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Pruritus (itchy skin): The Symptoms, Causes and Treatments Explained

Pruritus Symptoms

Many people are affected by pruritus – the medical term for itch – at some point. In most cases the itching only lasts for a short time and isn’t usually a sign of anything more serious than dry or irritated skin.

But when itching lasts longer than two weeks or keeps coming back, you may need to see your GP. If it lasts for more than six weeks, it’s classed as chronic pruritus.

According to the British Association of Dermatologists (BAD), itching is a normal body response that protects you from harmful external substances or parasites such as insect bites.

But it can also be a symptom of many skin problems, illnesses and psychological disorders. BAD experts also suggest it may be the commonest presenting symptom of skin disorders, with significant pruritus affecting around 8 - 9 per cent of the population. It’s thought to be more common in women than men, as well as people of Asian origin. The risk of pruritus also increases with age.

The itch itself – which may be localised in one area or found all over the body – is unpleasant and uncomfortable. But if you have chronic pruritus it can also be frustrating, and severe cases can lead to sleep problems, anxiety and depression.

Itching also makes you scratch, and constant scratching can damage your skin. If you scratch persistently for a long time, it can cause more than just scratch marks, with rough, thickened skin (lichen simplex), bruising and other skin lesions called papules and nodules often appearing.


Itch and the nervous system

Pruritus may be caused by a variety of conditions (see below) but in many cases there is no obvious cause. What we do know, however, is that it can originate anywhere from the central nervous system to the peripheral nervous system and the skin.

The itch signal is transmitted through special fibres and neurons and arrives in parts of the brain involved in sensation, emotion, reward and memory. Meanwhile, if you have chronic pruritus, you may have a heightened reaction to things that normally relieve itching – such as heat and scratching – while even things that shouldn’t cause itching, such as a light touch, can trigger the itch sensation. 

See your GP if you have itchy skin and it’s affecting your day-to-day living, if it’s caused by a new rash, lump or swelling, if it’s all over your body instead of just one specific area or if you’re worried for any reason.
 

What causes it?

Itching can be caused by many different things, including skin and other medical conditions:


Skin conditions

One of the most common things that can cause pruritus is dry skin. However, there are many more skin conditions that can make you itch, including:


Itching can also be the result of an allergic reaction to things like cosmetics, latex, nickel, dyes and resins in textiles, certain plants (sunflowers, daffodils, tulips and chrysanthemums are among those that can trigger allergies), foods and some types of medicines.

It can also be a symptom of a viral infection such as chickenpox, shingles, or rubella, or a yeast infection such as thrush, which can cause itching in and around the genitals.


Itch inducing illnesses

Pruritus can also sometimes be a sign of an underlying condition, including:


In women itching can also be caused by hormonal changes during pregnancy and after the menopause.
 

How is pruritus treated?

If your itch is caused by an underlying condition, treating that condition can sometimes also stop the itch. Similarly, if you’re taking a medicine that causes itching, when you stop taking it your itch should improve (however, never stop taking a medicine your doctor has advised you to take without discussing it with them first).

Meanwhile, if you have pruritus because your skin is dry, treating the dryness can bring relief from itching – though in most cases treatment needs to be ongoing (if you stop, your skin can become dry again and the itch can come back). A common treatment for dry skin is to use emollient creams, lotions and ointments.

Besides all of these things there are treatments you can apply to your skin that may help too, including:

  • Calamine lotion (this contains a substance called phenol that cools the skin)

  • Over-the-counter anti-itch creams (these contain ingredients such as crotamiton)

  • Lotions containing menthol or camphor

  • Creams containing local anaesthetic (though these are only suitable for small areas of skin – insect bites, for instance)

  • Mild steroid creams (for short-term use only)


Some medicines are also used to treat severe itching. These may help relieve the itch itself or they may have a mild sedating action:

  • Antihistamine tablets may be useful if you have itchy skin caused by urticaria or an insect bite or sting. Certain types of antihistamines also make you drowsy, which can be useful if itching is stopping you getting a good night’s sleep

  • Some tricyclic antidepressants act on the central and peripheral nervous systems and may help relieve itching at night if taken before bedtime

  • Epilepsy medicines may be useful if you have itch associated with chronic kidney disease


Meanwhile, there are other therapies that have been proven helpful for itching in some circumstances. Phototherapy (ultraviolet light therapy), for instance, may be useful for itching associated with psoriasis, eczema and chronic kidney disease. Relaxation therapies may also help some people with pruritus, while cognitive behavioural therapy (CBT) can help some people break the itch-scratch cycle (this describes the process whereby you scratch more because you itch, and itch more because you scratch).
 

Self-care for pruritus

As well as having treatment for any underlying cause of itching there are several things you can do to make your skin less irritated, which can help reduce the damage you can cause by scratching.


