Home Symptoms Itching (pruritus): causes, forms and tips

Itching (pruritus): causes, forms and tips

by Josephine Andrews
Published: Last Updated on 266 views

Itching (med.: pruritus ) is an abnormal sensation of the skin that makes you unable to sit still. The hands wander to the itchy area and start scratching – although there is temporary relief, the itching soon starts again. Allergies, insect bites or skin diseases can cause itching. However, leukemia and liver disease can also be associated with pruritus. The cause of chronic itching is often not easy to find. Find out here where the itching can come from and what can be done about it.

quick overview

  • Description: Disturbing to distressing sensory perception that tempts the sufferer to scratch
  • Cause: eg allergies, psoriasis, eczema, parasites, kidney and liver diseases, diseases of the blood and lymphatic system, metabolic disorders
  • When to the doctor? in case of recurring or long-lasting itching for no apparent reason as well as accompanying symptoms such as fever , exhaustion, skin rash
  • What to do? self-help e.g. B. through skin care, cotton gloves against scratch attacks during sleep, airy clothing, cool compresses with yoghurt, relaxation techniques. Doctors will treat itching depending on the underlying condition, such as: B. with certain drugs or (protracted) therapy

Itching: causes and possible diseases

Itching (pruritus) triggers the urge to scratch the affected area. The area of ​​skin that itches may appear normal, or it may be altered by a ( skin ) disease. If the itching does not subside after six weeks, it is referred to as chronic pruritus .

Possible causes of itching include:

Skin reactions and skin diseases

Skin reactions (eg to rapid temperature changes) and skin diseases are the main causes of itching. For example, the pruritus can have the following triggers:

  • Allergies: Contact with the allergenic substance leads to the release of histamine – itchy pustules and swellings are the result.
  • Neurodermatitis (atopic eczema): Scaling, itchy skin forms on typical skin areas such as the crook of the arm or the back of the knee.
  • Psoriasis: In psoriasis, scaly, itchy areas of skin develop, especially on the hairline, elbows and knees.
  • Eczema and hives (urticaria): They typically manifest themselves as pustules, crusting and pruritus.
  • Fungal infection: An infestation with the skin fungus Candida causes an itchy reddening of the skin that can smell unpleasant, especially in the skin folds.
  • Xeroderma: Reduced sebum production causes the skin to become dry and brittle. This often causes itching.
  • Parasites: Scabies (itch mite) in particular robs many people of sleep due to itching at night.
  • Environmental factors: Toxins released by an insect bite, plants, chemicals, or parasites often cause pain along with severe itching.
  • Autoimmune diseases of the skin: Examples are bullous pemphigoid (formation of blisters on the skin, especially in older people), pemphigus vulgaris (large, fast-bursting blisters, usually starting on the mucous membranes), lichen planus (lichen planus, reddish papules appear on the skin). , white stripes on the mucous membranes) and light dermatosis ( sun allergy, light allergy: redness and itchy blisters on the skin). This autoimmune disease manifests itself through various symptoms, but what they all have in common is itchy skin.
  • Age itch (pruritus senilis) and winter itch (pruritus hiemalis): Especially in old age, dry skin develops on the upper arms and lower legs, which must be cared for adequately, otherwise it will start to itch. A rapid change in temperature between cold and warm in winter also causes itching.
  • Aquagenic pruritus: Stinging itching can occur as a result of contact with water or temperature fluctuations in the air.
  • Dry skin : Flaking skin when peeling off a summer tan, lack of moisture, showering or drying care products cause itchy skin.

Diseases of internal organs and organ systems

Many other diseases can also be associated with itching:

