Pruritus is the medical term for itching that causes the urge to scratch. Pruritus is generally not a serious condition, but it can be uncomfortable and lead to sores and infection.
Pruritus is a symptom on the skin due to a certain disease or condition. Although it occurs on the skin, pruritus is not only caused by skin diseases, but can also be caused by problems in other organs or organ systems.
Although it can affect all age groups, pruritus is more common in the elderly. This is because the skin tends to get drier with age.
Causes of Pruritus
Pruritus is not a disease, but a symptom of another disease or condition. Pruritus occurs when the nerves that transmit itching signals in the skin are stimulated and send these signals to the brain.
There are various conditions that can stimulate itching. Even so, sometimes the cause of pruritus is difficult to know.
Based on the affected body part, pruritus can be divided into two types, namely:
Local pruritus
Local pruritus is itching that occurs in certain parts of the body only. This type of pruritus generally occurs due to irritation or inflammation in the skin area. In addition to itching, pruritus will usually cause a skin rash.
The following is a further explanation of the causes of localized pruritus:
1. Pruritus due to skin conditions
Localized pruritus generally occurs as a result of a disease or disorder in the skin. Some skin diseases that can cause pruritus, namely:
- Dry skin (xerosis)
- Dandruff
- Urticaria (hives)
- psoriasis
- Atopic dermatitis (eczema)
- Dermatitis herpetiformis
- Seborrheic dermatitis
- Lichen planus
- Bullous pemphigoid
- Miliaria (prickly heat)
- Pityriasis rosea
2. Pruritus due to infection
Skin infections can also cause localized pruritus. There are several causes of skin infections, namely:
- Viral infections, such as herpes zoster
- Parasitic infections, such as scabies, lice, and cutaneous larva migrans
- Fungal infections, such as water fleas, candidiasis, and ringworm
- Bacterial infections, such as folliculitis and impetigo
3. Pruritus due to allergies or irritation
Localized pruritus may result from allergies or skin irritation. Some things that can cause allergies or skin irritation are:
- Bath soap containing harsh chemicals, such as fragrances and detergents
- Cosmetic ingredients, such as perfume, hair dye, and nail polish
- Metal on jewelry
- Clothing materials, such as woolen cloth
- Use of topical medication
4. Pruritus due to certain exposures
Local pruritus can also occur due to exposure to the surrounding environment, including:
- Direct sunlight
- Dry air
- cold air
- Scratches (causing dermatographia)
- Insect bites
Localized pruritus can also occur in the absence of visible skin problems. This condition is usually caused by a disruption in the nerves that transmit itching signals in the area or along the way these nerves travel to the spine. Examples of conditions that can cause this type of pruritus are: multiple sclerosis and pinched nerves.
Systemic pruritus
Systemic pruritus causes itching all over the body. This type of pruritus occurs not because of a skin disorder, but because of a disturbance in the system in the body. Some of these disorders are:
- Allergy to drugs, such as aspirin and opioids
- Metabolic disorders, such as chronic kidney failure and liver disease
- Blood disorders, such as iron deficiency anemia and polycythemia vera
- Endocrine disorders, such as thyroid disease and diabetes mellitus
- Cancer or tumors, such as Hodgkin's lymphoma, leukemia, and tumors in the lungs, intestines, or brain
- Viral infections, such as HIV and hepatitis C
- Hormonal changes due to pregnancy or menopause
- Use of medications, such as ACE inhibitors
- Mental disorders, such as depression, anxiety disorders, obsessive compulsive disorder (OCD), and trichotillomania
Pruritus risk factors
There are several factors that can increase the risk of pruritus, namely:
- old age
- Suffering from allergies, eczema, or asthma
- Have a weak immune system, for example due to suffering from HIV/AIDS or cancer
- Is pregnant
- Suffering from kidney failure or undergoing dialysis
- Taking diuretic drugs
Symptoms of Pruritus
The main symptom of pruritus is an itching sensation on the skin. Itching can occur only in certain parts of the body, such as the scalp, arms, and legs. However, itching can also be felt all over the body.
In addition, there are also other symptoms that can accompany the occurrence of pruritus. Depending on the disease or condition that causes pruritus, the accompanying symptoms may vary, including:
- Reddish skin
- Scratches
- Bumps, spots, or blisters
- Dry to cracked skin
- Thick or scaly skin
Symptoms can last a long time and get worse. The itching can get worse when scratched, causing the sufferer to want to continue scratching.
