Your Skin, Pruritus, and Itching

Medically Reviewed by Zilpah Sheikh, MD on May 15, 2024
Written by Stephanie Langmaid
6 min read

Pruritus simply means itching. It can be associated with several disorders, including dry skin, skin disease, pregnancy, and rarely, cancer.

An itch may be confined to just one part of your body, or it could be generalized, meaning it's widespread.

There are several distinct types of pruritus that have specific causes or affect a certain part of your body. Some of these are: 

Nocturnal pruritus

This is an itch you have at night that can keep you from getting enough sleep. Many things can cause it, from changes in your body temperature and hormone levels that happen at night to bedbugs.

Brachioradial pruritus 

You mainly feel this itch on the outside of your forearms, but it can also affect your upper arms, shoulders, and neck. Doctors think a combination of nerve damage in your neck and sun exposure on your arms causes it.

Uremic pruritus

People with serious kidney disease can develop an itch that's widespread and very bothersome. It isn't clear exactly why it happens, but it may be related to a buildup of waste products in your blood or an autoimmune reaction in which your immune system attacks healthy cells.

Pruritus ani

This is itching that's confined to the area around your anus. It often comes from not wiping well enough after a bowel movement, or from a reaction to chemicals in cleansing products.

Senile pruritus

It's common for people over age 65 to have generalized itching. Your skin gets drier as you age, and you're more likely to have underlying medical conditions that can cause itching. But often, there's no known cause.

Anyone can get pruritus, but you're more prone to get it if you:

Pruritus makes you want to scratch yourself. Along with an itchy feeling, you may have other symptoms, especially if scratching has damaged your skin. These include:

  • Pain or tingling
  • Red, inflamed skin
  • Spots, blisters, or other types of rash bumps
  • Scratch marks
  • Cracked or broken skin
  • Scaly or leathery patches
  • Discolored skin

You itch because nerve endings in your skin send an itch signal to your brain. Many different things can make that happen -- some come from outside your body and some come from inside.

Skin issues

Dry skin is the most common cause of pruritus. Contact dermatitis is another main cause. That's an irritation or reaction that happens because of something that touches your skin, such as chemicals in laundry detergent or metals in jewelry.

Other skin issues include:

  • Bugbites and parasites
  • Infections such as folliculitis and impetigo
  • Skin diseases including eczema and psoriasis
  • Allergic reactions, such as hives

Pregnancy

It's common to itch while you're pregnant. It's usually nothing to worry about. Hormone changes and stretching skin can cause it. But intense itching late in your pregnancy could be a sign of a serious liver problem called cholestasis. This can be dangerous for your baby, so let your doctor know right away if you develop a nonstop, severe itch.

Medication

Some over-the-counter and prescription drugs that can make you itch are:

  • Pain relievers containing narcotics (opioids)
  • Aspirin
  • Blood pressure drugs
  • Antimalarial drugs
  • Contrast agents used in certain imaging tests

Itching can also be a side effect of several kinds of cancer treatment.

Underlying diseases

It's less common, but itching can be a sign of many different medical conditions, including:

  • Liver disease
  • Kidney disease
  • Diabetes
  • Gallbladder disease
  • Anemia
  • HIV/AIDS
  • Thyroid disease
  • Cancers, including lymphomas, leukemia, and skin cancer

Nerve problems

Neuropathic itching can happen when the nerves that send itch signals to your brain are damaged. That can come from:

  • Multiple sclerosis
  • Shingles (after the rash has cleared)
  • Pinched nerve
  • Stroke
  • Diabetes

Psychological issues

Psychogenic itching is pruritus that doesn't have a physical cause. Some psychiatric conditions that may make you itch include obsessive-compulsive disorder, anxiety, and depression. 

Finding the cause of the itching is the first step in treating pruritus. If you aren't able to get relief, if you're itching all over your body, or if you have other unusual symptoms, see your doctor.

They'll start by looking at your skin and asking you questions. They'll want to know things such as how long you've had the itch, whether anything makes it better or worse, and whether you're having any other symptoms.

You may have tests, including blood and imaging tests. The doctor may do a biopsy, where they remove a small piece of skin and look at it under a microscope.

If pruritus is caused by an underlying medical condition, treating that can bring you relief.

If a drug reaction is the cause, switching to a different medication may reduce the itching. Don't stop or change any prescription medications without clearing it with your doctor.

While you're waiting for those remedies to take effect, or if the problem is in the skin itself, medications or self-care strategies may help.

Pruritus medication

Anti-itch medications are either applied to your skin or taken as a pill that works throughout your body. Some of these you can get over the counter, or your doctor may prescribe them. You may try:

  • Topical immune-suppressing medications, including steroids and calcineurin inhibitors
  • Cooling or numbing creams
  • Antihistamines
  • Oral steroids
  • Antidepressants

Phototherapy

Certain itchy skin conditions, including eczema and psoriasis, can be treated by exposing your skin to ultraviolet light. This is usually done at a doctor's office using special equipment.

Home remedies for itchy skin

Steps you can take to soothe your skin include:

  • Soak in a tub with an oatmeal treatment or baking soda.
  • Place a cool washcloth or some ice over the area that itches.
  • Use a thick, allergen-free moisturizer several times a day, especially after a bath or shower. 
  • Do your best not to scratch, even if that means wearing gloves.
  • Instead of scratching, try pressing, gently rubbing, or applying vibration (like from a massage tool) to the itchy spot.

It may also help to lower your stress level and make sleep a priority.

The best way to prevent pruritus is to take care of your skin. To protect your skin:

  • Use skin creams and lotions that moisturize your skin and prevent dryness.
  • Use sunscreens regularly to prevent sunburns and skin damage.
  • Use mild bath soap and switch to allergen-free toiletries and laundry products. 
  • Keep baths and showers short, and use warm -- not hot -- water.
  • Avoid certain fabrics, such as wool and synthetics, that can make skin itch. Switch to cotton clothing and bedsheets.
  • Since warm, dry air can make skin dry, keep the thermostat in your house down and use a humidifier.
  • Drink plenty of water.

Pruritus is itchy skin that can have many different causes. You may be able to treat or prevent it by keeping your skin moisturized. If you don't know what's causing it, if it's widespread, or if you have other unusual symptoms, see your doctor.

What is the most common cause of pruritus?

Itching is usually caused by a problem with your skin, including skin diseases, infections, and bug bites. Dry skin is the most common cause.

Which antihistamine is best for pruritus?

Oral antihistamines sometimes work against certain types of itch, and those that make you sleepy can help if nighttime itching is keeping you awake. Research shows so-called second-generation antihistamines, such as cetirizine and loratadine, may be better choices than older drugs.

What autoimmune disease causes pruritus?

Several autoimmune diseases can cause itching, including bullous pemphigoid, scleroderma, Sjögren's syndrome, dermatomyositis, and vitiligo. An itchy rash can be associated with lupus and celiac disease. Immune system dysfunction also plays a role in eczema and psoriasis.