Pruritus refers to an unpleasant skin sensation that triggers the urge to scratch or rub. It can be related to physical and chemical irritants, skin diseases, and endocrine disorders. Traditional Chinese Medicine (TCM) believes that pruritus is often caused by external pathogens such as wind-toxins and rheumatism, which accumulate in the skin and lead to disharmony between the Ying and Wei systems, or by internal disturbances of blood heat or blood deficiency. While scratching can temporarily relieve itching, excessive scratching often further damages the skin, creating a vicious cycle of more scratching, which can lead to more serious consequences such as skin infections. Furthermore, pruritus can also indicate certain health problems. Therefore, if pruritus persists or worsens, seek medical attention promptly.
symptom
Classification
Traditional Chinese medicine classifies pruritus into five types, namely wind-heat syndrome of the skin, damp-heat syndrome of the skin, cold-stagnation and blood-astringency syndrome of the skin, insect poison accumulation syndrome and skin malnutrition syndrome.
1. Wind-heat syndrome of the skin
The itching is often recurrent and may affect the entire body. Warm bedding can easily cause itching. Scratching may cause bleeding, which will heal as soon as it is broken, preventing it from rotting. The tongue coating is thin and yellow, and the pulse is floating and rapid.
2. Damp-heat syndrome of the skin
Persistent itching of the skin, with scratches and scabs that easily erode along the epidermis, oozing yellow fluid, and increasing itching as it rots. This may be contagious, accompanied by a bitter taste in the mouth, dry throat, chest tightness, and poor appetite. A red tongue with a greasy yellow coating and a weak and rapid pulse.
3. Cold blood stagnation and astringent skin syndrome
Skin itching, worse in cold weather, relieved by hot ironing or scratching until bleeding. Dark red tongue with white fur, deep, slow or stringy pulse.
4. Insect poison accumulation in skin syndrome
The itching is severe, invasive and spreading, with frequent discharge of yellow fluid, resembling a worm crawling under the skin, and is easily contagious. The tongue is red, with a thin yellow coating and a wiry pulse.
5. Skin malnutrition syndrome
Itchy skin, long course, thickening, dryness, scaling, rarely erosion and discharge, accompanied by dizziness, sallow complexion, pale tongue, thin white fur, and thready pulse.
Typical manifestations
Pruritus can be localized or systemic, paroxysmal or persistent, and mild or intense. Constant scratching can lead to scratch marks, blood crusts, or hyperpigmentation, sometimes with secondary skin lesions such as lichenification. Furthermore, patients often experience negative emotions such as impatience, irritability, depression, and insomnia.
complication
1. Secondary skin infection
Itch can cause patients to scratch their skin, and excessive scratching can damage the integrity of the skin, causing problems such as skin ulceration and bleeding, making it easier for pathogens such as bacteria and fungi to invade the skin.
2. Sleep disorders
Itching may worsen at night, and persistent itching can disrupt the patient’s sleep quality, leading to difficulty falling asleep or frequent waking up at night, which not only affects the patient’s rest and recovery but may also affect daytime activities and overall health.
reason
Overview
Pruritus can be caused by a variety of factors, which can be broadly categorized into Western medicine and Traditional Chinese Medicine. Western medicine causes include physical and chemical stimulation, medication use, skin diseases, endocrine disorders, and blood disorders, while Traditional Chinese Medicine causes include external invasion of wind toxins, infiltration of dampness, stagnation of pathogenic heat, invasion of insect toxins, and blood deficiency and wind-dryness.
Cause of symptoms
1. Western medicine reasons
(1) Stimulation by physical and chemical factors: When the skin is stimulated by physical factors (such as friction, temperature changes, etc.) or chemical factors (such as acidic and alkaline substances, irritating detergents, cosmetics, etc.), the sensory nerve endings inside it will be activated, causing nerve impulses to be transmitted to the sensory center of the brain through nerve fibers. The brain interprets these signals as itching, thereby producing itching symptoms.
(2) The use of certain drugs: such as opioids, antidepressants, certain central nervous system stimulants, etc., may have the side effect of causing itching.
(3) Skin diseases: such as contact dermatitis, scabies, pityriasis rosea, psoriasis, neurodermatitis, urticaria, eczema, insect bite dermatitis, etc.
