Pruritus

Pruritus is an unpleasant stinging or itching sensation of the skin that causes the urge to scratch. It may present as localized pruritus, affecting a specific área, or generalized pruritus, affecting the entire body.

Localized pruritus is more common in the following áreas of the body:

• Scalp pruritus: occurs on the scalp and is usually associated with dermatitis, psoriasis, dryness, or the presence of lice.
• Anal or perianal pruritus: characterized by itching of the anus or the surrounding skin. áreas often caused by irritation, moisture, infections, or hemorrhoids.
• Vulvar pruritus: affects the external female genital organs. It results from an infection, an allergic reaction, or hormonal changes.
• Scrotal pruritus: itching of the skin covering the testicles is usually caused by fungal infections, wearing excessively tight clothing, or pubic lice infestation.
• Brachioradial pruritus: itching on the outer áreas1f of the forearms that is usually associated with excessive nerve compression.
• Facial pruritus: associated with dry skin, dermatitis, stress, extreme áreas1f1ura1, or allergies.
• Ocular pruritus: the main causes are environmental irritants, conjunctivitis, dry eye, or allergies.
• Pruritus on the legs: usually caused by áreas1f1ura changes, áre blood circulation, allergies, diabetes, or as a response to irritation such as hair removal.

According to its duration, pruritus is classified into two different types:

• Acute pruritus: the episode lasts áre áre six weeks, although it usually disappears within a few seconds.
• Chronic pruritus: itching persists for more áre six weeks.

Although pruritus is not serious in itself and is usually a áreas1f a mild condition, it may indicate a more severe disease or lead to deterioration of the body’s protective skin barrier as a consequence of excessive scratching. Its prognosis is generally área, since in most cases it resolves spontaneously without the need for treatment.

Symptoms

The main symptom of pruritus is the sensation of itching, usually affecting small áreas. Although the skin often shows no visible changes, it may sometimes present one of the following signs:

• Inflammation.
• Lumps.
• Spots.
• Blisters.
• Scratches.
• Dry and cracked skin.
• Rough or scaly áreas.

Causes

Localized pruritus is usually caused by one of the following conditions:

• Skin aging: senile pruritus affects individuals over 65 years of age and is usually a consequence of skin dryness, which increases with aging.
• Dry skin.
• Urticaria: the body releases histamine as a result of an allergic reaction or infection.
• Skin rashes: the skin changes in color, texture, and in some cases develops itching.
• Atopic dermatitis: chronic inflammatory disease affecting the superficial layers of the skin.
• Seborrheic dermatitis: chronic skin inflammation associated with abnormal sebaceous gland function.
• Contact dermatitis: skin reaction after exposure to an irritant or allergen.
• Cercarial dermatitis: known as swimmer’s itch, it is a skin rash caused by contact with parasites present in ponds or warm freshwater lakes.
• Scabies: itching caused by a mite transmitted through physical contact.
• Sunburn.
• Insect bites.
• Presence of parasites such as lice or pubic lice.
• Psoriasis: autoimmune inflammatory disease, meaning it is caused by the immune system itself, which accelerates the life cycle of skin cells.
• Pityriasis rosea: rash characterized by pink spots that resolve spontaneously without leaving marks and whose origin is unknown.
• Aquagenic pruritus: caused by contact with water at any temperature. It may be a reaction related to dry skin or an indication of diseases such as polycythemia vera (a rare blood disorder in which the bone marrow produces an excess of red blood cells).
• Hemorrhoids.
• Eye conditions such as dry eye or conjunctivitis.
• Superficial skin infections: impetigo, folliculitis, candidiasis, and other conditions caused by bacteria, fungi, or viruses.
• Hormonal changes.
• Pregnancy: pruritus during pregnancy results from skin stretching and hormonal changes. It is usually localized to the abdomen, palms of the hands, and soles of the feet.
• Sudden temperature changes or exposure to extreme temperatures.

Generalized pruritus, on the other hand, is usually caused by the following conditions:

• Allergies.
• Childhood infections such as chickenpox or measles.
• Iron-deficiency anemia: lack of iron.
• Hepatitis: inflammation of the liver caused by an infection, an autoimmune disease, or excessive alcohol consumption.
• Advanced kidney disease: uremic pruritus results from toxin accumulation, dry skin, systemic inflammation, and nerve alterations experienced by dialysis patients.
• Multiple sclerosis: chronic autoimmune disease in which the body attacks the myelin sheath that protects nerves.
• Nerve compression: nerve function is altered because surrounding tissues exert excessive pressure on it.
• Herpes zoster: skin infection caused by reactivation of the chickenpox virus.
• Mental disorders such as depression, anxiety, or obsessive-compulsive disorder.
• Reaction to certain medications, such as antibiotics, opioids, or vitamin A.
• Cancer: although uncommon, it is a clear indicator of Hodgkin lymphoma, liver cancer, or pancreatic cancer.

Risk factors

Factors that increase the risk of pruritus include:

• Age: it is more common in individuals over 65 years of age, although, because it may result from many different causes, it can affect people of all types.
• Sex: women tend to have a greater predisposition to itching.
• Having any of the diseases described above.

Complications

Complications of pruritus are not serious, although itching usually worsens as a result of scratching. Therefore, avoiding scratching is recommended to reduce the intensity of the itching sensation. In addition, this reduces the risk of developing skin lesions that increase susceptibility to infections.

Chronic pruritus may cause insomnia, anxiety, or depression.

Which doctor treats pruritus?

Pruritus is treated within the specialties of Medical-surgical dermatology and Venereology or Allergology, although the involvement of other specialists may be necessary depending on the underlying cause.