Pruritus


Pruritus

Description, Causes and Risk Factors:

Pruritus is a condition that creates an itch and a need to scratch. It can be caused by a number of disorders, comprising dry skin, skin disease, pregnancy, and rarely, cancer. This is the clinical term for itching. It is the one of the most common symptoms reported by people with hepatitis C (20%), but is more commonly found in people with advanced liver disease and cirrhosis. Pruritus is itching that may be localized to a specific part of the body such as hands and feet, but it can also be a generalized itching all over the body. Some people even report that it feels like their internal organs itch. Pruritus can be related to high bilirubin levels, autoimmune disease or dry skin, and can be a side effect of treatment. Use of moisturizing lotions, oatmeal baths or lotions, antihistamines, and cortisone creams and opiate drugs can help.

The exact cause of an itch is unknown. It includes nerves in the skin responding to unerring chemicals such as histamine, and then processing these signals in the brain. Itch is a raw feeling and sometimes bleeding (caused by scratching) are the normal symptoms.

Stress and emotional upset can make itching worse, no matter what the underlying cause. If emotional problems are the primary reason for the itch, the condition is known as psychogenic itching. Some people become convinced that their itch is caused by a parasite; this conviction is often linked to burning sensations in the tongue, and may be caused by a major psychiatric disorder.

Symptoms:

Pruritus symptoms can range from annoying mild itchingto severe itching that interferes with daily life. Often theitching is worse at night, and may prevent sleep. Simplescratching typically does not relieve pruritus. As a result,some people risk skin infection and injury by scratchingthemselves with sharp objects.

Diagnosis:

Because itching can be caused by such a wide variety of triggers, a complete physical exam and medical history will help diagnose the underlying problem. A variety of blood and stool testsmay help determine the underlying cause.

Treatment:

Specific treatment of itching depends on the underlying condition that causes it. In general, itchy skin should be treated very gently. While scratching may temporarily ease the itch, in the long run scratching just makes it worse. In addition, scratching can lead to an endless cycle of itch -- scratch-more itching.

Certain drugs can help reduce itching, particularly classical analgesics for neuropathic pain (gabapentin, antidepressants) which also exhibit antipruritic efficacy upon clinical use. Some people find that antihistamines, such as diphenhydramine (Benadryl) or hydroxyzine (Atarax), help relieve symptoms and allow better sleep. For pruritus due to cholestasis, cholestyramine (Questran) and colestipol (Colestid) may be effective. These drugs are bile acid binders that attach to bile acids in the blood and help eliminate them from the body. They can also interfere with the absorption of other medications, so other drugs should be taken at least two hours before or after bile acid binders. Some studies have shown that opiate antagonists such as naloxone (Narcan), naltrexone (Revia), and nalmefene (Revex)-which are used to block the effects of opiate drugs can also reduce severe itching. Rifampin, phenobarbital (Luminal), ondansetron (Zofran), and ursodiol (Actigall) may also be used, and several other medications are under study.

Experimental treatments for pruritus include plasmapheresis (in which blood plasma is removed, filtered, and returned to the body) and ultraviolet (UV) light therapy.

Preventive measure may include:

    Don't wear tight clothes.

  • Avoid synthetic fabrics.

  • Don't take long baths.

  • Wash the area in lukewarm water with a little baking soda.

  • For generalized itching, take a lukewarm shower.

  • Try a lukewarm oatmeal (or Aveeno) bath for generalized itching.

  • Apply bath oil or lotion (without added colors or scents) right after bathing.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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