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Chronic Itch – Causes and Treatment

Chronic itch (pruritus) is a persistent itching sensation lasting more than 6 weeks. It can have many causes and significantly reduce quality of life.

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Things worth knowing about "Chronic Itch"

Chronic itch (pruritus) is a persistent itching sensation lasting more than 6 weeks. It can have many causes and significantly reduce quality of life.

What Is Chronic Itch?

Chronic itch, medically known as chronic pruritus, is an itching sensation that persists for more than six weeks. It is not a disease in itself but a symptom that can be triggered by a wide variety of underlying conditions or external factors. The impact on daily life is often substantial: affected individuals frequently experience poor sleep, compulsive scratching, and psychological distress such as anxiety or depression.

Causes

Chronic itch can be triggered by many different factors. It is generally classified into skin-related, systemic, neurological, and psychiatric causes.

Skin Conditions

Atopic dermatitis (eczema)
Psoriasis
Contact dermatitis and allergic reactions
Dry skin (xerosis cutis), especially in older adults
Urticaria (hives)

Systemic Diseases

Liver and bile duct disorders (e.g., cholestatic pruritus)
Chronic kidney disease (uremic pruritus)
Thyroid disorders
Diabetes mellitus
Blood disorders such as polycythemia vera
Certain cancers (e.g., lymphomas)

Neurological and Psychiatric Causes

Nervous system disorders (e.g., multiple sclerosis, neuropathies)
Psychological stress, anxiety, depression
Somatoform disorders

Medications

Certain antihypertensives (ACE inhibitors)
Opioids
Antibiotics and other drugs can also trigger itching

Symptoms

The main symptom is a persistent, distressing itch that can affect specific areas of the body or the entire body surface. Common accompanying symptoms include:

Skin redness and scratch marks from repeated scratching
Sleep disturbances and fatigue
Skin thickening and hardening (lichenification)
Psychological burden, irritability, and difficulty concentrating
Secondary wounds or infections caused by scratching

Diagnosis

Diagnosing chronic itch requires a thorough medical history and physical examination. Because itching has many possible causes, several diagnostic steps are often needed:

Blood tests (liver, kidney, thyroid function, and blood count)
Skin biopsy if a skin condition is suspected
Allergy testing (prick test, patch test)
Imaging studies (ultrasound, X-ray) to rule out internal diseases
Neurological examinations if neuropathic pruritus is suspected

Treatment

Treatment is primarily directed at the underlying cause. In addition, symptomatic measures are used to relieve the itch itself.

General Measures

Consistent skin care with emollient and moisturizing creams
Avoiding triggers (e.g., certain soaps, fabrics, allergens)
Cool ambient temperatures and loose-fitting clothing

Medical Treatment

Antihistamines: Help relieve allergy-related itching
Corticosteroids: Applied topically or taken systemically for inflammatory skin conditions
Calcineurin inhibitors (e.g., tacrolimus): For atopic dermatitis and other inflammatory conditions
Biologics (e.g., dupilumab): For severe atopic eczema
Naloxone/naltrexone: For certain forms of cholestatic pruritus
Gabapentin/pregabalin: For neuropathic pruritus
Antidepressants: For psychogenic or treatment-resistant pruritus

Physical and Psychological Therapy

UV light therapy (phototherapy) for certain skin disorders
Cognitive behavioral therapy and relaxation techniques for psychologically influenced itch

References

Ständer S. et al. - Chronic Pruritus: Guideline of the German Dermatological Society (DDG), AWMF Register No. 013-048, 2022.
Weisshaar E. et al. - European Guideline on Chronic Pruritus, Acta Dermato-Venereologica, 2012.
Twycross R. et al. - Itch: Scratching More Than the Surface, QJM: An International Journal of Medicine, 2003.

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