Update on Generalized Itching (Pruritus)
Generalized itching (i.e., generalized pruritus) is a condition which can be quite annoying. It is when an individual has diffuse itching of the body usually without an associated rash. Approximately 20-25% of the general population experiences generalized pruritus at least one time in their life. The itching may be intermittent or it may be chronic in nature. “Acute” itching is when the itching has been present for less than 6 weeks. “Chronic” itching is defined by having it for 6 or more weeks. The itching may last for years in certain individuals. The severity of the itching may vary from very mild to very severe where it can interfere with one’s quality of life. If the itching becomes chronic, it is important to see a board certified allergist, like the ones at Black & Kletz Allergy, so that a cause of the itching can hopefully be identified. Note that generalized itching may also be associated with hives (i.e., urticaria) and/or swelling (i.e., angioedema).
There are many causes of generalized itching. Allergies are a very common cause of itching. Allergies to oral and topical medications, foods, cosmetics, fragrances, metals, shampoos, nail polish, latex, poison ivy, poison oak, and poison sumac are just some of the common allergies that may cause itching. Contact dermatitis and eczema, (i.e., atopic dermatitis) are 2 other allergic conditions that may cause itching. Although allergies may be the cause of a lot of individual’s itching, it by no means the only reason for the pruritus. There are a variety of underlying conditions that may cause a person to have itching even though it may not be the most common symptom of the disease. Some of the underlying conditions that can cause itching may include diabetes mellitus, hepatitis B, hepatitis C, kidney disease, thyroid disease, malignancy, iron deficiency anemia, dyshidrotic eczema, HIV, folliculitis, ringworm, seborrheic dermatitis, neurodermatitis, shingles, xerosis (i.e., dry skin), psoriasis, bed bugs, parasitic infections, pregnancy, as well as many others. It is important that a cause be identified so that either the allergen is avoided or the management can be focused on the underlying condition responsible for the itching.
The diagnosis of generalized itching begins with a comprehensive history and physical examination. By performing a comprehensive history, the allergist is trying to ascertain the cause of the itching. It is common for a patient to forget or not bring up pertinent information that can help the allergist figure out the cause, so it is important for the allergist to ask a variety of questions in order to try to establish a cause or trigger of the pruritus. Asking questions such as, “Have been on any recent antibiotics or new medications?” or “Do you take aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)?” are good questions because many patients will not volunteer this information because they do not feel that it is important enough to mention to the physician. In reality, antibiotics, new medications, aspirin, and NSAIDs use are very common reasons for generalized itching. If no obvious allergen can be identified and the itching has lasted 6 weeks or more, looking for an underlying condition is the next step. This is usually done by blood tests.
The treatment of generalized itching is directed at avoiding the offending agent. If for example a new medication appears to be causing the itching, the medication should be stopped or changed to another appropriate medication. If it is a certain cosmetic or a specific food, then obviously the cosmetic or food should be avoided. In addition, using oral H1 blockers (i.e., antihistamines) is the most common treatment. Sometimes, adding an H2 blocker and/or a leukotriene antagonist to the Hi blocker is needed. Rarely, oral corticosteroids are needed for severe cases. Topical creams/ointments have been used with limited success. In most cases, medications may only be needed for 1 or 2 weeks, but can be necessary is some individuals for several years. If the itching persists for more than 6 weeks and bloodwork is obtained in order to rule out underlying conditions, then treating the underlying condition may in fact get rid of the itching.
The board certified allergy doctors at Black & Kletz Allergy have been diagnosing and treating generalized itching for more than 50 years. We treat both pediatric and adult patients. Black & Kletz Allergy has offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All 3 of our offices have on-site parking. For further convenience, our Washington, DC and McLean, VA offices are Metro accessible. Our McLean office location offers a complementary shuttle that runs between our office and the Spring Hill metro station on the silver line. To schedule an appointment, please call our office or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. If you suffer from generalized itching, hives, swelling episodes, or any other allergic condition, the allergy specialists at Black & Kletz Allergy are happy to help you. We are dedicated to providing you with the highest quality allergy care in a relaxed, considerate, and professional environment.