Pruritus is an irritating sensation which compels us to scratch or rub. Itching may vary from mild to intense, making life almost impossible.
Itching can be localized and light, but also occur throughout the body and cause much suffering and trouble. It can be so annoying and may lead to insomnia, depression, aggression, and even suicidal tendencies.
Causes of Pruritus
• Itching due to an internal cause
• Itching caused by a skin disease
• Itching due to insect bites or irritation of the skin.
Itching due to an internal cause
This type of itching is also called pruritus. It’s itching and scratching effects in the absence of specific dermatological disorders that could explain the itching. A body type that dry or acidic has more tendency to catch this disease.
Possible causes of this type of itch are:
• Response to chemicals found in soaps, and cleaning detergents.
• Parasites (such as lice, scab, and worms )
• Food allergy or intolerance
• Hemorrhoids / Fissure
• Chronic Renal Insufficiency
• Iron Deficiency (anemia),
• Liver diseases
• Pregnancy (as a result of cholestasis)
• Rheumatoid Arthritis
• Thyroid disease (hyperthyroidism and hypothyroidism)
• Eosinophilia / Hypereosinophilic syndrome
• Multiple Sclerosis
• System Diseases
Usually, it indicates generalized itching all over the body, sometimes especially on the arms and legs and back.
Itching as a result of a skin condition or infection
This form of itching known as pruritus. People with this skin problem may itch all over their bodies. Also, itching may occur especially in certain places like in the skin folds (wrists, elbows, knees) and hands especially in people with eczema. People with psoriasis often itch on their heads. Also, it is known that the edges itch of psoriasis.
Skin conditions and infections which may be accompanied by itching are to:
• Dry skin (eg aging skin asteatosis cutis.)
• Atopic dermatitis (eczema)
• contact dermatitis
• hives (urticaria)
• scabies, pediculosis, etc. epizoönosen
• lichen simplex chronicles
• lichen planus
• herpes simplex
• chickenpox (varicella)
• Pityrosporum Folliculitis
• Fungal infections (such candiasis, tinea, athlete’s foot)
• Crystalline and miliaria rubra
Itching through bites, stabbing, or skin contact
Different insects (mosquitoes, flea, tick, louse, horseflies, pubic lice, mange mite, hairy caterpillars, etc.) can cause via bites, stabbing or direct skin contact locally intense itching and inflammation phenomena. Also, some animals (eg. Jellyfish), plants (eg. Nettle) or irritants (eg. Wool, glass wool, chemicals) can cause itching.
Why it causes itching?
The mechanism of itching is not well known. Probably, specific “itch nerves stimulated in the skin. These nerves may be activated by certain proteins such as histamine, neuropeptides, and prostaglandins. These substances mainly are released during inflammation of the skin.
Factors that can worsen itch are hard water, soap, dry air, heat, perspiration, irritation by textile fibers or glass wool, and alcohol.
The treatment of itching depends on the cause. Initially should always be attempted to treat the underlying cause and cure or at least control it.
If it can not, or not enough, some hygiene measures can relieve itching and may possibly drugs are used.
1. Observe the daily skincare
• Shower (5 to 10 minutes).
• Use lukewarm water (up to 30 degrees Celsius).
• Use a soap substitute such as unscented bath oil.
• If necessary, add a little baking soda (bicarbonate) to your bath water.
• Dry your skin dabbing off.
• Take care of your skin with the prescribed ointment.
2. Measures temporarily relieve itching
• Using cream after showering or bathing.
• Cool the skin with lukewarm water, cold wraps, fan, cool loose clothing, by inflating the skin or to go outside. Also, in insects stabbing and other forms of direct skin irritation is usually effective to cool. The house means vinegar acts somewhat as a slight burning sensation in the bite wound can suppress the itch stimulus.
• Use ice packs (cold packs) occurs as itching in a small area. Put a towel or washcloth to the cold pack, put the cold pack never directly on the skin.
3. Avoid factors that aggravate itching
• Avoid heat by wearing cool clothes and not put overheat.
• Shower immediately after sweating and then take care of your skin.
• Avoid tight or raw, provocative clothes like wool, wear cotton. It is also important to wear moisture-permeable clothes, so no nylon.
• Moderate your alcohol.
• Ensure proper condition by adequate sleep.
• Wash your clothes after washing carefully so not to leave any soap residue.
• Dry air can aggravate itch, for example by air conditioning. Ensure good ventilation and hanging containers of water to the heater.
• Chemical solutions can aggravate itch, go carefully. Protect your skin and, if necessary, wear gloves and a mask.
4. To avoid frequent scratching
Scratching is a first knee-jerk response to itching and gives normally a few minutes of illumination. It also leads to skin damage and secretion of inflammatory mediators, thereby increasing the itching. Advanced scratching can exacerbate an underlying skin condition and cause a vicious circle.
• Provide clean, smooth and short fingernails.
• Put cotton gloves, even at night (these are available in pharmacies).
• Cover the skin with clothes or bandage. Crab not on bare skin.
For people with chronic skin diseases and severe itching are being experimented in the Netherlands with a so-called crab management program that was developed at the University of Utrecht. Patients than patients who only undergo regular treatment significantly less itching are treated according to the directive after three months. The directive ‘Coping with itch’ provides a special clinic where a nurse analyzes what the underlying causes of itching are. The patient support and get tips to modify his behavior.
The crab management program consists of four steps:
(1) write down how often and when you scratch;
(2) determining a specific purpose (eg. At a certain time not to scratch more, to scratch out a situation more or not to scratch more a part of your body).
(3) How do I achieve this goal: Find behaviors that you can not run simultaneously with the crabs (eg, grasping an earring, playing with money or marbles in your (pants) pocket ….)
(4) Practicing the chosen behavior.
Local anti-itch agents (Antipruritics)
• Creams or gels based on menthol
• Phenolic preparations (calamine lotion) are not recommended for large areas of damaged skin because of the risk of capture.
• The use of camphor.
• Capsaicin cream is effective but does often redness and irritation of the skin.
• Topical antihistamines such Azaron (diphenhydramine) are not recommended because of the risk of allergic reactions.
•Local anesthetics are not recommended for the same reason, but the use of lidocaine (EMLA, Xylocaine) or pramocaine (pramocaine 1% zinc and 10% hydrophobic cream) occur few problems. Local anesthetics are used primarily in localized itching as anal itching (pruritus ani) due to eg. Hemorrhoids.
• Social Ointments and bufexamac ointment or cream itch-damping properties.
• Topical corticosteroids usually have a good anti-itch effect but are less suitable for long-treat itching due to the risk of thinning of the skin. They are mainly used in severe itching due to chronic skin diseases.
• Immunomodulatory creams and ointments are sometimes prescribed for chronic skin diseases.
For dry skin, one can use petroleum jelly mixed with equal parts of lanette cream or paraffin liquidum) to use, and moisturizing creams.
Oral anti-itch agents
Antihistamines are effective in pruritus of allergic origin, such as urticaria and atopic dermatitis. They have the added advantage that they have a slightly hypnotic effect and thereby improve sleep quality that may be disturbed by itching. Treatment should be continued until the itching persists.
Also, in some forms of itching due to internal diseases (eg. Certain liver diseases) can help oral antihistamines.
Itching due to an internal disease eg. Renal insufficiency are sometimes specific treatments used against itching.
Note: A Skin Specialist must be consulted to find the exact skin disease and medication.