What is pruritus?
Pruritus—the medical term for itching—is an unpleasant skin sensation that leads to scratching. It is a common symptom of allergies, inflammation or irritation. It results from a tingling, irritating or uneasy sensation on the skin. Depending on the cause, pruritus symptoms may affect one localized area or the entire body. It may also occur along with redness, pain, swelling, or lesions or pustules that may weep or ooze.
Skin irritation and inflammation from a rash is a common cause of pruritus. Other common pruritus causes include dry skin and chemical irritants, such as soap and laundry detergent. Insect stings and bites may also result in pruritus.
Allergic reactions can lead to itching of the skin and, sometimes, of the entire face or body. In rare cases, itching of the nipples is a symptom of breast cancer. Certain medications can cause pruritus. Examples include antibiotics (sulfonamides, penicillin), opiates (morphine and its derivatives), isoniazid, and phenothiazines like chlorpromazine (Thorazine) and prochlorperazine (Compazine). Vitamin A supplements may also cause pruritus.
Seek immediate medical care (call 911) if you have itching along with sudden face or throat swelling, breathing problems, a change in level of consciousness, or severe belly pain. These symptoms may be a sign of anaphylaxis—a life-threatening allergic reaction.
If your itching is persistent or causes you concern, see your doctor promptly.
What other symptoms might occur with pruritus?
Pruritus may accompany other symptoms that vary depending on the underlying disease, disorder or condition. Symptoms that frequently affect the skin may also involve other body systems.
Skin symptoms that may occur along with pruritus
Pruritus may accompany other symptoms affecting the skin including:
- Burning feeling
- Discharge from sores, lesions or pustules
- Redness, warmth or swelling
Other symptoms that may occur along with pruritus
Pruritus may accompany symptoms related to other body systems including:
- Abdominal pain or cramping
- Rash or hives
Serious symptoms that might indicate a life-threatening condition
In some cases, pruritus may occur with other symptoms that might indicate a serious or life-threatening condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:
- Confusion or loss of consciousness for even a brief moment
- Rapid heart rate (tachycardia)
- Sudden swelling of the face, lips or tongue
- Wheezing (whistling sound made with breathing)
What causes pruritus?
Pruritus is a common symptom of allergies, inflammation, or even physical irritation. Pruritus results from a tingling, irritating or uneasy sensation on the skin. It may occur in conditions affecting only a small area on the skin or along with more generalized conditions, such as hives or as a side effect of some medications.
In other cases, pregnancy, anemia, gallbladder disease, and many chronic conditions or cancers can be the cause of itching, or pruritus.
Skin causes of pruritus
Pruritus may be caused by skin disorders including:
- Atopic dermatitis (skin inflammation caused by an allergen)
- Contact dermatitis (localized skin irritation caused by contact with a particular substance)
- Dryness of the skin
- Eczema (skin inflammation or irritation)
Other causes of pruritus
Pruritus can also have other causes including:
- Allergic response
- Breast cancer
- Drug allergy, such as penicillin or codeine
- Food allergies (allergic reaction to certain foods)
- Hepatitis B or C
- HIV/AIDS (pruritus intensifies with disease progression)
- Insect bite allergy such as a bee sting
- Medications, such as antibiotics (sulfonamides, penicillin), opiates (morphine and its derivatives), phenothiazines (chlorpromazine, Thorazine), and prochlorperazine (Compazine), or isoniazid
- Vitamin A supplementation
Serious or life-threatening causes of pruritus
In some cases, pruritus may be a symptom of a serious or life-threatening condition known as anaphylaxis (life-threatening allergic reaction) that should be immediately evaluated in an emergency setting.
When should you see a doctor for pruritus?
Most causes of pruritus are not serious and the problem resolves on its own. However, there are times when seeing a healthcare provider is the safest option to see if something more concerning is to blame.
See your doctor promptly when itching:
- Affects the whole body
- Begins suddenly and for no apparent reason
- Interferes with daily activities, including sleep
- Lasts longer than two weeks and is not responding to self-care measures
- Occurs with other concerning symptoms, such as fever, fatigue, mood changes, night sweats, or unexplained weight loss
- Results in scratching that damages the skin or causes signs of infection, such as redness, swelling or pus
If itching persists despite your doctor’s recommendations, you may need to see a specialist. This may include a dermatologist, allergist, or internal medicine doctor. In general, you should consult one of these experts for itching that lasts longer than three months despite medical treatment.
