Links to other pages within Patient UK which are related to this topic:
Experience | Leaflets | News | Products | Other
Print options:   Other options:   Bookmark and Share

This is a PatientPlus article. PatientPlus articles are written for doctors and so the language can be technical. However, some people find that they add depth to the articles found in the other sections of this website which are written for non-medical people.

Synonym: pruritus

Pruritus is defined as the desire to scratch. Itch can either be peripheral, due to stimuli occurring in the skin, or central, when itching is perceived as occurring in the skin although it originates in the central nervous system.1 Itching may be associated with skin disease or have a systemic cause.2

Presentation
  • Will depend on the underlying cause.
  • Although itching is common and vast majority of cases have an obvious and benign cause, it is essential to consider possible less common but serious causes.3 Examination should therefore include careful assessment of the abdomen and lymph nodes.
  • Examination of the skin in the itchy patient can help to elucidate the aetiology of the itch. A thorough examination may reveal lesions that the patient has not altered by scratching and therefore help in the diagnosis.
Differential diagnosis

Skin causes

Systemic causes

Investigations

Any suspicion of systemic cause, lack of obvious cause for itching or any patient with pruritus that does not respond to conservative therapy should be evaluated for underlying systemic disease.

Management
  • The treatment of pruritus is aimed at identifying and treating the underlying cause as well as symptomatic treatment for the itch.
  • Symptomatic treatment is primarily aimed at keeping the skin moist and cool.

Non-drug

  • Advise the patient to avoid scratching the skin and keep their finger nails short. Wearing gloves at night and tapping the skin or drumming the fingers on the skin rather than scratching may be helpful.
  • Cooling: simple measures to create a cooler environment, such as wearing light clothing and keeping cool in bed, may help. Avoid use of vasodilators (caffeine, alcohol, spices, hot water) and excessive sweating.
  • Vibration: in localised pruritus the use of transcutaneous electrical nerve stimulation (TENS) may help in the short term.
  • Acupuncture: may be of benefit in localised pruritus.
  • Phototherapy: particularly UVB and topical PUVA, has been shown to be of benefit in uraemic pruritus and urticaria pigmentosa.

Drug

  • Simple emollients may be effective when itching is associated with dry skin or in otherwise healthy elderly people.
  • Preparations containing crotamiton are sometimes used but are of uncertain value.5
  • Oral colestyramine is the treatment of choice for pruritus due to biliary obstruction but its effect may be temporary and it is only effective if biliary obstruction is incomplete.6
  • Topical antihistamines and local anaesthetics are only marginally effective and may occasionally cause sensitisation.
  • Oral antihistamines may be effective, but mainly in urticaria and insect bites. They are ineffective in most dermatoses and systemic causes. Sedating antihistamines may be useful for night time use.
  • Other drug treatments for itch include rifampicin, colestyramine and 17-alpha alkyl androgens (cholestasis), thalidomide (uraemia), cimetidine and corticosteroids (Hodgkin's lymphoma), paroxetine (paraneoplastic itch), aspirin and paroxetine (polycythaemia vera) and indomethacin (some HIV positive patients).7
  • If these specific remedies fail, paroxetine and mirtazapine can be effective.
  • Ultraviolet B therapy may be more effective than drug treatment for itch in uraemia.
Complications
  • Itch is a distressing, subjective symptom that may interfere significantly with the quality of a patient's life.

Document references
  1. Greaves MW, Khalifa N; Itch: more than skin deep. Int Arch Allergy Immunol. 2004 Oct;135(2):166-72. Epub 2004 Sep 16. [abstract]
  2. Moses S; Pruritus. American Family Physician. 2003; September 15.
  3. Hiramanek N; Itch: a symptom of occult disease. Aust Fam Physician. 2004 Jul;33(7):495-9. [abstract]
  4. Bosonnet L; Pruritis: scratching the surface.; Eur J Cancer Care (Engl). 2003 Jun;12(2):162-5. [abstract]
  5. British National Formulary
  6. Bergasa NV; Treatment of the Pruritus of Cholestasis. Curr Treat Options Gastroenterol. 2004 Dec;7(6):501-508. [abstract]
  7. Twycross R, Greaves MW, Handwerker H, et al; Itch: scratching more than the surface. QJM. 2003 Jan;96(1):7-26. [abstract]
Acknowledgements EMIS is grateful to Dr Colin Tidy for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2009.
Document ID: 2345
Document Version: 21
Document Reference: bgp94
Last Updated: 4 Apr 2009
Planned Review: 4 Apr 2011

The authors and editors of this article are employed to create accurate and up to date content reflecting reliable research evidence, guidance and best clinical practice. They are free from any commercial conflicts of interest. Find out more about updating.

Patient UK Hearing Impairment Survey

Patient UK are grateful to the 550 people who took part in this survey.
To see the results click here.
If you'd like to leave your feedback, please go to our interactive forum.

Links to other pages within Patient UK which are related to this topic:
Experience | Leaflets | News | Products | Other
Print options:   Other options:   Bookmark and Share
Want to search some more? Use the Google Search box below to search our site.

