Itchy skin (pruritus)

Overview

Itchy skin is an uncomfortable, irritating sensation that makes you want to scratch. Also known as pruritus (proo-RIE-tus), itchy skin can be caused or worsened by dry skin. It's common in older adults, as skin tends to become drier with age.

Depending on the cause of your itchy skin, it may appear normal, red, rough or bumpy. Repeated scratching can cause raised thick areas of skin that might bleed or become infected.

Many people find relief with self-care measures such as moisturizing daily, using gentle cleansers and bathing with lukewarm water. Long-term relief requires identifying and treating the cause of itchy skin. Common treatments are medicated lotions, moist dressings and oral anti-itch medicines.

Symptoms

You may have itchy skin over certain small areas, such as on an arm or leg, or over your whole body. Itchy skin can occur without any other noticeable changes on the skin. Or it may be associated with:

  • Redness
  • Bumps, spots or blisters
  • Dry, cracked skin
  • Leathery or scaly 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.

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
  • Comes on suddenly and can't be easily explained
  • Affects your whole body
  • Is accompanied by other signs and symptoms, such as extreme tiredness, weight loss, changes in bowel habits, or urinary frequency, fever or redness of the skin

If the condition persists for three months despite treatment, see a dermatologist to be evaluated for skin disease and an internist to be evaluated for other diseases.

Causes

Causes of itchy skin include:

  • Skin conditions. Many skin conditions itch, including dry skin (xerosis), eczema (dermatitis), psoriasis, scabies, burns, scars, insect bites and hives.
  • Internal diseases. Itchy skin can be a symptom of an underlying illness. These include liver disease, kidney failure, iron deficiency anemia, thyroid problems and certain cancers, including multiple myeloma and lymphoma.
  • Nerve disorders. Conditions that affect the nervous system — such as multiple sclerosis, diabetes, pinched nerves and shingles (herpes zoster) — can cause itching.
  • Psychiatric diseases. Examples of psychiatric diseases that can cause itchy skin are anxiety, obsessive-compulsive disorder and depression.
  • Irritation and allergic reactions. Wool, chemicals, soaps and other substances can irritate the skin and cause itching. Sometimes the substance, such as poison ivy, parasites or cosmetics, causes an allergic reaction. Also, reactions to certain drugs, such as narcotic pain medications (opioids) can cause itchy skin.
  • Pregnancy. During pregnancy, some women experience itchy skin.

Sometimes the cause of the itching can't be determined.

Complications

Itchy skin that lasts more than six weeks (chronic pruritus) can affect the quality of your life, for example, by interrupting your sleep and causing anxiety or depression. Prolonged itching and scratching may increase the intensity of the itch, possibly leading to skin injury, infection and scarring.

Diagnosis

Tracking down the cause of your itch can take time and involve a physical exam and questions about your medical history. If your doctor thinks your itchy skin is the result of a medical condition, you might have tests, including:

  • Blood test. A complete blood count can provide evidence of an internal condition causing your itch, such as iron deficiency.
  • Tests of thyroid, liver and kidney function. Liver or kidney disorders and thyroid abnormalities, such as hyperthyroidism, may cause itching.
  • Chest X-rays. A chest X-ray can show if you have enlarged lymph nodes, which can go along with itchy skin.

Treatment

Itchy skin treatment focuses on finding the cause of the itch and removing it. If home remedies don't ease the itchy skin, your doctor may recommend prescription medications or other treatments. Options include:

  • Corticosteroid creams and ointments. If your skin is itchy and red, your doctor may suggest applying a medicated cream or ointment to the affected areas. You might then cover the treated skin with damp cotton material. Moisture helps the skin absorb the medication and has a cooling effect.
  • Other creams and ointments. Other treatments that you apply to your skin include calcineurin inhibitors, such as tacrolimus (Protopic) and pimecrolimus (Elidel). Or you may find some relief with topical anesthetics, capsaicin and doxepin.
  • Oral medications. Antidepressants called selective serotonin reuptake inhibitors, such as fluoxetine (Prozac) and sertraline (Zoloft), may be helpful in easing some types of chronic itch.
  • Light therapy (phototherapy). Phototherapy involves exposing your skin to a specific type of 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:

  • Avoid items or situations that cause you to itch. Try to identify what's causing your symptoms and avoid it. This might be heavy, rough clothing; an overly heated room; too many hot baths or exposure to a cleaning product.
  • Moisturize daily. Apply hypoallergenic and fragrance-free moisturizer (Cetaphil, Eucerin, CeraVe, others) to affected skin at least once a day.
  • Use creams, lotions or gels that soothe and cool the skin. Short-term use of nonprescription corticosteroid cream may temporarily relieve an itch accompanied by red, inflamed skin. Or try calamine lotion or creams with menthol or capsaicin, or a topical anesthetic, such as pramoxine.
  • Avoid scratching whenever possible. Cover the itchy area if you can't keep from scratching it. Trim nails and wear gloves at night.
  • Take a bath or shower. Use lukewarm bathwater and sprinkle in Epsom salts, baking soda, uncooked oatmeal or colloidal oatmeal — a finely ground oatmeal that is made for bathing (Aveeno, others). Some people with chronic pruritus say that a hot shower eases their symptoms for hours. Others say a cold shower helps. Whatever method you prefer, use a mild cleanser and don't scrub too hard. Then rinse thoroughly, gently dry your skin and apply moisturizer.
  • Reduce stress. Stress can worsen itching. Counseling, behavior modification therapy, acupuncture, meditation and yoga are some ways of relieving stress.
  • Try over-the-counter allergy medicine. Some of these drugs, such as diphenhydramine (Benadryl), can make you drowsy. They might be helpful at night if your itchy skin keeps you awake.
  • Use a humidifier. A humidifier may provide some relief if home heating causes the air in your home to be dry.
  • Wear lightweight clothing. This may help keep the skin cool and reduce the sensation of itching.

Preparing for an 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?
  • Have you gone swimming or wading in a lake or pond recently?
  • What is your typical diet?
  • Are you in contact with possible irritants, such as pets or certain metals, at home or at work?

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