Itching (Pruritus)

What Causes Itching (Pruritus)

Some of the most common causes for itching without a skin rash include dry skin, thyroid disease (which can lead to dry skin), liver disease, kidney disease, blood disorders such as iron deficiency anemia or polycythemia vera.

If the itching has not responded to conventional treatments, an internal cause might be investigated to begin the search for a cause of itching. Your provider may do some basic lab tests, iron studies, thyroid studies including free T4 and TSH, liver enzymes, kidney tests, and possibly hepatitis tests.

Medications can occasionally cause itching, so be certain that your provider has a list of your current medications and when you started each one.  Sometimes, frustratingly, we cannot find a cause for the itching, but it is important to rule out systemic diseases through a detailed medical history and lab tests.

What are good “Itching Treatments”?

Keeping the skin moisturized is important.  To keep the skin moist, the patient should take a bath or shower every day in lukewarm (not hot) water.  Do not use soap unless areas are especially dirty.  Soaps are made to strip away oils, and those oils made by the skin are needed to hold in moisture.  Within 3 minutes of getting out of the bath or shower, apply a moisturizing cream to the body to help “trap” the water in the skin.

Patients often prefer lotions because they rub in better, but they also evaporate faster and do not work as well.  Ointments are the best, but ointments can often seem messy to patients.  Creams are a happy medium – thicker than lotions, but not as messy as ointments.

Sometimes your provider will recommend a cream with menthol.  These stinging or cooling preparations can confuse the receptors in the skin that transmit itching signals and thereby help relieve the itching for a short time.  The use of cool compresses or even ice packs can sometimes relieve itching by confusing the same receptors.

Oral antihistamines medications are often used to try to decrease the itch.  You may be given several non-sedating (non-drowsy) antihistamines to use in the morning, and more sedating (drowsy) antihistamines at night.  These are meant to be taken every day to help prevent the itching from occurring and to make it less severe when it does occur.

 

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