Pruritus

What is pruritus?

Pruritus is the medical term for itchy skin. Itchiness that causes a constant urge to scratch can be caused by a variety of issues including skin conditions, allergic reactions, irritants and diseases that affect the nervous system. A clinician can help you identify the reasons why your skin is persistently itchy and find suitable treatments.

Itching can occur anywhere on the body, and is either:

• localised – where you get itchiness in a particular part of your body
• generalised – where you get itchiness all over your body^[1]

There are lots of different ways to treat itchy skin. Cold compresses, moisturising lotions, creams and ointments and antihistamines might all help, but how effective any medication is will depend on the cause of the itchiness.

Pruritus can sometimes be exposure-related. This can be from allergens such as the pollens that cause hay fever, or during periods of cold weather when some people experience ‘winter itch’ (medically known as pruritus hiemalis).

Who gets pruritus?

Anyone can develop itchy skin, and there are a number of reasons why it can occur. It’s not usually a sign of a serious condition (such as kidney or thyroid problems) but getting a thorough diagnosis from a healthcare professional can help determine what’s causing it.

It’s common to develop itchy skin after the menopause, and it often affects pregnant women. Itchy skin during these periods develops as a result of hormonal changes, and should get better over time.^[2]

Skin changes that cause pruritus can be age-related. Xerosis (extremely dry skin) affects over 50% of elderly people, and can cause itchiness as the skin loses its ability to repair itself and provide a barrier function.^[3]

How common is pruritus?

Itchiness is one of the most common symptoms of skin diseases, and a complaint that dermatologists hear often.^[4] It’s hard to say how common pruritus is, because so many different factors are involved in it.

The causes can be simple, such as dry or cracked skin that creates an urge to scratch, or there can be more complex pathophysiology (bodily changes that result from disease or injury) behind it.

What causes pruritus?

Itchy skin has multiple causes. Dermatological conditions such as eczema, folliculitis and psoriasis can all cause your skin to itch. Insect bites and stings can also lead to inflammation and soreness that can irritate your skin.

Scabies, an infestation caused by mites, can create intense itching at night. The mites lay eggs that live on the skin’s surface, and usually cause a raised rash with visible spots. It’s normally treated with a cream or lotion that you apply to your entire body.^[2]

Fungal infections, like vaginal thrush and athlete’s foot, can create localised itchiness in the infected areas. Occasionally, systemic conditions like an overactive thyroid gland or kidney problems can be behind itchy skin. If a clinician suspects anything like this is behind your pruritus, you might be advised to take some blood tests through your GP or be sent for a skin biopsy.

What are the symptoms of pruritus?

The main symptom of pruritus is an urge to scratch the areas of your skin that feel itchy. This can be small patches (localised) or cover larger areas of skin (generalised) all over your body.

The itchiness might develop with no other visible changes to your skin, or it could be caused by a condition that changes the appearance of affected areas. These changes might appear in the form of spots, bumps, or blisters. Patches of skin might become leathery or scaly, and can feel dry and sore. Some skin conditions, like folliculitis, cause your hair follicles to become raised and inflamed.

Your pruritus might become worse during flare-ups, such as with eczema. Constant rubbing and scratching of your skin to relieve persistent itching can often make the symptoms worse, causing scratch marks or leading to infection.

Can pruritus lead to other problems?

Pruritus might be a sign of a more serious condition, but this is rare.^[1]

If your pruritus is caused by a dermatological issue like eczema, your skin might become broken, especially if you’re constantly scratching it. This means bacteria can enter the cracks in your skin and cause an infection. Skin infections often need treating with antibiotics, which is a much stronger type of medication than topical creams that treat dryness and irritation.

Chronic itching is also associated with anxiety and stress. The cycle of constant scratching to soothe your itchiness followed by an exacerbation of symptoms can take its toll on your psychological health.^[3] Pruritus caused by injuries, such as burns, can have a similar effect. Getting the right treatment and receiving practical advice from clinical experts can help break the itch-scratch cycle, and improve both your symptoms and your mental wellbeing.