for example diseases of the liver and biliary tract, lymphogranulomatosis. The appearance of itching may be the first sign of intolerance to drugs, foods, or other allergic conditions (urticaria).
Itchy skin most often occurs with the following somatic diseases.
- Obstruction (blockage) of the bile ducts, when itching is a consequence of jaundice with hyperbilirubinemia, which is very typical for cholestasis syndrome of various origins (especially with cirrhosis of the liver, namely primary biliary cirrhosis of the liver, its drug-induced damage). Itching is also possible in pregnant women with the development of so-called cholestasis of pregnancy (itching of pregnancy).
- In chronic renal failure, itching is one of the symptoms of its terminal stage (uremic intoxication).
- Diabetes.
- Tumor diseases (lymphomas, including lymphogranulomatosis; tumors of the abdominal organs, etc.).
- Blood diseases (erythremia).
We should not forget that itching can be a consequence of helminthiasis, scabies, and lice. and also have a psychogenic nature – the so-called psychogenic itching during stress.
What to do if you have itchy skin
Anamnesis
The key elements are exposure to medications and occupational activities/hobbies. Skin itching can be so unbearable that sleep-deprived patients resort to the most extreme measures, even suicidal attempts are possible. With prolonged severe itching, scratching marks are usually found on the skin.
Inspection
It is necessary to focus on identifying the skin disease. Identification may be complicated by redness, papules, scratching of the rash, fissures, lichenification and hyperpigmentation, which may result from constant scratching.
Research
Some rashes that are itchy require a biopsy. If a systemic disease is suspected, studies include a clinical blood test, liver tests; kidney and thyroid function is assessed; diagnosis of malignant neoplasms is carried out.
Treatment for itchy skin
Any identified disease is treated. Maintenance therapy includes appropriate skin care and the use of local, systemic and physiotherapeutic methods.
Skin care includes using cool or warm (but not hot) water when bathing, limiting the use of soap, regulating the duration and frequency of bathing, generous use of emollients such as Vaseline and other oil-based products, humidifying dry air and wearing loose clothing.
External remedies help localize skin itching. It is optimal to use a lotion or cream with camphor/menthol, 0,125 to 0,25% menthol, doxepin, 0,5 to 2% phenol, pramoxine, a solution of local anesthetics and glucocorticoids. Topical diphenhydramine and doxepin should be avoided as they may sensitize the skin.
Systemic remedies are prescribed for general or local itching that is resistant to local remedies. Antihistamines, mainly hydroxyzine, 10 to 50 mg orally every 4 hours, depending on the patient’s condition, are very effective and are the most commonly used. First generation antihistamines are used with caution in older people, as they are addictive and can cause fainting; Newer generation non-addictive antihistamines such as loratadine, fexofenadine and cetirizine are believed to be preferable for itchy skin, although this has not been proven. Other agents include doxepin (for atopy), cholestyramine (for renal failure, cholestasis, polycythemia), opioid antagonists such as naltrexone and nalmefene (for biliary pruritus), cromolyn (for mastocytosis), and possibly gabapentin (for hepatic pruritus).
Physical therapy modalities that may be effective for itching include ultraviolet (UV) phototherapy, transcutaneous electrical nerve stimulation, and acupuncture.