Itching sensations or skin pruritus

Pruritus is the scientific term used by doctors to refer to itching. The definition of pruritus is quite simple, it is the unpleasant sensation leading to the need to scratch. It is a universal, physiological and unconscious reflex. When scratching becomes too intense and uncomfortable on a daily basis, something is wrong. Written by health professionals, this file on pruritus is intended to help people with itchy skin or an itchy scalp. Our objective? A better understanding and optimal management of their itching.



What causes pruritus?

Itchy skin is an extremely common phenomenon, affecting between 13% and 30% of the population(1). Skin itching affects everyone: babies, children, adults, the elderly, men, women, pregnant or breastfeeding mothers. Pruritus can be concentrated on one or more parts of the body, or it can be generalized pruritus.

Pruritus is a common yet complex sensation. Many people think that it is a simple release of histamine when in fact pruritus involves many structures, nerve fibers and biological molecules like cytokines or neurotransmitters. There is not one single type of pruritus, there are many.

" Why do we scratch?" is often a difficult question to answer. The causes of pruritus and itching are extremely variable from one individual to another.

Itching sensations on the skin of dermatological origin are the best known and easiest to understand because they are accompanied by skin lesions such as plaques or spots. It is precisely these skin lesions that cause this type of pruritus. Among the main pruritic dermatoses, we can list eczema, psoriasis, seborrheic dermatitis and even scabies, chicken pox, insect and plant bites, sunburns, etc. Itching all over the body can also result from non-dermatological causes, and this is where everything gets more complicated. In this case, pruritus is not associated with one or more skin lesions that could explain it. This is pruritus sine materia, in other words pruritus without spots or plaques. The sources of pruritus sine materia are varied: kidney or liver diseases, endocrine disorders, cancers, medications, pregnancy, neurological diseases, psychiatric diseases, etc.

Advanced age is also a cause of pruritus in its own right. Many elderly people are affected by senile pruritus, at home or in an institution. Their distress in the face of itching should not be overlooked: family, friends and medical staff must be attentive to the elderly and their needs.

Cancer treatments are another possible cause of pruritus. The itching related to cancer treatments can be intense. It can affect the skin as well as the scalp, and accompany any type of treatment: chemotherapy, radiation therapy, targeted therapy or immunotherapy.

Finally, many environmental parameters can accentuate pruritus: hard water, climatic conditions, perspiration, friction, the use of unsuitable cosmetics, stress, etc.

How do you detect pruritus?

When you have itchy skin or an itchy scalp, we recommend you consult a medical professional to identify the cause of the itching. General practitioners or specialists are there to help patients suffering from pruritus. They perform complete skin examinations, looking for skin lesions that may explain the itching or that result from scratching. They question the patient thoroughly, looking for factors that may be contributing to the pruritus. In some cases, they will order additional tests to determine the cause of the itching.

The psychological and social impact of pruritus must also be taken into account. In fact, itching of the skin and scalp is a source of anxiety, insomnia and even depression. Itching on the face can lead to visible skin lesions and damage self-image. Scratching in public is rather embarrassing, so people suffering from itching hold back (and then sometimes violently scratch themselves in private) and isolate themselves.

How do you cure pruritus?

Once the source of the itching has been identified, solutions can be offered to the scratching patient to relieve and soothe the itching. Curing pruritus completely is sometimes difficult, especially when the cause of the pruritus is a chronic disease. On the other hand, it is possible to alleviate the itching and thus regain a more serene life.

Patients with itchy skin who self-medicate very often turn to antihistamines to fight itching. Unfortunately, they are not always effective. It is best to consult a doctor to receive appropriate and personalized treatment.

The management of pruritus of dermatological origin is relatively simple since it is a question of treating the dermatosis in question. For example, eczema is treated with cortisone creams and emollients.

The management of non-dermatological pruritus is more complex and depends on the disease causing the pruritus. For example, in the case of pruritus due to a liver disease called cholestasis, taking a specific oral treatment can improve the liver's biological parameters and improve pruritus.

At the same time, the person suffering from pruritus must adapt their daily hygiene and skin care routines to relieve their skin. Lukewarm, quick showers with a superfatted soap, syndet or soothing cleansing oil, without perfumes are recommended. Washing hair with a shampoo enriched with anti-itching active ingredients is also recommended. Drying off skin and hair should be as gentle as possible. Applying anti-itching cream with moisturizing and soothing properties to the skin once or several times a day is also a best practice. Place the tube of cream in a cool place to provide a cooling sensation or keep the tube on your bedside table to quickly relieve nighttime itching.

It is also advisable to implement anti-stress solutions on a daily basis, such as meditation, yoga or coherent breathing.

(1) The epidemiology of itch: Adding to the Burden of Skin Morbidity. F. Dalgard, E; Weisshaar. Acta Derm Venerol 2009; 89:339-350

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