Pruritus: Causes, Symptoms, Diagnosis and Treatment

Pruritus is a common skin condition marked by intense itching that creates a strong urge to scratch. It may affect a small area or the entire body, and continuous scratching can lead to skin damage, infection, and thickened skin. Pruritus can occur with or without visible skin changes and may become chronic if it lasts for more than six weeks.

The condition can be caused by skin disorders, internal diseases, allergies, drug reactions, or psychological factors. Diagnosis involves medical history, skin examination, and tests for underlying diseases. Treatment aims to control itching, heal the skin, and prevent complications using topical medicines, oral drugs, and supportive care.

Pruritus

Pruritus is the medical term for severe itching of the skin. This condition makes a person want to scratch intensely. The notes explain what causes this itching, how it appears, how doctors find its root cause, and the ways to treat it. It is important for understanding skin health.

Pruritus is a common skin condition marked by intense itching. This urge to scratch can affect a small area or the whole body. Prolonged scratching can lead to skin irritation, bleeding, and infection. Finding the source of itching is crucial for lasting relief.

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Causes Of Pruritus

Various factors can cause itching. These range from simple skin issues to more complex internal conditions.

• Skin Problems:

• Xerosis (dry skin), dermatitis, psoriasis.

• Scabies, parasites, burns, scars.

• Insect bites, hives.

• Internal Diseases:

• Liver disease, kidney disease, and anaemia.

• Diabetes, thyroid problems.

• Certain cancers (malignancies).

• Psychiatric Disorders:

• Anxiety, Obsessive Compulsive Disorder (OCD), and depression.

• Allergies and Irritation:

• Reactions to wool, chemicals, and detergents.

• Allergens like cosmetics or poison ivy.

• Adverse drug reactions (e.g., opioids).

Symptoms Of Pruritus

Pruritus symptoms can vary, sometimes showing no visible skin changes. The itching can affect small areas or the entire body.

• Visible Skin Changes:

• Skin inflammation.

• Scratch marks.

• Bumps, blemishes, blisters.

• Cracked, dry skin.

• Leathery or scaly patches.

• Itch-Scratch Cycle: Itching can be severe and long-lasting. Scratching makes the area itchier, forming a difficult cycle to break.

Diagnosis Of Pruritus

Doctors diagnose pruritus by reviewing medical history and performing a physical exam. Further tests help identify the underlying cause.

• Physical Examination: Doctors check the skin and ask about symptoms.

• Blood Test: A complete blood count can detect anaemia.

• Organ Function Tests:

• Kidney and liver function tests rule out related diseases.

• Thyroid function tests check for hyperthyroidism.

• Chest X-ray: This can reveal swollen lymph nodes, sometimes linked to itchy skin.

Treatment Of Pruritus

Treatment focuses on addressing the root cause of the itching. Long-term management might be necessary for persistent cases.

• Topical Treatments:

• Corticosteroid creams and ointments reduce inflammation and itching. Apply on wet skin after a lukewarm bath for better absorption.

• Calcineurin inhibitors (tacrolimus, pimecrolimus) are alternatives.

• Topical anesthetics, capsaicin cream, or doxepin cream provide relief.

• Oral Medication:

• Antidepressants like SSRIs (sertraline, fluoxetine) help with chronic itching.

• Tricyclic antidepressants like Doxepin are another option. These may take weeks to show full effect.

• Light Therapy (Phototherapy):

• Skin exposure to specific light types helps some individuals. This is an option for those unable to use oral medications. Multiple sessions may be needed.

Complications Of Pruritus

Severe itching lasting over six weeks is chronic pruritus. This can impact a person's daily life.

• Impact on Life Quality:

• Sleep disruption.

• Anxiety and depression.

• Skin Damage:

• Increased risk of skin damage from scratching.

• Infection and scarring.

Management and Treatment Strategies of Pruritus

Managing pruritus involves breaking the itch-scratch cycle and treating specific underlying conditions. The goal is to reduce discomfort and prevent complications.

Addressing the Itch-Scratch Cycle

The continuous cycle of itching and scratching worsens skin irritation. Stopping this cycle is a key part of treatment.

• Moisturizing the skin regularly helps maintain the skin barrier.

• Using mild cleansers prevents further irritation.

• Taking short, lukewarm baths can soothe the skin without drying it out.

Treatment Strategies for Specific Causes

Treatments are chosen based on the identified cause of pruritus.

• Skin Conditions: Topical corticosteroids or specific treatments for conditions like scabies or psoriasis.

• Internal Diseases: Managing the primary condition, such as liver or kidney disease, helps relieve associated itching.

• Allergic Reactions: Avoiding known allergens and using antihistamines or topical anti-inflammatory creams.