When to go to the doctor
Check with your doctor if you experience more serious symptoms of pruritus, such as:
- Itching lasts more than 2 weeks and doesn't get better even after trying to treat it
- Itching is so severe that it interferes with daily activities, causing you to wake up from sleep or have trouble sleeping at night
- Itching appears suddenly without a definite cause
- Itching occurs all over the body
- Itching is accompanied by other symptoms, such as weight loss, fever, night sweats, changes in urination or bowel movements, fatigue, and anxiety due to the discomfort caused by itching
If the condition still does not improve after 3 months of undergoing treatment from a doctor, an examination to an internal medicine doctor needs to be carried out to detect the presence of diseases or other conditions that may cause pruritus.
Diagnosis of Pruritus
The diagnosis of pruritus can be made by asking questions about the symptoms experienced and the patient's medical history. A thorough physical examination will also be carried out to see firsthand the condition of the skin.
If necessary, the doctor will perform further tests to confirm the diagnosis. Some of the inspection methods that can be carried out are:
- Allergy testing, to see if the itching is caused by an allergen.
- Blood tests, to detect conditions that can cause itching, such as anemia, thyroid, liver, or kidney disorders.
- Scanning tests, such as chest X-rays, to detect enlarged lymph nodes.
- Swab test, to determine the cause of pruritus by taking a swab sample from the itchy skin area and examining it in the laboratory.
- Skin biopsy, to see the condition of the itchy skin tissue by taking a skin sample and examining it using a microscope.
Pruritus Treatment
Treatment of pruritus is based on the cause and severity of the patient. Mild pruritus can generally be managed with independent efforts at home, such as:
- Using moisturizing creams or lotions, especially those containing calamine or menthol, to relieve itching and prevent dry skin
- Using anti-dandruff shampoo, to relieve itching on the scalp
- Use sunscreen, to prevent sunburn and skin damage from sun exposure
- Using bath soap and mild detergent, to prevent irritation to the skin
- Take a bath with warm water (not hot water), to relieve itching
- Avoid certain clothing materials that can cause itching, such as wool and synthetics
- Avoid the heat and use air conditioning and humidifier, to keep the environment cool and humid
- Compress the itchy skin area with a cold cloth or ice cubes, to relieve itching without having to scratch the skin
- Avoid drugs that have the potential to cause allergies or itching on the skin
- Refrain from scratching the itchy area by covering the area
- Doing meditation or counseling with a psychologist, to manage any stress or anxiety you may be experiencing
- Ensuring the body gets enough rest
If the pruritus does not improve despite the above steps, it is advisable to consult a doctor. Treatments that can be given include:
- Corticosteroid cream, to relieve itching and redness on the skin
- Antihistamines, to treat pruritus caused by urticaria
- Tricyclic antidepressants, such as doxepine, to treat chronic pruritus in the absence of depressive symptoms
- Phototherapy using ultraviolet light exposure, to reduce itching
- Cognitive behavioral therapy, to help patients deal with stress or mental health problems that trigger pruritus
If the itching experienced by the patient is known to be a symptom of another disease, the treatment will refer to the treatment of the disease. However, topical medications such as calamine lotion or corticosteroid creams are also given to relieve itching.
Pruritic Complications
Pruritus can be very disturbing and reduce the sufferer's quality of life. In addition, complications can also occur if the patient continues to scratch the itchy skin. These complications include:
- Wound
- Infection
- Lichenification (thickening of the skin)
- Neurodermatitis (lichen simplex)
- Prurigo
- Black scars
Pruritus Prevention
Pruritus can be prevented by avoiding the underlying cause. In allergy sufferers, pruritus can be avoided by avoiding allergy triggers or taking allergy medications regularly. Meanwhile, in diabetics, keeping blood sugar levels under control can prevent pruritus.
In addition, maintaining healthy and clean skin can also prevent pruritus. Some things that can be done are:
- Eat a healthy and balanced diet
- Meet the needs of body fluids
- Use moisturizer regularly to prevent dry skin
- Use warm water when showering, not hot water
- Use sunscreen