  • Kidney diseases: A large proportion of patients with severe kidney failure who receive blood washing ( dialysis ) suffer from severe, generalized itching shortly after the therapy. The exact causes are still unclear.
  • Liver diseases: Disorders of bile drainage (cholestasis) and liver damage such as liver cirrhosis cause an increase in the bile pigment bilirubin . This not only leads to the typical yellowing (icterus) of the skin and mucous membranes, but also to severe itching.
  • Thyroid disorders: Overheated, itchy skin is common with overactive thyroid (hyperthyroidism). Pruritus is rather rare in hypothyroidism .
  • Diabetes mellitus: Nerve damage (neuropathies) and increased susceptibility to skin fungal infections can cause itchy skin in diabetics.
  • Hodgkin’s disease : Itching all over the body or only in the area of ​​the lymph nodes can precede the malignant tumor of the lymphatic system for years. The pruritus is a sign here – the patients should be examined several times a year.
  • HIV infection: The immune deficiency favors the development of skin diseases caused by fungi or parasites, which are unobtrusive but can be accompanied by severe itching. However, pruritus can also occur in the course of antiviral therapy.
  • Other infectious diseases: Chickenpox and measles are also often accompanied by itching.
  • Polycythemia vera : The thickening of the blood due to excessive formation of blood cells first appears as aquagenic pruritus (itching after contact with water).
  • Iron deficiency anemia: Cracked corners of the mouth, brittle hair , brittle nails and dry, itchy skin are early signs of this form of anemia.
  • Anorexia nervosa, gluten intolerance or malnutrition can also be accompanied by itching.
  • Neurological diseases: Damage to the central nervous system such as multiple sclerosis (inflammatory disease of the central nervous system with symptoms of paralysis and a feeling of stiffness), polyneuropathies (damage to the peripheral nerves, e.g. in the arms or legs) or viral diseases such as herpes zoster (shingles ) can trigger the itchy discomfort.
  • Psyche: In some patients, depression, obsessive-compulsive disorders such as the compulsion to wash or hallucinations are responsible for severe itching.


There are a number of medications that can cause pruritus:

  • antibiotics
  • opiate
  • anti-inflammatories
  • antimalarials
  • Psychotropic drugs (used to treat mental illness)
  • hormones
  • Diuretics (medicines for dehydration, water pills)
  • Cytostatics (substances that inhibit cell growth and/or division)
  • Medicines for high blood pressure
  • Gold (gold compounds are or were used, for example, in rheumatism therapy)
  • anticoagulants
  • Retinoids (derivatives of vitamin A used to treat psoriasis and acne )

Other causes of itching

  • Hormone fluctuations: Generalized itching can occur during pregnancy, during the menstrual cycle or after the menopause (climacteric).
  • Cancer therapies: Many cancer patients experience itchy skin as a result of therapy such as radiation or various medications.

The direct association between a tumor and pruritus is unlikely, although itchy skin in the anal region has been described in colon, prostate, or cervical cancer .

Itching: what to do?

In the case of itching, those affected often feel high levels of suffering. The itching is unpleasant, maybe even tormenting, and should stop as soon as possible. In some cases of itching, those affected can help themselves, in others a visit to the doctor is also necessary.

You can do that yourself

Regardless of the cause of the itching, you can often find relief and relief yourself with simple tips:

  • Avoid dry skin: Avoid a dry room climate, frequent showers, baths, saunas or care products that contain alcohol. Dry skin is often also itchy skin.
  • Caring for the skin: Use moisturizing creams and lotions. Showering and bathing dries out the skin in particular – subsequent care is absolutely necessary here. Care products with urea also give the skin a lot of moisture.
  • Reduce irritation factors: Very spicy food, alcohol, stress, excitement and anger often lead to itching. Try to limit these factors in your life.
  • Skin-friendly bathing: A bath in lukewarm water for no more than 20 minutes should replace a quick shower. However, you should avoid using drying shower gels. In the case of skin diseases or severe scratch marks, the skin should not be scrubbed with a towel when washing or drying, but should be gently dabbed off. Then you should moisturize the skin with lotions.
  • Wear cotton gloves : Cotton gloves protect the skin from scratch attacks during sleep. They are particularly suitable for children.
  • Choose airy clothing: Wear loose clothing that does not chafe or irritate the skin, such as cotton.
  • Provide quick relief: If severe itching suddenly sets in, cool, damp compresses with yoghurt or a little vinegar will help. Envelopes with black tea are also good. With all wet wraps, however, you should apply lotion to the skin afterwards. Lotions containing urea or menthol cool and moisturize itchy skin.
  • Preventing allergies: Here it only helps to avoid contact with the substance that causes the itching.
  • Use relaxation techniques: Some methods such as autogenic training, progressive muscle relaxation or yoga not only help to reduce stress, but are also intended to distract from scratching, especially in the case of chronic pruritus.

Itching: what does the doctor do?

Sometimes patients have to visit several doctors until the cause of the itching is found. The first point of contact is the dermatologist , who recognizes skin changes and skin diseases. Physicians from other disciplines (internist, psychiatrist, etc.) are in demand when the cause of the itchy skin is not “clear on the skin” but is hidden in the body.

In a detailed discussion with the patient (anamnesis), you should describe to the doctor exactly when the pruritus occurred, where the itching is particularly strong, whether something helps or whether the itchy skin wakes you up at night. It is also important whether the itchy skin is caused by contact with water or mechanical stimuli. Existing allergies, the infestation of family members with parasites, recent vacation spots and the use of medication can also provide the doctor with the first important clues as to the cause of the itching. You should also mention any other complaints, even if they seem insignificant to you, such as dizziness or weakness.

