Definition

Pruritus is derived from the Latin verb” prurire”

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etiology
Dry skin. If you don't see a crop of bright, red bumps or some other dramatic change in the itchy
area, dry skin (xerosis) is a likely cause. Dry skin usually results from older age or environmental
factors such as long-term use of air conditioning or central heating, and washing or bathing too
much.
Skin conditions and rashes. Many skin conditions itch, including eczema (dermatitis), psoriasis,
scabies, lice, chickenpox and hives. The itching usually affects specific areas and is accompanied
by other signs, such as red, irritated skin or bumps and blisters.
Internal diseases. Itchy skin can be a symptom of an underlying illness. These include liver
disease, kidney failure, iron deficiency anemia, thyroid problems and cancers, including
leukemia and lymphoma.
The itching usually affects the whole body. The skin may look otherwise normal except for the
repeatedly scratched areas

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Cont.…
Nerve disorders. Conditions that affect the nervous system — such as multiple sclerosis, diabetes
mellitus, pinched nerves and shingles (herpes zoster) — can cause itching.
Irritation and allergic reactions. Wool, chemicals, soaps and other substances can irritate the skin
and cause itching. Sometimes the substance, such as poison ivy or cosmetics, causes an allergic
reaction. Food allergies also may cause skin to itch.
Drugs. Reactions to drugs, such as antibiotics, antifungal drugs or narcotic pain medications, can
cause widespread rashes and itching.
Pregnancy. During pregnancy, some women experience itchy skin, especially on the abdomen and
thighs. Also, itchy skin conditions, such as dermatitis, can worsen during pregnancy.

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 Epidemiology

USA

 Pruritus patients occurs in approximately 20% of adults. It is present in approximately 25%

 International
Pruritus appears to affect up to 30% of patients with severe chronic renal insufficiency who are not undergoing
dialysis.
 Hyperthyroidism is the most common cause of endocrine pruritus.
 The rate is 4-11%, and the condition is especially prevalent in patients with untreated Graves disease.
 Pruritus is rare in patients with diabetes mellitus and hypothyroidism.
 The rate of malignancy in patients presenting with generalized pruritus is less than 1-8%.

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subtypes of pruritus

Pruritus liver disease — Some research suggests that up to 70 percent of people with
cholestatic liver disease experience pruritus.
It’s also common in people with chronic viral hepatitis, especially hepatitis C.
>>accumulation of bile salts in skin tissues in patients with cholestatic disease is what leads to
pruritus.
People with liver disease who suffer from pruritus tend to have normal-looking skin but feel
intense itchiness over most of their body, which can become very debilitating and even lead to
problems like depression

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Pruritus anusitis (also called pruritus ani) — Pruritus ani is the term for
itching and discomfort of the anal area. Some of the reasons this can develop
include:
◦ suffering from diarrhea
◦ fungal infections
◦ taking antibiotics
◦ wearing tight synthetic clothing that traps in moisture
◦ reactions to soaps and cosmetic products
◦ hemorrhoids
◦ diabetes
◦ warts
◦ skin conditions like eczema and seborrhoeic dermatitis

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Pruritus vulvae — This is the term for itching of the vulva, the area of skin located just outside
the vagina that comes into contact with clothes, soap, toilet paper, etc. Causes of pruritus vulvae
are similar to those of pruritus anusitis and can also include wearing menstrual pads or tampons,
douching, using lubricants, or an infection such as bacterial vaginosis.
Pruritus scroti — This is the term for itching of the scrotum in men, which is less common than
itching of the vulvae in women. It can be caused by infections, topical irritation from products,
reactions to medications, and skin conditions like dermatitis.

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CLASSIFICATION OF PRURITUS
Based on etiology of pruritus its classified into different
categories:
• Category I: Dermatological diseases
•Category II: Systemic diseases including diseases of
pregnancy and drug-induced pruritus:
• Category III: Neurological pruritus:
• Category IV: Psychiatric / psychosomatic diseases.
•Category V: Mixed overlapping and coexistence of several
diseases
• Category VI: Undetermined origin

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Pathophysiology
Scratching the pruritic area causes the inflamed cells and
nerve endings to release histamine, which produces more
pruritus, generating a vicious itch–scratch cycle.
If the patient responds to an itch by scratching, the integrity of the
skin may be altered, and excoriation, redness, raised areas
(i.e., wheals), infection, or changes in pigmentation may result.
Pruritus usually is more severe at night and is less frequently reported during waking hours, probably
because the person is distracted by daily activities.
At night, when there are fewer distractions, the slightest pruritus cannot be easily
ignored.
Severe itching can be debilitating

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Signs and symptoms
Redness (inflammation)
Bumps, spots or blisters
Dry, cracked skin

Leathery or scaly texture to the skin

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Diagnostics
Diagnosis
• History collection
• Physical examination
• Blood tests. A complete blood count can provide
evidence of systemic disease.
• Liver function tests
• Kidney function tests (creatinine)

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 Nursing Management
 Determine the cause of pruritus
Assist client and family with identifying and
avoiding irritants that exacerbate pruritus.
 Apply cool, moist compresses to pruritic areas
 Keep client's fingernails short; have client wear
mitts if necessary.
 Scratching with fingernails can
excoriate the area and increase skin damage.
 Leave pruritic area open to the air if possible.
Covering the area with a non-ventilated
dressing can increase itching sensation and
warmth in the area.