(4) Endocrine diseases: such as hyperthyroidism, hypothyroidism, diabetes, etc.
(5) Blood diseases: such as iron deficiency anemia, lymphoma, leukemia, etc.
(6) Others: such as primary biliary cirrhosis, biliary obstruction, hepatitis, chronic renal failure, visceral malignancies, central nervous system tumors, systemic lupus erythematosus, rheumatic fever, rheumatoid arthritis, intestinal parasitic diseases, schistosomiasis, AIDS, delusional disorder, etc.
2. Traditional Chinese Medicine reasons
(1) External invasion of wind-toxicity: The patient is intolerant by nature and has loose skin pores. Wind-evil or wind-toxicity invades the skin, which can lead to disharmony between the local Ying and Wei systems and cause itchy skin.
(2) Dampness infiltrates the skin: Rheumatism infiltrates the skin, causing disharmony of qi and blood, which in turn causes itchy skin.
(3) Stagnation of pathogenic heat: Stagnation of pathogenic heat in the skin and heat disturbance of the meridians can lead to skin disharmony and further cause itching.
(4) Insect poison invades the skin: Insect poison invades the skin and the poison spreads through the blood vessels, which can cause disharmony of qi and blood, and then cause skin itching.
(5) Blood deficiency and wind dryness: Chronic skin diseases that do not heal for a long time can lead to blood deficiency, wind and dryness, and skin malnutrition, which in turn causes itching.
Common diseases
Contact dermatitis, scabies, pityriasis rosea, psoriasis, neurodermatitis, urticaria, eczema, insect bite dermatitis, hyperthyroidism, hypothyroidism, diabetes, iron deficiency anemia, lymphoma, leukemia, primary biliary cirrhosis, biliary obstruction, hepatitis, chronic renal failure, visceral malignancies, central nervous system tumors, systemic lupus erythematosus, rheumatic fever, rheumatoid arthritis, intestinal parasites, schistosomiasis, AIDS, and delusional disorder
Seeking medical treatment
Outpatient indications
1. Long-term or recurring skin itching;
2. The itching gradually worsens;
3. The itching is severe and affects sleep or daily life;
4. Itching accompanied by rash manifestations such as erythema, papules, blisters, erosion, exudation, etc.
5. Itching causes skin damage and skin infection;
6. Other severe, persistent or progressive symptoms and signs occur.
All of the above require prompt medical consultation.
Treatment department
1. Patients should first visit the dermatology department.
2. If you suspect that it is caused by infection, you can go to the infectious disease department for treatment.
3. If you suspect that it is caused by endocrine disease, you can go to the endocrinology department for treatment.
4. If you suspect that it is caused by a blood disease, you can go to the hematology department for treatment.
5. If you suspect that it is caused by liver and gallbladder disease, you can go to the gastroenterology department for treatment.
6. If you want to take traditional Chinese medicine treatment, you can go to the Traditional Chinese Medicine Department for treatment.
Medical preparation
1. Make an appointment in advance and bring your ID card, medical insurance card, medical card, etc.
2. The doctor may examine multiple areas of your skin, so it is best to wear loose clothing.
3. If some special examinations are required, such as liver function, you must fast as directed by the doctor.
4. If you have had medical treatment recently, please bring relevant medical records, examination reports, etc.
5. If you have taken some medicine to relieve symptoms recently, you can bring the medicine box with you.
6. Family members can be arranged to accompany the patient to seek medical treatment.
7. Patients can prepare a list of questions they want to ask in advance.
What questions might a doctor ask a patient?
1. When did you start to feel itchy?
2. Does the itching occur all over the body, or is it limited to a specific area?
3. Is the itching constant or intermittent? Are there any characteristics?
4. What is the severity of the itching? Is it mild and tolerable, or is it severe enough to affect your normal life?
5. In addition to itching, do you have other discomfort symptoms, such as burning or stinging?
6. Will scratching relieve itching?
7. Have you ever suffered from skin diseases such as eczema, psoriasis, etc.?
8. Do you have any systemic diseases, such as liver disease, kidney disease, diabetes, etc.?
9. Do you have any allergies? Have you recently been exposed to new substances, including new cosmetics, detergents, clothing materials, etc.?