During the physical examination , the skin is examined closely. The genital area, hair, nails and the mucous membranes in the mouth are also examined. It is not uncommon for germs to be hidden in skin folds that are easy to overlook. Chronic itching is often also recognizable from smooth nails or hair loss from the eyebrows.

The physical examination also includes palpation of the liver , spleen , lymph nodes and kidneys to detect organic diseases.

If the itchy skin seems to appear for no reason, further investigations will follow. Blood tests can detect changes in the liver, bile ducts , kidneys, and any inflammation or worrisome changes. Further tests can be used to check the blood for autoimmune diseases.

Swabs of the skin and mucous membranes or small tissue samples are often taken, which are then examined under the microscope for parasites, fungi or bacteria .

If there is a suspicion of diseases of internal organs such as liver, kidney or tumor disease, imaging tests such as X -rays , ultrasound , computed tomography (CT) and magnetic resonance imaging (MRI) can be informative.

Pruritus can also be a precursor to Hodgkin’s lymphoma before the disease itself appears. Since the blood values ​​and other tests are unremarkable here, the search for the cause of the pruritus should be repeated at least once a year.

Itching: Medical treatment

Patients with itching sometimes have to undergo a series of tests before the cause is found. Subsequent treatment always depends on the underlying disease and can therefore vary greatly. Simple measures, such as avoiding allergy-causing substances or certain medications, often provide relief. In other cases, sometimes lengthy therapies are necessary, for example in liver, kidney and cancer diseases.

Itching: description

In order to be able to at least roughly assess where the itching could be coming from and whether a doctor’s visit is necessary (it is definitely necessary if it lasts longer than six weeks!), it helps to understand the “itching” phenomenon.

Itching is a disturbing, sometimes even tormenting sensory perception that is accompanied by an insatiable urge to scratch. If the hands cannot reach the itchy spot, objects are also used to help – it is not for nothing that there are scratching aids for the back.

However, pruritus is not just annoying and uncomfortable. It also has a benefit: the mechanical friction is intended to remove intruders such as parasites, fleas or lice. Prolonged scratching, however, damages the skin and causes injuries and tears. Children in particular find it difficult to control itchy diseases such as chickenpox. Disfiguring scars can remain as a result of the scratched skin .

development of itching

It has long been assumed that itching is triggered by the same nerve endings as the pain stimulus. However, more recent findings indicate that it is a separate subgroup of nerve fibers that are stimulated by certain messenger substances, above all histamine and serotonin . This thesis is proven, for example, by the fact that opiates inhibit pain, but trigger itching.

Itching can also be caused by toxins, mechanical stimuli, temperature changes, or even minor electrical shocks that cause histamine to be released from cells. The itching can appear on specific parts of the body (localized) or all over the body (generalized).

Scratching creates pain stimuli that temporarily mask the itching and provide relief. However, the mechanical stimulation of the skin releases messenger substances, which in turn promote itching – a vicious circle is created. The itchy skin can also be perceived as burning or slightly painful.

It is not uncommon for severe, chronic itching all over the body to become a stress test for the sufferer: there is a lack of sleep, exhaustion, scratch marks on the skin (such as bleeding or weeping wounds) and the permanent feeling of being able to get relief by scratching. For some, this leads to psychological problems that can even end in suicide.

Classification of itch

The itching can also be divided according to the condition of the skin:

  • Pruritus cum materia: The itching is caused by an already clearly visible skin disease.
  • Pruritus sine materia: The skin still appears visibly healthy and without changes.
  • Pruritus with chronic scratch marks: Here the skin is so scratched that it is no longer clear whether a skin disease is the cause.

Itching: when do you need to see a doctor?

Itchy skin after an insect bite or an allergic reaction is very uncomfortable, but it usually goes away on its own within a short time. These one-off events are not a reason to see a doctor. However, if the itching keeps coming back for no apparent reason, a specialist should take a close look at the pruritus.

Especially in older people, the itching often occurs as a result of systemic diseases, sometimes accompanied by dizziness, insomnia and a feeling of weakness. If the itching persists for a long time, those affected can increasingly withdraw from their fellow human beings – there is a risk of social isolation. Psychological help is definitely advisable here.

In general, you should see a doctor if:

  • the pruritus lasts for an unusually long time and for no apparent reason (all over the body).
  • additional symptoms such as exhaustion, tiredness or fever
  • the skin shows changes in addition to the itching

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