Related pages in Patient UK

Your Experience (^ top of page)

 Please add your experience about this condition / medicine
 View Patient Experience for 'Itching' (12 there)
 Itch

Recent related news items

 Why trying to quit smoking can be an itchy problem
 Scientists find an itchiness cell
 Spring water could 'help treat eczema when applied directly to the skin'

All news by related topic

 Itching news

Online Pharmacy

 Allercalm Tablets 28 Pack
 Allergy and Hayfever Relief Loratadine 30 Days
 Aveeno Baby Colloidal
 Aveeno Bodywash Intensive Therapy
 Aveeno Colloidal Bath Powder
 Aveeno Daily Moisturizing Body Lotion
 Aveeno Skin Relief Moisturising Lotion Menthol
 Balneum Plus Cream 100g
 Balneum Plus Cream 500g
 Benadryl Skin Allergy Relief Cream
 Clarityn Allergy Syrup
 Clarityn Allergy Tablets
 Dead Sea Spa Magik - Conditioning Scalp Mud
 Dermacool Extra Strength Cream
 Dermol Cream 100g
 Dermol Cream 500g
 Doublebase Emollient Shower Gel
 Doublebase Hydrating Gel Tube
 Magicool Plus Itchy Skin
 Magicool Plus Prickly Heat
 Oilatum Scalp Treatment Shampoo 150ml
 Oilatum Shower Gel Fragrance Free
 Witch Doctor Skin Treatment Gel

Medical equipment


Visit the Patient UK Medical Equipment shop

Books


Visit the Patient UK shop

Other - Useful resources (^ top of page)

Pictures, diagrams, photos, images, etc.
Evidence based medicine
Online textbooks and journals
UK Guidelines
Online Videos
Medline
Other good health sites

Want to search some more? Use the Google Search box below to search our site.

Advertisements











Disclaimer: Patient UK has no control over the content of any external links above. Inclusion does not imply endorsement by Patient UK.

Want to advertise on this site? Find out how >>

Clicking here will take you to the foot of this page where you'll find a list of Information Leaflets which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of Support Groups which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of Medicines & Drugs which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of diagrams which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of PatientPlus (detailed reference) articles which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of UK Guidelines which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of other selected websites which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of Poems and Stories which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of Operations and Procedures which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of Online Videos which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find links through to our interactive forum.
Here you can follow a link to view existing patient experiences on this subject, or to add your own
Clicking here will take you to the foot of this page where you'll find links to news stories on this subject in our Online Newspaper
Clicking here will take you to the foot of this page where you'll find links to related products
Clicking here will take you to the foot of this page where you'll find links to other useful sources of information
Click here to open a printer-friendly version of this document, in a new window, together with the print dialogue box
Click here to open this document in PDF format
This will offer you the usual PDF options i.e. document navigation, search, zoom and formatted print
Note: this is the best way to print the document
Click here to listen to the MP3 audio recording of this document
Click here to download the audio recording of this document as a podcast, for listening to at your leisure
Click here to open our Dictionaries and Glossaries page
Click here to see related products in our Online Pharmacy
Note: this will open in a new window
Click here to add this page to a social bookmarking site of your choice
Click here if you want to find out more about social bookmarking. This link will take you to the Wikipedia explanation
Note: this will open in a new window
Clicking here will take you to the foot of this page where you'll find a list of Information Leaflets which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of Support Groups which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of Medicines & Drugs which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of diagrams which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of PatientPlus (detailed reference) articles which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of UK Guidelines which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of other selected websites which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of Poems and Stories which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of Operations and Procedures which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find a list of Online Videos which are related to the topic you are currently viewing
Clicking here will take you to the foot of this page where you'll find links through to our interactive forum.
Here you can follow a link to view existing patient experiences on this subject, or to add your own
Clicking here will take you to the foot of this page where you'll find links to news stories on this subject in our Online Newspaper
Clicking here will take you to the foot of this page where you'll find links to related products
Clicking here will take you to the foot of this page where you'll find links to other useful sources of information
Click here to open a printer-friendly version of this document, in a new window, together with the print dialogue box
Click here to open this document in PDF format
This will offer you the usual PDF options i.e. document navigation, search, zoom and formatted print
Note: this is the best way to print the document
Click here to listen to the MP3 audio recording of this document
Click here to download the audio recording of this document as a podcast, for listening to at your leisure
Click here to open our Dictionaries and Glossaries page
Click here to see related products in our Online Pharmacy
Note: this will open in a new window
Click here to add this page to a social bookmarking site of your choice
Click here if you want to find out more about social bookmarking. This link will take you to the Wikipedia explanation
Note: this will open in a new window
Click here to return to the home page
Click here to read our 'About Us' page
Go to the Emis Access website, where you can book an appointment with your GP, order a repeat prescription or view you medical record online.
Note: this will open in a new window
View and/or join in discussion about health, lifestyle and disease in our interactive forum.
Note: this will open in a new window
Visit our pharmacy product price comparison website
Go to our online newspaper for current medical news and commentary.
Note: this will open in a new window
Adverts on this site do not influence the medical content. Click to read more.
Adverts on this site do not influence the medical content. Click to read more.