10. Are you taking any medications recently?
11. How is your mental state recently?
12. Have you received treatment at other hospitals? What treatment methods did you use? What were the results?
What questions can patients ask their doctor?
1. Why do I feel itchy?
2. What tests do I need to do?
3. What treatment do I need now?
4. Is there any way to quickly relieve itching?
5. How long does it usually take to recover?
6. Can it be cured? Will it recur after treatment?
7. I have other diseases. Will it affect my treatment?
8. What do I need to pay attention to in my daily life?
9. Is follow-up examination necessary? How often?
examine
Scheduled inspection
The doctor will first perform a physical examination on the patient to gain a preliminary understanding of the lesion. He may then recommend a blood test, blood biochemistry, serum IgE measurement, thyroid function test, skin tissue pathology examination, dermatoscopy and other examinations to determine the cause of the disease.
Physical examination
1. Visual examination
Doctors will primarily observe the itchy area for signs of skin lesions such as papules, blisters, scabs, scratches, discharge, erosions, and desquamation. If lesions are present, their characteristics, including number, extent, and distribution, will be noted.
2. Medical consultation
The doctor will ask the patient about the time, severity, accompanying symptoms, personal life history, and medical history of the itching.
3. Palpation
The doctor can gently touch the itchy area to determine if there is a rash and whether it fades when pressed. In addition, the Chinese medicine doctor will also feel the changes in the pulse to help determine the syndrome.
Laboratory tests
1. Blood routine test
This test can understand the levels of white blood cells, red blood cells, hemoglobin and other indicators, thereby determining whether the body has problems such as infection and anemia.
2. Blood biochemistry
This test can understand the patient’s liver function, kidney function, blood sugar levels, etc., thereby helping to determine whether the patient has liver disease, kidney disease and diabetes.
3. Serum IgE determination
Doctors can preliminarily determine whether itching is related to an allergic reaction by testing the level of IgE in the blood.
4. Thyroid function test
This test can determine whether the patient’s thyroid function is normal and whether the itching is caused by thyroid disease.
Pathological examination
If necessary, the doctor will take some untreated typical skin lesion tissue for pathological examination to clarify the nature of the skin lesions, thereby helping to diagnose and differentially diagnose skin diseases and guide clinical treatment.
Other tests
Dermatoscopy can magnify living skin several to dozens of times, allowing observation of submicroscopic structures and pathological changes both on the surface and beneath it. Doctors can use the observed changes in the morphology and patterns of structures like pigment and blood vessels to assist in the diagnosis and differential diagnosis of various skin diseases.
diagnosis
Diagnostic principles
Generally, a diagnosis can be made based on a medical history, the patient’s symptoms of itching, erythema, papulovesicles, and lichenoid lesions, and combined with a physical examination, blood count, blood biochemistry, serum IgE assay, thyroid function tests, skin histopathology, and dermoscopy. During the diagnosis process, doctors need to differentiate between several common pruritus-causing diseases, such as scabies, eczema, and psoriasis.
Differential diagnosis
1. Scabies
Scabies is a contact-transmitted skin disease caused by the parasitic mites Sarcoptes scabies, which inhabit the epidermis. It can spread within dormitories or families. Patients often experience intense itching, especially at night. Skin lesions manifest as pinhead-sized papules, papulovesicles, and blisters, often distributed symmetrically. Furthermore, burrows dug by scabies mites are often visible between the fingers, appearing as grayish-white or light-black, curved, slightly raised lines, a characteristic symptom of scabies.
2. Eczema
Eczema is an inflammation of the superficial dermis and epidermis caused by a variety of internal and external factors. In the acute phase, lesions primarily present as papulovesicles with a tendency to exudate; in the chronic phase, lesions primarily present as lichenification and are prone to recurring. Patients often experience intense itching, which can be aggravated by alcohol, scratching, washing with soap, or scalding with hot water, sometimes even affecting sleep.