Call 911 or go to your nearest emergency room for itching along with anaphylaxis symptoms including:
- Rapid pulse
- Swelling of the face, lips, tongue or throat
- Wheezing or difficulty breathing
How do doctors diagnose the cause of pruritus?
Getting a detailed history is very important in diagnosing the cause of itching.
Questions for diagnosing the cause of pruritus
Your doctor will likely ask you several questions related to your itching including:
- When did you first notice your itching?
- Do you itch all over or only in one area? On what part of your body do you notice the itching?
- How severe is your itching? Does it interfere with sleep, work, or other activities?
- Is the itch present all day or does it only occur during certain times of day?
- What, if anything, seems to make the itching better or worse?
- Have you had this kind of itching in the past?
- Do you have any other symptoms?
- Do you have seasonal allergies or any other type of allergy?
- Are you using any new soaps, detergents, or personal products, such as deodorant? If so, when did you start?
- What do you do for a living? What hobbies do you have?
- Have you recently traveled, used a hot tub, or gone swimming or wading?
- What medications are you taking?
- What treatments have you tried?
After getting an understanding of your itching, your doctor will perform a physical exam. A focus will be your skin to check for lesions, pustules, bumps or other symptoms. Your doctor may also examine your hair, nails, eyes, abdomen, and nervous system status.
Using your answers and the results of the exam, your doctor may order testing. This could include:
- Allergy tests
- Blood tests to check blood cell counts, blood sugar levels, thyroid hormone levels, and kidney and liver function
- Chest X-ray to look for enlarged lymph nodes in the area
- Skin biopsy to take a sample of tissue and examine it under a microscope
Diagnosing the cause of itching can be challenging. It is not always possible to diagnose an underlying cause or condition. If the problem persists and your doctor is unable to determine a cause, seeking a second opinion may give you more information and answers.
What are the treatments for pruritus?
The goal of pruritus treatment is to remove the cause, if possible, and improve your comfort. The treatment you need depends on the severity of the itching and the underlying cause. If doctors identify a root cause, treating it is an important part of relieving the itch. When medications are the cause, switching to another drug is an option.
To help stop the itching, doctors may recommend medications including:
- Antihistamines: These drugs block histamine—a key mediator of itch. Diphenhydramine (Benadryl) is a common example.
- Corticosteroids: Options include both topical and oral medicines. Topical creams are available as both over-the-counter and prescription-strength products. Creams have fewer side effects than taking an oral steroid, but sometimes an oral steroid is necessary. Hydrocortisone and prednisone are examples of corticosteroids.
- Other topical medicines: This category includes over-the-counter products, such as cooling gels and anesthetics, and prescription products, such as calcineurin inhibitors, including pimecrolimus (Elidel) or tacrolimus (Protopic).
- Antidepressants: This class of drugs can be helpful for some types of chronic itch. Examples include doxepin (Sinequan), fluoxetine (Prozac), and sertraline (Zoloft).
- Immunosuppressants: These drugs interfere with the immune system’s inflammatory response. Cyclosporine (Gengraf, Neoral, Sandimmune) is an example.
Light therapy and TENS (transcutaneous electrical nerve stimulation) may be an option for people with certain kinds of itching.
Home remedies for pruritus
In addition to over-the-counter remedies, there are several strategies for managing itch at home. This includes:
- Applying a daily moisturizer for sensitive skin after your bath or shower
- Avoiding scratchy clothes and fabrics, such as wool and synthetics
- Bathing or showering with warm water instead of hot water and using oatmeal-based bath products
- Humidifying the air in your home
- Placing cool compresses on the itchy skin
- Practicing stress reduction
- Using mild soaps, cleansers and detergents
- Wearing cotton clothes and using cotton fabric sheets and towels
Alternative treatments for pruritus
Acupuncture is a potential alternative treatment for pruritus. Research suggests it can decrease the sensation of itch. There is also support for the use of acupressure. One group of researchers found acupressure helped improve itch and overall skin condition in people with eczema—a common cause of itching. Whereas acupuncture uses fine needles in the skin, acupressure uses fingertips or small pellets to apply pressure to the skin surface.
What are the potential complications of pruritus?
Because pruritus can be due to serious diseases, failure to seek treatment can result in serious complications and permanent damage. Once the underlying cause is diagnosed, it is important for you to follow the treatment plan that you and your healthcare professional design specifically for you to reduce the risk of potential complications including:
- Adverse effects of treatment
- Secondary skin infections due to scratching
- Spread of cancer
- Spread of infection
- Lesions on breast