Pruritus is the medical term used to describe an itching or tingling sensation on the skin that provokes the desire to scratch or rub. In some cases, pruritus may be a minor but persistent nuisance for patients. In other instances, it can cause major discomfort, frustration and even potential health risks for the patient.

Pruritus may occur either all over the body (generalized) or may be limited to specific areas of the body (localized). Pruritus is experienced subjectively, is not precisely defined, and can be associated with a variety of medical conditions. Pruritus may affect people in any age group, but it is especially prevalent in older people, who are more likely to have dry skin (xerosis) than other members of the population.

The itch impulse travels in the body along the same pathways as pain impulses, from the nerves on the surface of the body to the brain. The normal response to the itch sensation is scratching. Scratching can relieve an itch for 15 to 25 minutes, but it can also worsen itchiness by creating a cycle of itching and scratching. In addition, persistent scratching may produce the following:

• Redness
• Irritation
• Fissures (cracks in the skin)
• Lichenification (thickening of the skin)
• Infection
• Other undesirable side effects

Most cases of pruritus can be treated at home and do not require professional treatment. However, pruritus that is severe, prolonged or cannot be explained requires a visit to a physician. Medical care should also be sought if pruritus is associated with loss of sleep, anxiety, depression or unexplained symptoms.

In order to determine the cause of pruritus, a physician will perform a complete physical examination and compile a thorough medical history. While collecting the patient’s medical history, the physician will ask detailed questions regarding the characteristics of the pruritus, including the time of onset, the extent (generalized or localized), the severity, the quality (e.g., burning sensation, pricking sensation), the duration, and diurnal and seasonal variations (e.g., worse at night or in the winter).

The physician will also attempt to determine any aggravating factors (e.g., bathing, exercise, clothing). Questions regarding the patient’s daily activities, health, hobbies, workplace responsibilities and use of medications and cosmetics can also help the physician pinpoint the underlying cause.

In many cases, a visual examination of the skin is sufficient to diagnose the cause of pruritus. However, a blood test or biopsy may be necessary to confirm a diagnosis in some cases. Diagnosis is also sometimes complicated by the fact that excessive scratching and rubbing can obscure features usually used to diagnose a type of rash or other skin disorder.