Pruritus

Pruritus General Information

In this section we intend to offer you the information we consider necessary for you to learn how to deal with this type of medical condition. Pruritus, more commonly known as itching is considered a symptom of other medical disorders, of systemic diseases or of primary skin diseases. Because it is very prominent and disturbing, it was known by the physicians from the Old Age, for example Hippocrates. It is described as a common unpleasant sensation that is always accompanied by scratching. This medical disorder can be caused by internal disorders or by certain cutaneous diseases. So, in order to treat it effectively, health care providers must be very careful when they decide upon the diagnosis. The most common skin diseases that lead to the appearance of Pruritus include: insect bites, miliaria, urticaria, dermatitis herpetiformis, scabies, lichen planus, pediculosis or atopic and contact dermatitis.

This type of annoying condition is meditated by substance P, proteases, histamine and prostaglandins. If this symptom appears and no skin lesions can be identified, then drugs, dry skin (especially in older adults) and systemic diseases must be considered. Some examples of systemic diseases that cause itching are: uremia, hematological malignancies, cholestatic diseases and polycythemia vera. The most common drugs that may lead to unpleasant sensations of itching may be cocaine, barbiturates, morphine (Ms Contin, Duramorph or Ruxanol) and salicylates. Other more special conditions, less well-defined causes of itching, are represented by last months of pregnancy, diabetes, different types of internal cancers, iron deficiency or hyper/hypothyroidism. Pruritus is very rarely caused by psychological factors.

Pruritus Symptoms

Although Pruritus is not seen as a medical condition, but more as a symptom, we will try to make a list of the signs provoked by this disorder. You must have in mind that the list may not be complete and further information can be obtained from a trained specialist in this type of health problems. A problem of this kind affects both sexes and patients of all ages; it has no preference in certain races or ethnic groups. The majority of signs and symptoms caused by Pruritus are experienced by the majority of patients although some cases of unique and particular manifestations were reported. All the signs and symptoms of this complicated medical disorder vary in intensity and range from mild, to moderate and extremely severe. The most worrying signs are loss of weight, distress, increased irritability and insensibility, disturbances, discomfort, stress and problems in the daily activities.

Because of its special neural mechanisms, this medical disorder is usually experienced only on the surface of the skin and permits a precise localization. The main signs of this disorder are an unpleasant sensation and urgent need to scratch. Because it has similarities with other medical conditions, Pruritus must be carefully distinguished from certain sensations such as burning, pain, touch and tickling. This particular sensation is a subjective one, although it can sometimes be accompanied by crusts, increased skin creasing, excoriations, lichenification with thickening, burnished nails or hyperpigmentation. Itching may sometimes cause pyodermatization. The sensations may last or may be gone after several minutes.

Pruritus Treatment

Pruritus can be really annoying and can affect the patient’s quality of life very easily. An adequate treatment received in time can get the patient rid of this medical disorder. Although it is not a serious medical condition, treatment is needed anyway in order to relieve the symptoms. This is why it is better for you to visit a health care provider as soon as you start experiencing any of the specific signs and symptoms of itching. When seeing a doctor, you will be asked about your symptoms, your family and personal medical history and then the doctor will perform a physical exam that will focus on identifying the exact underlying cause of this skin condition. Lesions on the surface of the skin, for example fissures, papules, hyperpigmentation, redness excorination or lichenification may interfere in the process of identification and may be a result of intense and persistent scratching. In the case of Pruritus with lesions, a biopsy may be helpful.

Other tests, such as CBC (complete blood count), measuring renal, thyroid or liver function are appropriate evaluations that will reveal the systemic disease or the underlying malignancy. As you see, testing is very important when you deal with a skin disorder as this one that puts so many problems in the process of diagnosing. After the results of these tests are ready and if they indicate Pruritus, then the health care provider will proceed with the adequate treatment. Usually, the agents used to cure this disorder are called antipruritics or anti-itch drugs that reduce itching caused by sunburn, eczema, chickenpox, fungal infections, allergic reactions, urticaria, psoriasis or contact dermatitis. Topical antipruritics appear in the form of sprays or creams and are available over-the-counter. The most common classes of antipruritics are: local anesthetics, Antihistamines, Calamine lotion, counterirritants (menthol, camphor or mint oil) and corticosteroids.  The health care provider must treat first the underlying cause and then the lesions, if they exist. Systemic, topical or/and physical agents represent a supportive treatment for the skin care. Also, it is very important to use lukewarm or cool water (not very hot) when bathing, as well as limitations of bathing control, frequency and use of soap.

The patient is advised too use emollients, for example white petrolatum and other similar products based on oils. Tight clothes and irritating materials must be definitely avoided. For treating Pruritus, pharmacists will recommend menthol or camphor creams and lotions that contain 0.2 to 0.3 % menthol, 0.5 to 3% phenol, corticosteroids and certain medication treatments based on Pramoxine, EMLA (eutectic mixture of local anesthetics), Tronolane Cream, Chloraseptic Gargle, Cepastat, Ulcerease, or Tucks Hemorrhoidal. There are certain drugs that must be avoided because they increase the skin sensitivity: topical diphenhydramine (prescribed as Nytol or Benadryl) or Doxepin (prescribed as Zonalon and Sinequan). Very effective and very commonly used are the Antihistamines, especially Hydroxyzines (Vistaril or Atarax). If the Pruritus is resistant to topical agents, systemic agents are indicated. The physical agents considered to give positive results are UV (ultraviolet) phototherapy, acupuncture or TENS (transcutaneous electrical nerve stimulation).