Itching (Pruritus)
George Woodbury MD 5/10/2023
Itching or Pruritus is a common and aggravating issue faced by Dermatologists like myself, my perspective being that of a Board-certified Memphis Dermatologist, practicing at Rheumatology and Dermatology Associates, Cordova TN, since 1993 (www.Rheumderm.com: 1-901-753-0168: 8143 Walnut Grove Road, Cordova TN 38018).
Let’s take a look at what Dermatologists often do for evaluation of and treatment of Itching but without a rash, or without much of a rash. We have to act like Itch Detectives to help to sort out the underlying cause it Pruritus, and sometimes the revealing clue comes from the skin examination, and sometimes it comes from the patient’s history.
First, Itching can be triggered by factors both within the body and from the skin itself. Among the leading internal factors are disorders of the Kidneys, Lungs, and even the bloodstream, so Dermatologists often consider running screening labwork. Sometimes a reaction to a medication or drug taken either orally or used on top of the skin is at the root of the problem, so we usually take a medication history, including Drugs taken orally, and also those used topically. It often helps for the patient to bring medication bottles or a list of medications being used, at the time of the appointment.
We must always remember that rarely certain internal causes can trigger Itching or Pruritus, including internal blood disorders and internal cancers. Sometimes Dermatologists will collaborate with a patient’s primary care physician or other medical specialists, the result of which might be a Physical Exam, or testing to further evaluate or work up the Pruritus, which might include CT scans or MRI scans, or chest X-rays, or studies such as a mammogram, prostate exam, colonoscopy, or more involved studies.
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Among the leading skin causes of itching are Dry Skin, which can be caused by too frequent bathing practices or cleansing practices, or use of detergents that are too strong for a person’s skin, or a variety of different skin diseases, including Atopic Dermatitis (Eczema), Psoriasis, and Contact Dermatitis.
Eczema often develops on the arms and legs, but also the face, neck, or body, affecting 3% of the population. It runs in families along with asthma, hay fever, and food allergies, and seems to be more common among Asian-Americans and African-Americans, though it affects all racial groups.
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Years ago, we used to think that food allergies were the trigger for Atopic Dermatitis. But Dermatologic research now points to a combination of genetic factors – and low skin oil level.
Sometimes the root cause of Itching or Pruritus is a skin allergy to certain fragrances, dyes, preservatives, or components within latex or certain metals can cause attacks of itching in patients with Eczema. As a member of the American Contact Dermatitis Society, at Rheumatology and Dermatology, as a Cordova Dermatologist, since 2004 I have offered extended Allergy Patch Testing to help search for trigger chemicals. This type of Skin Allergy Testing can lead to a “cure” from the itching of Eczema, by identifying trigger factors, which could be a metal like nickel, or a preservative, fragrance, dye, or component of latex.
The good news is that Dermatologists have a growing arsenal of medications to put Pruritus or Itching to rest, depending upon the diagnosis that we arrive at. We have the topical steroids, of which there are over 30 available, most of which are by prescription only. Topical steroids must be used carefully, to minimize thinning of the skin, and stretch marks. Dermatologists also sometimes use oral Antihistamines, such as Fexofenadine and Hydroxyzine, and in certain cases we consider courses of oral steroids, until we get back results of initial testing that we may have run.
Sometimes to help to sort out the cause of Pruritus, we communicate with the patient’s primary care physician about the advisability of stopping certain oral medications that are being used for underlying medical conditions, such as high blood pressure or hypertension, diabetes, or even blood conditions like excessive iron (Hemochromatosis). It is always a good idea for the patient to check with the physician who started the medication or medications first, before stopping a medication.
If we decide to run bloodwork testing, the results generally take one to two weeks to come back from the lab. We generally communicate by a phone call or blood test with the patient about these results, which at times lead on into more detailed testing.
So the bottom line is: Never Itch in Silence. If you or family member are suffering from itching and rash, consider getting your condition properly diagnosed. My own Dermatology practice – with Rheumatology and Dermatology – is with Rheumatology and Dermatology Associates, at 8143 Walnut Grove Road, Cordova TN, a suburb of Memphis TN (www.Rheumderm.com; 1-901-753-0168; 8143 Walnut Grove Road, Cordova TN 38018). Or you can find a Dermatologist closer to you by going to the American Academy of Dermatology web site, to the “Find a Dermatologist” tab: just plug in your zip code, and you’ll get a list of Board-certified Dermatologists.
In 2016, to help my patients with their itching, I became President of Big River Silk Skincare Inc., to manufacture and distribute three lines of helpful lubricating agents (moisturizers) containing an Alpha-Hydroxy chemical (AHA)called Glycolic Acid: GLYCOSHEA® Hand&Body Cream/Standard Strength (1 oz: $19.95; 2 oz: $29.95; 8 oz: $89.95); GLYCOSHEA® Hand&Body Cream/High Strength (1 oz: $29.95; 2 oz: $44.95; 8 oz: $139.95); and GLYCOSHEA® Facial&Neck Cream (1 oz: $39.95/2 oz; $59.95; 8 oz: $179.95). GLYCOSHEA is helpful in both moisturizing the skin and decreasing the appearance of fine lines in the skin, promoting skin smoothness, making it into an Anti-Wrinkle Cream.
Big River Silk also manufactures a special gentle moisturizer for babies, senior, and those with especially sensitive skin, a hypoallergic moisturizer: HypoShea™ Moisturizer Cream (1 oz: $12.95; 2 oz: $18.95; 8 oz: $39.94).