3. Psoriasis
Psoriasis is a chronic, relapsing, inflammatory, systemic, immune-mediated disease caused by a combination of genetic and environmental factors. Patients primarily present with scaly, erythematous plaques or patches on the skin, which can be localized or widespread, and may be accompanied by itching.
treat
Expected treatment
For patients experiencing itching, the first step is to try to alleviate the symptoms by avoiding contact with irritants, keeping the skin clean, and adjusting one’s mood. If the itching persists or is accompanied by other discomfort, seek medical attention promptly to determine the cause, and then take targeted measures such as topical medications, oral medications, and physical therapy.
Treatment of the cause
1. Scabies
Once diagnosed with scabies, patients should be immediately isolated, and their clothing and bedding should be boiled and disinfected to reduce the risk of infection. Treatment primarily relies on topical medications, commonly including sulfur ointment, salicylic acid ointment, and benzyl benzoate liniment, to quickly kill the scabies mites. If itching is severe, antihistamines such as loratadine and cetirizine can be taken as directed by a doctor. If secondary infection develops, antibiotics should be used concurrently. For patients whose scabies nodules are unsuccessful with other treatments, surgical treatment may be considered. Furthermore, family members or those living in groups should be treated simultaneously to prevent cross-infection.
2. Eczema
For patients with acute exudative eczema, wet compresses such as 1%–3% boric acid solution, 0.9% sodium chloride solution, dehumidifying and antipruritic lotion, Furukang lotion, Erfukang liniment, and Shenbai lotion can be used as directed by a doctor to reduce exudate and relieve redness and swelling. For patients with acute non-exudative and subacute eczema, topical glucocorticoids are the preferred treatment. Commonly used medications include dexamethasone cream, hydrocortisone cream, and mometasone furoate cream (such as 999 mometasone furoate cream). If patients are afraid of hormones and still refuse to use them after sufficient explanation, tacrolimus ointment, crisaborole ointment, and calamine lotion can be used as directed by a doctor. For patients with chronic eczema, topical hormones should be used as directed by a doctor, and if necessary, a seal or wet pack can be used to enhance efficacy. Patients are generally advised to take non-sedating second-generation antihistamines (such as cetirizine and loratadine) regularly as directed by their doctor until symptoms subside. If severe itching interferes with sleep, a sedative first-generation antihistamine (such as diphenhydramine and astemizole) can be added before bed. In addition, traditional Chinese medicine extracts (such as compound glycyrrhizin and total glucosides of white paeony), immunosuppressants (such as cyclosporine and mycophenolate mofetil), and traditional Chinese medicines (such as Piminxiao Capsules and Xiaofeng Zhiyang Granules) are also effective in treating this condition.
3. Psoriasis
Treatment for this disease primarily relies on topical medications, commonly including emollients, glucocorticoids, vitamin D3 derivatives, and tretinoin. These medications are administered through topical application, occlusive packs, and wet packs. Systemic medications include methotrexate, cyclosporine, adalimumab, and apremilast. Furthermore, psychotherapy and physical therapy (such as photodynamic therapy and pulsed dye laser) are also important.
General treatment
1. Avoid scratching. If the itching is unbearable, you can try to relieve it by patting or applying cold compress.
2. Keep your skin clean, but be careful to avoid over-cleansing and using irritating products.
3. Maintain appropriate indoor temperature and humidity.
4. Avoid contact with known allergens and irritants, such as pollen, dust mites, animal hair, etc.
5. Wear loose, pure cotton clothing and avoid tight, chemical fiber clothing.
6. You can relax your emotions, reduce stress and anxiety through deep breathing, meditation, yoga, etc., thereby relieving itching to a certain extent.
Drug treatment
See causal treatment and Traditional Chinese Medicine treatment for details.
Related drugs
Sulfur ointment, salicylic acid ointment, benzyl benzoate liniment, loratadine, cetirizine, 1%-3% boric acid solution, 0.9% sodium chloride solution, dehumidifying and antipruritic lotion, Furukang lotion, Erfukang lotion, Shenbai lotion, dexamethasone cream, hydrocortisone cream, mometasone furoate cream (such as 999 mometasone furoate cream), tacrolimus ointment, crisaborole ointment, calamine lotion, diphenhydramine, astemizole, compound glycyrrhizic acid glycosides, total glucosides of white paeony, cyclosporine, mycophenolate mofetil, methotrexate, Piminxiao capsules, Xiaofengzhiyang granules, adalimumab, apremilast
Surgical treatment
If the patient with pruritus is diagnosed with an organic lesion after examination and other treatments are ineffective or unsuitable, surgical treatment should be considered.
