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Pruritus (Itching): Causes, Symptoms & Treatment

Pruritus is the medical term for itching. It can affect the entire body or occur locally and may have many different underlying causes.

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Things worth knowing about "Pruritus"

Pruritus is the medical term for itching. It can affect the entire body or occur locally and may have many different underlying causes.

What is Pruritus?

Pruritus is the medical term for itching -- an unpleasant skin sensation that creates a strong urge to scratch. It can be acute (short-term) or chronic (lasting more than six weeks) and is one of the most common symptoms in dermatology. Pruritus may be localized (affecting a specific area) or generalized (affecting the whole body).

Causes

Pruritus can be triggered by a wide range of conditions. Physicians classify the causes into several categories:

Dermatological Causes (Skin Disorders)

Atopic dermatitis (eczema): a chronic inflammatory skin condition with intense itching
Psoriasis: an inflammatory skin disease causing scaly patches
Contact dermatitis: a reaction to allergens or irritants
Urticaria (hives): raised welts accompanied by intense itching
Dry skin (xerosis cutis), particularly common in older adults

Systemic Causes (Internal Diseases)

Liver and bile duct diseases (e.g., cholestasis)
Chronic kidney disease (renal failure)
Thyroid disorders (hyper- or hypothyroidism)
Diabetes mellitus
Blood disorders such as polycythaemia vera or lymphoma
Iron deficiency

Neurological and Psychiatric Causes

Neuropathic pruritus (e.g., associated with nerve pain or herpes zoster)
Psychogenic pruritus related to stress, anxiety, or depression

Medication-Induced Causes

Certain medications such as opioids, ACE inhibitors, or antibiotics can cause itching as a side effect.

Symptoms

The primary symptom is the itch sensation itself. Additional complaints may include:

Redness and skin irritation from scratching
Sleep disturbances due to nocturnal itching
Visible scratch marks, wounds, or scaling
Secondary skin infections from broken skin
Psychological burden, irritability, and difficulty concentrating in chronic cases

Diagnosis

Diagnosing pruritus and its underlying cause requires a thorough medical evaluation, typically involving:

Medical history: Questions about the onset, duration, intensity, and triggers of itching, as well as existing conditions and medications
Physical examination: Inspection of the skin for visible changes
Laboratory tests: Blood count, liver, kidney, and thyroid function tests, blood glucose levels
Allergy testing: If an allergic cause is suspected
Skin biopsy: Tissue sampling for microscopic analysis in cases of unclear skin changes
Imaging: Such as ultrasound or CT scan if an internal disease is suspected

Treatment

Treatment is primarily directed at the underlying cause. In addition, symptomatic therapies are available to relieve the itch:

General Measures

Intensive skin care with moisturizing lotions and creams
Avoidance of triggers (allergens, irritants, hot water)
Cooling compresses for short-term relief
Keeping fingernails short to minimize scratch damage

Medications

Antihistamines: Block histamine, a chemical mediator that can trigger itching
Corticosteroids: Anti-inflammatory creams or tablets for inflammatory causes
Calcineurin inhibitors (e.g., tacrolimus): Suppress the immune response in the skin
Biologics: Modern targeted therapies for severe atopic dermatitis or psoriasis
Antidepressants or anticonvulsants: Used for neuropathic or psychogenic pruritus
Cholestyramine: For cholestatic pruritus caused by liver disease

Physical Therapies

UV light therapy (phototherapy) for certain skin conditions
Acupuncture as a complementary treatment option

When to See a Doctor?

The following situations require medical evaluation:

Itching that persists for more than two weeks
Generalized itching without an identifiable cause
Itching accompanied by symptoms such as jaundice, weight loss, night sweats, or fever
Significant impairment of sleep or quality of life

References

Ständer S. et al. - Guidelines on Chronic Pruritus, AWMF Guideline No. 013-048, German Dermatological Society (2022).
Weisshaar E. et al. - European guideline on chronic pruritus, Acta Dermato-Venereologica (2019).
Twycross R. et al. - Itch: scratching more than the surface, QJM: An International Journal of Medicine (2003).

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