This book describes Pruritis (Itch), Diagnosis and Treatment and Related Diseases

Happiness is having a scratch for every itch - Ogden Nash

I have a female patient who always consulted me for chronic itch of the skin.

Sometimes she will have scratch marks all over her arms and legs and her back with areas of infection and bleeding.

I have advised her to avoid all dusts, soaps and detergents, certain food, stress, animals, etc from her environment and not to scratch. I have asked her to go for skin allergy tests.

With treatment the rash will disappear but it will recur one or two weeks later.

I have also advised her to see a psychiatrist for stress and tension.

Pruritus is the medical term for itch.

Itch is such an unpleasant sensation on the skin that stimulates the desire to rub or scratch the area to obtain relief.

Itch can produce discomfort and frustration; in severe cases it can cause disturbed sleep, anxiety and depression.

Constant scratching to obtain relief can injure the skin (excoriation, lichenification) and decrease its effectiveness as a major protective barrier.

Consistent scratching over a period of time may cause:

1. Lichenification (thickened skin, lichen simplex)


2. Prurigo papules and nodules

Pruritus is often a symptom of an underlying disease process such as a skin disorder, a systemic disorder, or abnormal nerve impulses.

There are no specific skin signs linked with pruritus, besides scratch marks and signs of the underlying disorder.

The skin is the body's largest organ, and itching can be a sign something is not right with the skin.

Itch, like pain, can begin anywhere along the neural itch pathway, from the central nervous system (brain and spinal cord) to the peripheral nervous system and the skin.

The mechanisms underlying pruritus are complicated.

The itch signal is transmitted mostly through small, itch-selective C-fibers in the skin in addition to histamine-triggered and non-histaminergic neurons.

These bind with secondary neurons which cross the opposite side of the spinothalamic tract and go up to parts of the brain involved in sensation, emotion, reward and memory.

These brain regions partly cover those activated by pain.

Patients with chronic pruritus normally have both peripheral and central hyper-sensitization (a heightened reaction) which indicates that they are likely to overreact to noxious stimuli which normally inhibit itch (e.g., heat and scratching) and misinterpret non-noxious stimuli as an itch (e.g., light touch)

The reason why scratching stops the itching has been explained by an interaction with pain pathways within the dorsal horn of the spinal cord.

Depending upon the underlying disorder, itchiness may be linked with other symptoms and signs.

Most often, these linked findings are skin lesions such as rash, blisters, bumps, or redness of the affected area.

Dryness of the skin is a frequent cause of itch.

Itching of skin can cause tears in the skin from scratching.

Less often, generalized itching all over the body can be a sign of chronic medical disorders such as liver disease.

In these circumstances, there may be no alterations to the appearance of the skin.

Stress, anxiety or other emotional disorders can induce itching.

If a skin disorder is responsible for the itch, occasionally a biopsy may be done to identify the disorder.

The treatment of pruritus depends on establishing the underlying disorder and then either removing or treating the disorder to prevent further itching.

TABLE OF CONTENT

Introduction

Chapter 1 Pruritis (Itch)

Chapter 2 Causes

Chapter 3 Symptoms

Chapter 4 Diagnosis

Chapter 5 Treatment

Chapter 6 Prognosis

Chapter 7 Pruritis Ani

Chapter 8 Pruritis Vulvae

Epilogue