Itchy skin (pruritus)
Learn about causes of this common irritating skin condition and which treatments and self-care measures may provide relief.
Itchy skin is an uncomfortable, irritating sensation that makes you want to scratch. Also known as pruritus (proo-RIE-tus), itchy skin is often caused by dry skin. It's common in older adults, as skin tends to become drier with age.
Depending on the cause of your itchiness, your skin may appear normal, red, rough or bumpy. Repeated scratching can cause raised thick areas of skin that might bleed or become infected.
Many people find relief with self-care measures such as moisturizing daily, using gentle cleansers and bathing with lukewarm water. Long-term relief requires identifying and treating the cause of itchy skin. Common treatments are medicated creams, moist dressings and oral anti-itch medicines.
Itchy skin can affect small areas, such as the scalp, an arm or a leg, or the whole body. Itchy skin can occur without any other noticeable changes on the skin. Or it may be associated with:
- Scratch marks
- Bumps, spots or blisters
- Dry, cracked skin
- Leathery or scaly patches
Sometimes itchiness lasts a long time and can be intense. As you rub or scratch the area, it gets itchier. And the more it itches, the more you scratch. Breaking this itch-scratch cycle can be difficult.
When to see a doctor
See your doctor or a skin disease specialist (dermatologist) if the itching:
- Lasts more than two weeks and doesn't improve with self-care measures
- Is severe and distracts you from your daily routines or prevents you from sleeping
- Comes on suddenly and can't be easily explained
- Affects your whole body
- Is accompanied by other signs and symptoms, such as weight loss, fever or night sweats
If the condition persists for three months despite treatment, see a dermatologist to be evaluated for skin disease. It may also be necessary to see a doctor who specializes in internal medicine (internist) to be evaluated for other diseases.
Causes of itchy skin include:
- Skin conditions. Examples include dry skin (xerosis), eczema (dermatitis), psoriasis, scabies, parasites, burns, scars, insect bites and hives.
- Internal diseases. Itching on the whole body might be a symptom of an underlying illness, such as liver disease, kidney disease, anemia, diabetes, thyroid problems, multiple myeloma or lymphoma.
- Nerve disorders. Examples include multiple sclerosis, pinched nerves and shingles (herpes zoster).
- Psychiatric conditions. Examples include anxiety, obsessive-compulsive disorder and depression.
- Irritation and allergic reactions. Wool, chemicals, soaps and other substances can irritate the skin and cause rashes and itching. Sometimes the substance, such as poison ivy or cosmetics, causes an allergic reaction. Also, reactions to certain drugs, such as narcotic pain medications (opioids) can cause itchy skin.
Sometimes the cause of the itching can't be determined.
Itchy skin that is severe or lasts more than six weeks (chronic pruritus) can affect the quality of your life. It might interrupt your sleep or cause anxiety or depression. Prolonged itching and scratching can increase the intensity of the itch, possibly leading to skin injury, infection and scarring.
Tracking down the cause of your itch can take time and involve a physical exam and questions about your medical history. If your doctor thinks your itchy skin is the result of a medical condition, you might have tests, including:
- Blood test. A complete blood count can provide evidence of an internal condition causing your itch, such as anemia.
- Tests of thyroid, liver and kidney function. Liver or kidney disorders and thyroid abnormalities, such as hyperthyroidism, may cause itching.
- Chest X-rays. A chest X-ray can show if you have enlarged lymph nodes, which can go along with itchy skin.
Itchy skin treatment focuses on removing the cause of the itch. If home remedies don't ease the itchy skin, your doctor may recommend prescription medications or other treatments. Controlling itchy skin symptoms can be challenging and may require long-term therapy. Options include:
Corticosteroid creams and ointments. If your skin is itchy and red, your doctor may suggest applying a medicated cream or ointment to the affected areas. You might then cover the treated skin with damp cotton material. Moisture helps the skin absorb the medication and has a cooling effect.
If you have severe itching or a chronic condition, your doctor might recommend this bedtime routine: Bathe in plain lukewarm water for 20 minutes, and then apply triamcinolone .025% to 0.1% ointment to the wet skin. This traps the moisture and helps the medication absorb. Then put on a pair of old pajamas. Repeat this routine at bedtime for several nights.
- Other creams and ointments. Other treatments that you apply to your skin include calcineurin inhibitors, such as tacrolimus (Protopic) and pimecrolimus (Elidel). Or you may find some relief with topical anesthetics, capsaicin or doxepin.
