Itch (pruritus) without a rash

What is pruritus?

Pruritus (itching) refers to a sensation in the skin which causes a desire to scratch. It is very common, and in many cases is caused by skin conditions such as eczema and urticaria. This leaflet refers to pruritus where there is no rash or visible skin disorder.

What causes itch without a rash?

There are many potential causes including underlying diseases (i.e. a medical condition affecting internal organs such as the liver or kidneys) and certain medications. However, in many people no cause is found; this is called idiopathic pruritus - such a diagnosis can only be made if investigations have shown no underlying cause.

What else can contribute to pruritus?

• Age - pruritus is more common in older people
• Stress - can cause or aggravate pruritus
• Heat - will often make pruritus worse

Things you can do to help yourself

• Try to avoid overheating - wear appropriate cool, breathable clothing (e.g. cotton). Make sure baths and showers are lukewarm. Keep your bedroom cool and do not sleep with heavy or heat retaining bedclothes

• Do not wash (bath or shower) more than once a day. Avoid soap or anything else that makes a lather, even if it claims to be good for skin. Many of these contain detergents which remove natural oil from the skin, tending to aggravate pruritus

• Manage stress, get help from a health professional if needed

• Prevent skin damage - keep nails short. If you feel like you want to scratch your skin find something for your hands to do until the itch passes (e.g. a job around the house or use a stress ball). If you must touch your skin try patting rather than scratching or rubbing (scratching can break the skin, rubbing can causes the skin to thicken, which we call lichen simplex)

• See your pharmacist and ask about emollient creams (moisturisers) containing cooling agents - moisturisers containing menthol may be helpful. If you pay for prescriptions, ask about a pre-payment certificate

Make an appointment at your GP surgery

If the pruritus goes on for more than 6 weeks you must make an appointment to see a health professional as they will need to do a physical examination and arrange investigations including bloods tests and a chest x-ray to see if a cause can be found. If the pruritus is associated with night sweats and/or weight loss, then you must arrange an urgent appointment as this may suggest a more serious cause.

Your health professional may recommend an alternative cream, antihistamines, or tablets that act on the nerves relaying the sensation of itch to your brain. Steroid creams will not help if the skin is not inflamed (red and dry). This link provides information on specific treatments.

If you are prescribed sedating antihistamines (which make you feel tired) you need to be mindful that they may affect your driving / ability to work the next morning. Sedating antihistamines must not be used regularly in the long-term as there is some evidence linking them to an increased risk of dementia (memory loss).

Your mental health

Pruritus can have a significant psychological impact and may affect many areas of daily life including work and personal relationships. If the pruritus is affecting your mental health, you should discuss this with a health professional. 

Referral to a specialist

If your pruritus remains troublesome you may need to be referred to a specialist, who will generally be a Dermatologist. Treatment options include alternative topical treatments (creams, ointments, gels), or a course of light treatment (phototherapy).

What will happen when you are referred?

The appointment may be face-to-face (the person attends the clinic), or a video call (teledermatology).

Can pruritus be cured?

If investigations find a cause for the pruritus, treatment of this will sometimes lead to resolution of the itch. Stopping a causative drug can lead to resolution of pruritus. If a cause is not found, treatment is about managing the pruritus and keeping the itch to a minimum. In some, pruritus will persist for many years, in others it may resolve spontaneously (of its own accord).

CAUTION

This leaflet mentions ‘emollients’ (moisturisers). Pure petroleum emollients are flammable and should never be used near a naked flame. Non-paraffin-based emollients may also act as accelerants if they have a high oil content, so caution is advised with all topical treatments.

Your hands may be slippery after applying a greasy moisturiser, so allow time for them to soak in before driving or operating machinery.

Helping with other skin conditions

If you, a family member, or friend have an undiagnosed skin condition; or you want to learn more about how to treat skin conditions, please view our short video on how to get the best from this website.