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Cont. …
 Use non-allergenic mild soap and use it
limited. Many soaps can be irritating to the skin and
increase the itching sensation.
Apply emollient creams or ointments frequently to
prevent dryness.
Pat skin dry after bathing, making sure to dry
thoroughly.
Provide distraction techniques such as music,
Television, or massage to distract the client from the
itching sensation.
• Administer Antihistamins and Corticosteroids.

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Interventions
Medical management:
• Topical Corticosteroids Prednisolone, Dexamethasone Etc.
• Oral antihistamines.
An antihistamine, such as ,cetirizine, diphenhydramine
(Benadryl) or hydroxyzine (Atarax),
prescribed in a sedative dose at bedtime is effective in producing a
restful and comfortable sleep.
.

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Antidepressants;
Tricyclic antidepressants, such as doxepin, may be
prescribed for pruritus of neuron-psychogenic origin.
• Treating the underlying disease
• Light therapy (phototherapy)
Phototherapy involves exposing the skin to certain
wavelengths of ultraviolet light. Multiple sessions are
usually scheduled until the itching is under control

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phototherapy)

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Wet dressings. This involves applying medicated cream to affected areas and then covering these
areas with damp cotton material that has been soaked in water or other solutions. The moisture in
the wet dressings helps the skin absorb the medicated cream.
Treating the underlying disease. If an internal disease is found, whether it's kidney disease, iron
deficiency or a thyroid problem, treating that disease often relieves the itch. Other itch-relief
methods also may be recommended.
Light therapy (phototherapy). Phototherapy involves exposing your skin to certain wavelengths
of ultraviolet light. Multiple sessions are usually scheduled until the itching is under control

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 Risk factors
Personal factors (land allergic family) can move towards a allergic itching in children: asthma, hay
fever, hives, eczema.
- Life in the community promoting the development of lice, intestinal worms, and infectious
childhood diseases (chicken pox).
Wearing closed shoes types sports shoes with synthetic socks, maceration and promotes the
development of fungi (athlete’s foot) and juvenile plantar dermatosis.
The presence of pets in the house encourages the maintenance of intestinal parasites.
Care and hygiene too excessive skin are aggressive, especially in children, and promote skin
irritation (vulva, anus, body) altering its barrier function.
Travel, by country, exposed to certain parasites.
Overcrowding and poor living conditions favor contamination by scabies.

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Exposure to stinging plants, the processionary caterpillar hairs,
certain medications or foods (fish, shellfish, strawberries), heat,
emotion, cold, pressure are all factors that can lead hives.
 Exposure to insect bites. Field allergic, Heat;
The act of scratching can relieve a moment, but can end up creating
sores from scratching that itch, which brings the child into a vicious
circle (itch – scratch – scratch injury – itching).
 Friction from clothing or sheets on the skin;
 The consumption of allergenic foods (shellfish, strawberries, fish).

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complications
Itching skin can affect the quality of your life. Prolonged
itching and scratching may increase the intensity of the itch,
possibly leading to:
 Skin injury
 Infection
 Scarring

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Prevention and Control (To protect skin)
The best way to prevent pruritus is to take care of 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 that won't irritate your skin.
 Take a bath or shower in warm -- not hot -- water.
Avoid certain fabrics, such as wool and synthetics, that can make skin itch. Switch to cotton
clothing and bed sheets.
Since warm, dry air can make skin dry, keep the thermostat in your house down and use a
humidifier.
To relieve itching, place a cool washcloth or some ice over the area that itches, rather than
scratch

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Reference
 Linda Nazarko Nurse Consultant Physical Health Care
 Brunner's and Suddarths Textbook Of medical Surgical Vol 2 ,12th Ed ,2010
Paus R, Schmelz M, Bíró T, et al. Frontiers in pruritus research: scratching the brain for more
effective itch therapy. J Clin Invest. 2006;116(5):1174–1186....
 Anands ,2012; Pruritus in palliative care
 PloS one ,2010 June 4th .
 Dermatol 2014 april (medline)
 Tarikci 2015, Review of aetiological factors and new treatment mopdalities

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