- Oral medications. Antidepressants called selective serotonin reuptake inhibitors, such as fluoxetine (Prozac) and sertraline (Zoloft), and tricyclic antidepressants, such as doxepin, may be helpful in easing some types of chronic itch. You may not feel the full benefit of some of these drugs for 8 to 12 weeks after starting treatment.
- Light therapy (phototherapy). Phototherapy involves exposing your skin to a specific type of light. This can be a good option for people who can't take oral drugs. You'll likely need multiple phototherapy sessions, until the itching is under control.
For temporary relief of itching, try these self-care measures:
- Avoid items or situations that cause you to itch. Try to identify what's causing your symptoms and avoid it. This might be wool clothing, an overly heated room, too many hot baths or exposure to a cleaning product.
- Moisturize daily. Apply hypoallergenic and fragrance-free moisturizer (Cetaphil, others) to affected skin at least once a day. For dry skin, thicker creams and ointments work better than lotions.
- Treat the scalp. For a dry, itchy scalp, try over-the-counter medicated shampoos containing zinc pyrithione (Head & Shoulders, others), ketoconazole (Nizoral, others), selenium sulfide (Selsun Blue, others) or coal tar (Neutrogena T/Gel, others). You might need to try several products before finding one that works for your hair and condition. Or you may find that alternating between products helps. Don't use a medicated shampoo right after having a chemical relaxing process — rather, use a neutralizing shampoo.
- Reduce stress or anxiety. Stress or anxiety can worsen itching. Many people have found that techniques such as counseling, behavior modification therapy, acupuncture, meditation and yoga can help reduce stress or anxiety.
- Try over-the-counter oral allergy medicine. Some OTC allergy medicines (antihistamines), such as diphenhydramine, can make you drowsy. This type of pill might be helpful before bedtime if your itchy skin disrupts your sleep. Antihistamines do not help with the itch that follows a shingles infection.
- Use a humidifier. A humidifier may provide some relief if home heating causes the air in your home to be dry.
- Use creams, lotions or gels that soothe and cool the skin. Short-term use of nonprescription corticosteroid cream may temporarily relieve an itch accompanied by red, inflamed skin. Or try calamine lotion or creams with menthol (Sarna, others), camphor, capsaicin, or a topical anesthetic, such as pramoxine (adults only). Keeping these products in the refrigerator can enhance their soothing effect. Corticosteroid creams do not help with the itch that follows a shingles infection.
- Avoid scratching. Cover the itchy area if you can't keep from scratching it. Trim your nails and, if it helps, wear gloves when you sleep.
- Take a bath. Use lukewarm water and sprinkle in about a half cup (100 grams) of Epsom salts, baking soda or an oatmeal-based bath product (Aveeno, others). Use a mild cleanser (Dove, Olay, Cetaphil), limiting its use to the underarms and groin. Don't scrub too hard and limit your bathing time. Then rinse thoroughly, pat dry and moisturize.
- Stay well rested. Getting enough sleep might reduce the risk of itchy skin.
You're likely to start by seeing your family doctor or primary care doctor. In some cases, you may be referred to a specialist in skin diseases (dermatologist).
Here is information to help you get ready for your appointment and to know what to expect from your doctor.
What you can do
Write down your signs and symptoms, when they occurred, and how long they lasted. Also, make a list of all medications, including vitamins, herbs and over-the-counter drugs, you're taking. Or take the original bottles and a written list of the dosages and directions.
Write down questions to ask your doctor. For itchy skin, questions you may want to ask include:
- What is likely causing my symptoms?
- Are tests needed to confirm the diagnosis?
- What are other possible causes for my symptoms?
- Is my condition likely temporary or chronic?
- What is the best course of action?
- I have other health problems. How can I manage them together?
- What are the alternatives to the primary approach you're suggesting?
- Do I need prescription medication, or can I use over-the-counter medications to treat the condition?
- What results can I expect?
- Can I wait to see if the condition goes away without treatment?
Don't hesitate to ask any other questions you have.
What to expect from your doctor
Your doctor is likely to begin with your medical history and to ask you some questions, such as:
- When did you begin experiencing symptoms?
- What did your skin look like when your symptoms started?
- Have your symptoms changed?
- Is your itchiness interfering with your daily activities?
- What, if anything, appears to worsen your symptoms?
- What, if anything, appears to improve your symptoms?
- What at-home treatments have you tried?
- What prescription and over-the-counter medications are you taking?
- Have you traveled recently?
- Have you gone swimming or wading in a lake or pond recently?
- What is your typical diet?
- Are you in contact with possible irritants, such as pets or certain metals, at home or at work?
January 6th, 2021