Itch (Pruritus) – Diagnosis, Prevention & Treatment

What is Itch (Pruritus)?

Itch (Lat. pruritus) is a skin sensation that provokes a desire to scratch (1). Itching occurs when certain substances produced by the body, like biliary salts or histamine, or those coming from the outside, like wool or nickel, irritate nerve endings in the skin.

Itch is not the same as tingling, or burning pain; they may sometimes all appear together, though.

Mechanism of Itch

Stimuli that cause itch may originate from the skin, peripheral nerves or central nervous system (spinal cord and brain). A substance histamine is usually released from mastocytes (special cells in the skin) in itch. This is why antihistamines may help in different types of itch.

1. Dermal Itch (Originating in the Skin)

Stimuli that can irritate the skin may be mechanical, thermal, chemical, or electrical. If they irritate itch-related nerve endings (itch receptors – pruriceptors), they cause itch, and if they irritate pain related nerve endings (pain receptors – nociceptors) they cause pain (2).

It seems that itch and pain mechanisms overlap considerably and may exclude each other to some level. For example: opioids (e.g. morphine) reduce pain, but may increase itch at the same time. On the other hand, painful scratching may reduce itch (3). Information of skin irritation is conveyed via peripheral nerves through spinal cord into the brain where it is interpreted either as an itch or as a pain.

Itch receptors are present only in uppermost layer of the skin (epidermis) and mucous membranes of  body openings (eyes, ears, nose, mouth and throat, anus, urethra, and genitalia), but not in the muscles, joints and internal organs, which therefore cannot itch (4).

2. Neuropathic Itch (Due to Nerve Damage)

Examples of neuropathic pain are brain tumors, multiple sclerosis, peripheral neuropathy (like in diabetes), and nerve injury.

3. Neurogenic Itch

Neurogenic itch originates from central nervous system but not from damage of the nerve tissue. It may be associated with opioids (analgesic substances) secreted from brain, or by synthetic opioids.

4. Psychogenic Itch

It is known that a person who does not feel comfortable about something or is about saying something not really convincing often rubs the bottom part of the nose.A feeling of itch may also appear in psychological disorders, like delusion of parasitosis or neurotic scratching.

Causes of Itch

Skin itch can be caused by sweating, dry skin, infections, allergies, liver or kidney disease, hormonal disorders, medications, psychological causes, and so on (read more about causes of itchy skin). Seeing someone to scratch or even discussion about itch can cause itchy sensation in some individuals; this is called contagious itch.

Localized Itch

Itch can be generalized (itching all over), or can affect only limited parts of the skin or mucosa:

Diagnosis of Itch

First, itch has to be distinguished from tingling and pain. Often a cause of itch can be determined from circumstances, like insect bite, food allergy, medications, drugs…or from skin changes like swelling, redness, discolorations or rash.

When the cause of itch is not obvious, the following tests may be needed (9):

  • Measuring of body temperature (temperature is raised in many in infections and some cancers), and weight (weight loss occurs in malabsorption, some cancers, eating disorders, stress, and so on)
  • Body examination to find jaundice, rash, parasites, painful spots, areas of changed sensitivity, and other skin changes.
  • Blood tests:
    • Red cells (decreased in anemia, increased in polycythemia)
    • White cells (increased in various infections, leukemia, lymphomas)
    • Sedimentation rate, CRP (elevated in some infections and in most malignancies)
    • Glucose – blood sugar (elevated in diabetes)
    • Urea (increased in kidney failure), blood urea nitrogen (BUN)
    • Liver enzymes
    • Thyroid and parathyroid hormones
    • Vit A level
    • Zinc level (zinc deficiency can cause itching and gastrointestinal problems)
    • Toxic heavy metals (mercury, lead, aluminium, arsenic, bismuth, cadmium, etc.) (8)
  • Chest X-ray, if Hodgkin lymphoma is suspected
  • Abdominal ultrasound in suspected liver/gallbladder disease
  • Urine tests may reveal liver or kidney disease, elevated glucose levels, and so on.
  • Stool tests may reveal intestinal parasites; hemoccult testmay reveal intestinal bleeding (in Crohn’s disease, colorectal cancer)
  • In skin diseases, a skin scraping, or skin biopsy, during which a small piece of skin is surgically removed and investigated under microscope may be required. Skin redness, rash, blisters, swelling, bumps or lumps are often associated with skin causes of itch, but rash can also appear in gut diseases, like celiac disease, Crohn’s diseaseand others. It is important to remember that the presence of skin changes does not exclude the possibility of an underlying disease, and the absence of a rash does not exclude skin disorders. Besides that, two or more causes of chronic pruritus may exist at the same time.
  • If an allergy is suspected, skin tests and blood tests (eosinophils – a type of white blood cell) may be done.
  • Diet trials may reveal food intolerances (lactose intolerance, fructose malabsorption, celiac disease), or allergies.
  • Temporarily discontinuation of medications may reveal drug side effects or allergies to certain drugs.

