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Itching of the skin (itchy skin)
Last reviewed: 16.10.2021
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[Causes of itching of the skin
When the itching of the skin is permanent, without any rashes on the skin, the cause may be dry skin (especially in the elderly), a systemic disease and reaction to medications. Systemic diseases that cause general itching include cholestatic diseases, uremia, polycythemia and haematological malignancies. Skin itching can also occur in the last months of pregnancy. Barbiturates, salicylates, morphine and cocaine can also cause itching of the skin. Less severe causes of itching may be a violation of the thyroid gland, diabetes, anemia and cancer of internal organs. Very rarely, itching is due to a mental trauma.
Itching of the skin is possible with dry skin, so this cause of pruritus should be excluded first. Usually, simultaneously with the itching during the examination of the skin, a number of its changes are revealed, especially traces of scrapings. Itching of the skin can also be a manifestation of various diseases of the internal organs, for example, diseases of the liver and biliary tract, and lymphogranulomatosis. The appearance of pruritus may be the first sign of intolerance to drugs, food, other allergic conditions (urticaria).
Itching of the skin most often occurs with the following somatic diseases.
- Obstruction (blockage) of the biliary tract, when the itching is a consequence of jaundice with hyperbilirubinemia, which is very characteristic of the syndrome of cholestasis of various origins (especially with cirrhosis of the liver, namely, primary biliary cirrhosis, drug damage). Itching is also possible in pregnant women with the development of so-called cholestasis of pregnancy (pruritus).
- 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 cavity, etc.).
- Diseases of the blood (erythremia).
It should not be forgotten that itching can be a consequence of helminthiasis, scabies, and pediculosis. And also have a psychogenic nature - the so-called psychogenic itching under stress.
Who to contact?
What if you have itchy skin?
Anamnesis
The key elements are the impact of drugs and professional activities / hobbies. Skin itching can be so intolerable that sleep deprived patients resort to the most extreme measures, even suicidal attempts are possible. With prolonged itching, skin is usually found on the skin.
Inspection
It is necessary to focus on the establishment of skin disease. Identification can be complicated by redness, papules, rash combs, cracks, lichenization and hyperpigmentation, which can be the result of constant scratching.
Study
With some rashes, accompanied by itching, you need a biopsy. If suspected of a systemic disease, the studies include a blood count, liver tests; the function of the kidneys and thyroid gland is evaluated; the diagnosis of malignant neoplasms is carried out.
Treatment of skin itching
Treatment is carried out for any identified disease. Supportive therapy includes appropriate skin care and the use of local, systemic and physiotherapy methods.
Skin care consists in using cool or warm (but not hot) water during bathing, limited use of soap, in regulating the duration and frequency of bathing, abundant use of emollients such as petroleum jelly and other oil-based products, moist air and wearing free clothes.
External agents help to localize the itching of the skin. The optimal use is a lotion or cream with camphor / menthol, from 0.125 to 0.25% menthol, doxepin, phenol from 0.5 to 2%, praoxin, a solution of local anesthetics and glucocorticoids. Topical use of diphenhydramine and doxepin should be avoided, as they can increase the sensitivity of the skin.
Systemic drugs are prescribed with general or local itching, resistant to local remedies. Antihistamines, mainly hydroxyzine, 10 to 50 mg orally every 4 hours, depending on the condition of the patient are very effective and are used most often. Antihistamines of the first generation are used with caution in the elderly, as they are addictive and cause fainting; believe that antihistamines of a new generation that are not addictive, such as loratadine, fexofenadine and cetirizine, are preferable for itching of the skin, although this has not been proven. Other drugs include doxepin (for atopy), cholestyramine (in renal failure, cholestasis, polycythemia), opioid antagonists such as naltrexone and nalmefene (with biliary itching), cromolin (with mastocytosis) and possibly gabapentin (with hepatic itching).
Physiotherapy methods that can be effective for itching include ultraviolet (UV) phototherapy, percutaneous electrical stimulation of nerves, and acupuncture.