Joseph R Anticaglia MD
Medical Advisory Board
“Coming up with the right diagnosis for constant itching is difficult, frustrating and maddening,” according to Cecilia.
“One morning, it was 3:47 a. m. I woke with intolerable, unbearable itching all over my body. I went to the emergency room and the doctor prescribed an antihistamine and steroid cream — No relief!
I called my internist and the ‘misery go around’ began in earnest. He referred me to a well-respected dermatologist who teaches at a university medical school. On my first visit he injected me with a steroid and prescribed pills for me to take. At last some relief. But the itchiness never went away completely. It would go away only to return.
He had his technician draw blood, do skin testing and prescribed different medications. After 6 weeks and several visits he sat me down and said,”
“I’m sorry; in spite of my efforts, I have not been able to solve your problem. I want you to see my colleague and I’m confident he’ll come up with the answer to your problem that we both want. I’ll discuss your situation with him and send your records and my findings to him.”
I felt he truly wanted me to get well and I agreed with his recommendation. I filled out the patient information sheet and gave my medical information to the physician assistant. The new dermatologist walked into the examining room, I recited my medical history, he examined me and he said,
“We need to do some testing. My assistant will make the arrangements and I’ll review the findings with you after the tests are done.”
“He had the bedside manner of a “cold clam,” but he solved my problem. He printed out a list of all the items and chemicals I was allergic to and said, “You must avoid all of these chemicals and products — No exceptions.” He then referred me back to my original dermatologist.
Itchy skin is a common, irritating sensation that usually goes away after you give the skin a rub or a scratch. People with dry skin are more prone to experience itchy skin, also called pruritis.
Although itching is usually temporary, it can persist for days or weeks making life miserable. It can be severe and unrelenting leading to anxiety and insomnia. The more you scratch the area, the more irritated the itch becomes, intensifying your discomfort. Scratching the same area repeatedly can result in the skin becoming red, bumpy, rough or leathery.
The skin is the largest organ in the body and there are more than a hundred causes of itchiness. An important first step is to determine if the itchiness originates in the skin or outside the skin, as can happen if you have liver or kidney disease.
One distinguishes itchy skin with or without a rash to help determine if an internal organ or skin is the cause of the problem.
Causes of Itching without Rash
Not all itchiness is allergic. Itching without rash can be due to the side effects of medication, systemic disease, nerve dysfunction, psychological conditions or unknown causes.
Medication side effect
Many medications cause itching. If your doctor increased the dosage of your medication or placed you on a new one, the itchiness may be due to the side effect of that medication.
Systemic Disease
Itchy skin can be a symptom of an internal disease. Examples of this problem include HIV infections, kidney and liver disease, thyroid disease and lymphoma.
Nerve Dysfunction
Damaged or pinched nerves can make the skin feel itchy. Damaged nerves secondary to shingles or diabetes are two examples of this problem.
Psychological Conditions
Stress and anxiety disorders may lead to bothersome itching. At times, unknown causes result in chronic itching.
Itching with a Rash
Dry skin, (xerosis), is the number one cause of itchy skin in the elderly
Infections caused by scabies, a fungus lice or other bugs may result in itchiness and a rash
Allergic Reactions
The skin can become red, irritated and itchy when it comes in contact with certain substances. These include deodorants, laundry detergents, wool, soaps, cosmetics or poison ivy which can trigger an allergic reaction.
Skin Conditions
Many diseases cause itchy skin. Examples are skin cancer, burns, eczema, hives, insect bites and psoriasis.
Diagnosis
The diagnosis begins with a good medical history, followed by a relevant physical examination and the ordering of appropriate tests. A complete blood count can provide information as to the reason you itch such as an elevated bilirubin or iron deficiency.
Tests of thyroid, liver kidney and thyroid may provide evidence of abnormalities in the internal organ systems. Cirrhosis of the liver, hyperthyroidism and waste buildup in the body because of kidney disease all can cause itching. Image studies of the chest can demonstrate enlarged lymph nodes which can be associated with itchy skin.
Treatment
No matter the cause of itchiness, it’s essential you treat the problem of dry skin. Use warm water, not hot water, when bathing or showering and limit the bath and shower time to 10 minutes or less. Use a moisturizing cream, remain hydrated and use a humidifier if the air is dry.
All that itches is not allergies. It’s useful to distinguish itchy skin with and without a rash to determine if an internal organ or skin is the cause of the problem.
Treatment is based on the correct diagnosis, which often is avoiding the offending agent. One distinguishes itchy skin with or without a rash to help determine if an internal organ or skin is the cause of the problem. If home remedies are not successful, your physician might consider: oral medications, corticosteroid creams and ointments and light therapy phototherapy — the use of ultraviolet light for its healing effects. For Cecilia, it was a misery go-round with a happy ending.
References
- American Academy of Dermatology: “How to Relieve Itchy Skin”
- Ratika Gupta, M. D.; An Allergist Explains Why You Might Be Itchy All Over; Health; September 13, 2018
- National Library of Medicine; Itching, February 7, 2019
- James S. Taylor et al; Pruritis; Cleveland Clinic, April 2010
This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.