Keep your skin cool

Cooling your skin can help make it feel less itchy while overheated skin can make itching worse. Try having baths or showers in cool or lukewarm water rather than hot water and don’t stay in or under the water for too long (20 minutes at the most). You could also try holding a cold compress – a damp flannel, for instance – against the affected area or keeping moisturiser in the fridge so it’s cool when you use it (use an emollient cream or lotion for best results, as they help ease itching and soften dry, cracked areas of skin).

Also, try to keep your bedroom as cool as possible at night, and use cool, lightweight, loose bedclothes rather than anything heavy that could trap a lot of heat. Using a fan to cool yourself down during the day or at night may also be useful.


Limit scratching

It’s natural to want to scratch an itch, but in the long term this can cause a lot of skin damage. So, try to dab or pat the affected area instead of scratching it. Keeping your nails short and well-kept may also help reduce any damage scratching may cause. If you find you tend to scratch your skin in your sleep, try wearing cotton gloves in bed.


Avoid irritants

Soaps, bubble baths, shower gels, deodorants and any perfumed skincare products may contain detergents that may irritate your skin. Instead, use unperfumed products that are labelled hypoallergenic, as these are kinder to your skin and don’t strip it of its natural oils.

Also, avoid clothes that irritate your skin, including those made from wool and some man-made fabrics – cotton and silk are the kindest to your skin, so wear clothes made from them whenever possible. Try not to wear anything too tight, as this too can irritate, and use a mild non-bio washing powder.


Eat smart

It’s also a good idea to avoid spicy foods, as well as alcohol and caffeine. All of these things can affect blood flow in your skin and can make itching worse.

Practice relaxation

Stress can make itching worse in some people, so anything you can do to feel calmer whenever you’re under pressure may help bring some relief.
 

Natural support for pruritus

There are a few natural nutritional supplements that may be useful if you’re affected by pruritus, including the following:


Turmeric 

Some of the conditions that cause pruritus are inflammatory skin conditions, including psoriasis and eczema. Turmeric is a curry spice that contains a substance called curcumin, which is widely thought to have anti-inflammatory properties. indeed, there is some evidence turmeric works by blocking substances that play a role in inflammation (i).

Meanwhile many people with chronic kidney disease and those having dialysis treatment experience intense itching called uremic pruritus. Again, turmeric may be helpful as it has been found to reduce itching in end-stage renal disease patients (ii).


Zinc

Some natural health practitioners recommend zinc supplements to prevent or treat dry, itchy skin. Like turmeric, it may also be useful to help reduce persistent pruritus in people with kidney disease who are having dialysis treatment (iii).


Fish oils

Fish oil supplements may be useful too, as many nutritional experts believe the omega-3 fatty acids found in oily fish help relieve itching as well as skin inflammation and dryness. According to one small-scale study, taking fish oil capsules may significantly reduce itching and scaling in psoriasis (iv), while other researchers suggest that one of the main omega-3 fatty acids found in fish oil – namely DHA (docosahexaenoic acid) – may have a beneficial impact on the outcome of atopic eczema (v).

Another study has found omega-3 fatty acids may help reduce uremic pruritus in people with end-stage renal disease (vi).


Anthocyanidins

Avoiding strong sunshine is one way to protect yourself against itching caused by sunburn. However, people can’t avoid the sun altogether. So, protecting your skin with a good-quality sunscreen is a must. Plant substances called anthocyanidins – found in dark and richly coloured fruit such as blueberries, blackberries, raspberries and red grapes – may provide extra protection by helping the skin cope with exposure to the sun’s UV rays.

 



References:

 

  1. Safety and anti-inflammatory activity of curcumin: a component of tumeric (Curcuma longa). J Altern Complement Med. ;9(1):161-8.

  2. , , , Effects of turmeric on uremic pruritus in end stage renal disease patients: a double-blind randomized clinical trial. J Nephrol. ;7(2):203-7.. Available online: https://www.ncbi.nlm.nih.gov/pubmed/24482090

  3. , , Beneficial effect of zinc supplementation on pruritus in hemodialysis patients with special reference to changes in serum histamine levels. J Hinyokika Kiyo. ;33(12):1955-60. Available online: https://www.ncbi.nlm.nih.gov/pubmed/3448919

  4. , , et al. A double-blind, randomised, placebo-controlled trial of fish oil in psoriasis. Lancet. Available online: https://www.ncbi.nlm.nih.gov/pubmed/2893189

  5. , , et al. Docosahexaenoic acid (DHA) supplementation in atopic eczema: a randomized, double-blind, controlled trial. Br J Dermatol. ;158(4):786-92. Available online: https://www.ncbi.nlm.nih.gov/pubmed/182412601

  6. , et al. Efficacy of omega-3 fatty acids supplementation in treatment of uremic pruritus in hemodialysis patients: a double-blind randomized controlled trial. Iran Red Crescent Med J. ;14(9): 515–522. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3482323