Traditional Chinese Medicine treatment
1. Syndrome differentiation and medication
(1) Wind-heat syndrome of the skin: Treatment should be to dispel wind, clear heat and relieve itching. The main prescription is Xiaofengsan. Commonly used Chinese herbs include Angelica sinensis, Radix Rehmanniae, Saposhnikovia divaricata, Periostracum Cicadae, Rhizoma Anemarrhenae, Sophora flavescens, Sesame Seed, Schizonepeta tenuifolia, Atractylodes macrocephala, Arctium lappa, Gypsum, Licorice, Akebia trifoliata, etc.
(2) Skin damp-heat syndrome: Treatment should focus on clearing away heat, dispelling dampness, and relieving itching. The main prescription is Dixie Shenshi Decoction. Commonly used Chinese herbs include Dixie, Coix Seed, Phellodendron, Poria, Paeonia Suffruticosa, Alisma, Talc, and Smilax glabra.
(3) Cold blood stagnation and astringent skin syndrome: Treatment should be to warm the yang and dispel cold, activate blood circulation and remove blood stasis. The main prescription is Jingfang Baidu San. Commonly used Chinese herbs include Schizonepeta spicata, Saposhnikovia divaricata, Notopterygium wilfordii, Angelica dahurica, Ligusticum chuanxiong, ginger, licorice, mint, Bupleurum chinense, Peucedanum chinense, Citrus aurantium, Platycodon grandiflorum, Poria cocos, etc.
(4) Insect poison accumulation in the skin: Treatment should focus on killing insects, detoxifying, and relieving itching. External treatment is the main approach. When accompanied by infection, Xiaofengsan combined with Huanglian Jiedutang should be used. Commonly used Chinese herbs include Angelica sinensis, Radix Rehmanniae, Saposhnikovia divaricata, Periostracum Cicadae, Rhizoma Anemarrhenae, Sophora flavescens, Sesame Seed, Schizonepeta tenuifolia, Atractylodes macrocephala, Arctium lappa, Gypsum, Licorice, Akebia trifoliata, Coptis chinensis, Scutellaria baicalensis, Phellodendron amurense, and Gardenia jasminoides.
(5) Skin malnutrition syndrome: Treatment should focus on nourishing yin, replenishing blood, and relieving itching. The main prescription is Danggui Yinzi. Commonly used Chinese herbs include Danggui, Chuanxiong, White Peony Root, Rehmannia Glutinosa, Saposhnikovia Divaricata, Tribulus Terrestris, Schizonepeta Tenuifolia, Polygonum Multiflorum, Astragalus, and Licorice.
2. External treatment
(1) For patients with general itching, you can use antipruritic tincture or Stemona tincture for external application as prescribed by the doctor.
(2) For patients with mucosal damage, topical application of Xilei Powder, Bingpeng Powder, Danbai Zhenzhu Powder, etc. can be used as prescribed by the doctor.
(3) For patients with dry, scaly, and thick skin, they can use indigo ointment, coptis ointment, black oil ointment, moisturizing cream, etc. for external application as prescribed by the doctor.
3. Acupuncture
Commonly used acupoints include Quchi, Zusanli, Hegu, Sanyinjiao, Xuehai, Weizhong, etc. The specific acupoint selection and operation should be performed by professional doctors.
It should be noted that patients who need Chinese medicine treatment should first go to a regular Chinese medicine hospital for treatment, and then be prescribed Chinese medicine by a professional Chinese medicine doctor after diagnosis. When purchasing medicine, you should pay attention to identifying the supplier of medicinal materials. It is recommended to choose large pharmaceutical companies such as China Resources Sanjiu. Such companies can strictly follow national standards, control the quality of medicinal materials from the source, and ensure the quality and efficacy of the Chinese medicine sold.
Treatment cycle
The treatment cycle is affected by factors such as the severity of the disease, treatment plan, treatment timing, age and physical condition, and may vary from person to person.
Estimated treatment costs
There may be significant individual differences in treatment costs, which are related to the selected hospital, treatment plan, medical insurance policy, etc.