Treatment of Skin Itching

What to do to get rid of itching (9):

1. Avoid Scratching

Scratching can cause more itch, so resist to scratch, if possible.

2. Wash

Washing helps to relieve itching after:

  • An usual working day…
  • Excessive perspiration
  • Folliculitis
  • Contact with irritant substances, like fiberglass (washing will not help, if dermatitis has already developed)

Avoid bathing in hot water, excessive use of soaps, and rough drying with towels.

3. Cool

Cold baths, light clothes, cool temperature at home and work relieves itch, while hot and humid environment aggravates it. Cool showers and light bed clothes can relieve itch at night. Cold tap wateror compresses rinsed in cold water, ice cubs in plastic bag, or cooling lotions (calamine, pramoxine, menthol, eucalyptus, camphor) placed over the itchy skin area can help in:

  • Bacterial skin infection like folliculitis
  • Contact dermatitis
  • Insect bite
  • Allergies

4. Moist (Emollients, Moisturizers)

Therapy of itch due to dry skin bases on maintaining adequate skin moisture. Over-the-counter moisturizing cream (they should be odorless and colorless), applied right after bathing can help (6). Gently massaging itchy area may also bring some relief.

5. Antipruritics – Medications and Remedies Against Itch

Topical antipruritics (creams, sprays) are often available over-the-counter. Oral drugs are usually need prescription.

  • Antihistamines like diphenhydramine (Benadryl per mouth) help in allergic reactions. Antihistamines can cause drowsiness, so they should not be taken before driving. Antihistamines without sedation effect are loratidin and fexofenadine, available without prescription. Topical antihistamines should not be used as they may cause allergic dermatitis.
  • Corticosteroids: hydrocortisone topical cream in low (1%) concentration (to prevent thinning of the skin) can reduce skin inflammation. Corticosteroids per mouth are used in heavy arthritis, multiple sclerosis, or other systemic inflammatory diseases.
  • Local anesthetics (benzocaine topical cream) may be used in intense itching or burning pain.
  • Opioid-receptor antagonists (naloxone, butorphanol intranasal spray, naltrexone tablets) may be used in sever pruritus, for example, in kidney or liver disease.
  • Tricyclic antidepressants as Doxepin or amitriptyline have antipruritic properties. Tetracyclic antidepressants, such as mirtazepine and selective serotonin reuptake inhibitors (paroxetine, fluoxetine), may help in severe itch.
  • Adstringents (drying agents). Burrow’s solution (containing aluminium acetate) shrinks vessels in the skin or mucous membranes thus reducing inflammation and itch. It may be used as a cold compress in inflammed swollen skin (like in hives in poison ivy, cellulitis) or mucosal membranes, for example, to treat vulvar or vaginal itch.
  • Capsaicin ointment may help in intense localized itch like in nostalgia paresthetica (back itch), or in localized tingling.
  • Tacrolimus ointment can be prescribed in atopic dermatitis.
  • Crotamiton (Eurax) cream can be used to treat scabies.
  • Exchange resins such as cholestyramine bind bile salts in skin and thus help in relieving itch caused by liver disease with cholestasis.
  • Chelating agents, like EDTA, bind heavy metals and may help in itch due to toxic metal intoxications.
  • Pramoxin is effective in rosacea.
  • Low protein diet may help in relieving itch in chronic renal failure.
  • Cholestyramine and rifampin help in liver disease with bile flow obstruction. Cholestyramine was not proved effective in renal failure.
  • Aspirin may help in certain non-allergic causes of pruritus. Aspirin should not be used to treat itch in children with viral diseases, since it can cause Reye’s syndrome – a rare but severe hepatic disorder.

6. Antimicrobials

In fungal, parasitic or bacterial infections, antimicrobial ointments or soaps, or antibiotics by mouth or injection may be required. In some viral infections (Epstein-Barr, Herpes zoster, citomegalovirus…), acyclovir (or its variants) per mouth or as ointments may help.

7. Phototherapy

Phototherapy using ultraviolet UV-B rays is effective in severe itch (renal failure, prurigo nodularis, atopic dermatitis, AIDS, and aquagenic pruritus). Psoralen plus ultraviolet A (PUVA) phototherapy may help in polycythemia.

8. Treat the Cause

The cause of itchiness can be usually successfully treated in bacterial and fungal infections and parasites. Most kidney and hormonal disorders and even several cancers can be successfully treated.

9. Wait and Prevent

Sometimes treatment of the cause is not possible, or not necessary, so waiting that a disease heals by itself, and prevention of its re-occurrence is recommended. This may apply for:

  • Most viral skin infections
  • Staphylococcal or pseudomonas folliculitis
  • Viral hepatitis
  • Contact dermatitis
  • Allergies
  • Ciguatera poisoning

Itch Prevention

Measures to reduce possibility to get an itching condition include:

  • Showering or bathing regularly, washing hair at least once a weak, washing hands to avoid contracting skin staph infection or parasites, washing sportswear after each use
  • Avoiding hot humid environment
  • Avoiding alcohol, caffeine, spices that dilate skin vessels and thus heat the skin
  • Wearing light, lose clothes and underwear made by material that absorb sweat (like cotton). Wool, rough natural materials like flax, and synthetic clothes may irritate the skin.
  • Using protective clothes when dealing with irritant substances, like fiberglass or detergents, working on garden, walking through woods
  • Protecting against wind and sun by using appropriate clothes and cremes
  • Limiting cosmetics


Scratching can irritate the skin and aggravate itch. Vigorous scratching may cause deep scrapes in the skin. In some people, even gentle scratching causes raised, red streaks that can itch intensely. Prolonged scratching and rubbing can thicken and scar the skin. Fingernails, especially in children, should be kept short to minimize abrasions from scratching. If the urge to scratch is irresistible, rubbing the skin with the palm rather than scratching is recommended.

Scratching an itch on one part of the body can cause itchy sensation on another, obviously unrelated part of the body. This is called referred itch or Mitempfindung (7).


  1. Itching (pruritus) definition (
  2. Prurireceptors (
  3. Antagonistic action of pain and itch stimuli (
  4. Mechanism of itch (
  5. Medications for itchy skin (
  6. Remedies and medications for itchy skin (
  7. Referred itch – Mitempfindung (
  8. Toxic metals (
  9. Tests and treatment of generalized pruritus (
About Jan Modric (249 Articles)
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  • Steve

    Dear Doctor,

    My name is Steve 37 yrs a Nigerian,I am feeling itching all over my body including the the rectum and am feeling burning sensation within my private part,I urinate every 1 hour and am pressed i did not urinate immediately and later when i want to pass the urine i will force my self to urinate and it will come out just little,I complained to my physician he said is infection and sent me for lab (diagonise)and he recommended AVEFLOX 500mg 2 tabs per day and i have taken it 2 packets no relief till now.It has started affecting my sight now, i cannot see very far anymore.

    Everything started from constipation 7 years ago, i have done colonoscopy 3 months ago nothing was found and my physician said he is suspecting (IBS).

    Please help me to restore my health especially my private part,I want to be urinating normal again.

    I am waiting for your positive response.



    • Jan Modric


      I’m not a doctor, but itching all over the body, in rectum and genitalia, may be due to parasitic infection. Urine and stool test specifically for parasites could reveal them. Medications you got, act only against bacteria, but not parasites.

  • helen

    i use to have ictching all over my body after bath every day so what do i do

    • Jan Modric


      do you itch only after contact with hot water or also lukewarm water? Do you itch only after washing hair? Do you itch even without using any soap or shampoo? Does any rash appear during or after bath? From when do you have this problem? How old are you? Do you have any allergies or are you taking any medicines? Do you have any chronic disease? Does anyone else living with you have the same problem?

  • Monu

    i m male 23 years old.
    i use to have itching all over my body after bath every day so what do i do.
    No rashes appear on my body ,it is only sometimes severe itching only.
    This problem is with me from last 2-3 months.
    Kindly help me out by giving some solution.
    I will be very uch thankful to you.

    • Jan Modric


      the itch can be related to groin itch you have described in another thread.

  • shabbir hussian

    please suggest me medicines for reducing the itching in my head

    • Jan Modric

      shabbir hussian,

      do you have any rash or other change on the scalp?

  • Evans

    I am from Zambia,africa, I have a three year old son who was accidentally sat in boiling water abot four months ago. His bums got burn badly about 10 percent burns.
    He is now healed from the burns but has burn scars on his bums. The problem is that after the wounds had healed, we have never had a peaceful sleeps! he tends to scratch the whole night, we have tried various creams but they seem not to be working, the itching seems to be getting worse. Is there anyone one who can help me with a solution to the itching?

    • Jan Modric


      a plastic surgeon or dermatologist may examine your son’s scars and tell what can be done.

  • Bruno

    Thanks for this thread and the physician in the house. I have been having this 3 minutes body itching after a cold bath. since i was 12 years old and now I’m 41. First, I thought it was allergies to certain foods like eggs or alcohol, it actually reduced when I stopped consumption of the mentioned foods. But I noticed that this always happens during the summer period whenever i take a cold shower because the itching after bath during the winter (due to warm water bath) never occurs. Due to this temperature effect, I started suspecting chlorine in waters because i could remember I use to have severe itching after bath when I bath in well water and swimming pool. What could be the exact remedy or solution to my problem. Please help!!!

    • Hi Bruno. We do not prescribe any treatment or make any diagnoses on this platform. Without knowing what is causing the itching it can be difficult to guide you to what could help in terms of a remedy. Temperature changes may trigger the itch receptors which is why you are finding this occur after a bath. Chlorine is another matter altogether as it is known to irritate the skin with some people experiencing an irritation more easily than others. You may want to read this article on itching after bathing