Itching without rashes

Such a common symptom as skin itching usually accompanies a rash. However, itching without rashes can also occur, caused by a fairly wide range of pathological conditions and systemic diseases.

In terms of scale, pruritis without visible skin changes can be generalized (widespread) or localized, and in terms of duration – acute, periodic or chronic.

Causes itching without rashes

Itching without rashes – pruritus sine materia (from Latin – itching without matter), that is, without primary skin lesions – is usually not related to skin diseases, and in dermatology is a diagnosis of exclusion.

The simplest case - itching of the hands without rashes - is caused by dry skin of the hands. But it should be taken into account that dry skin (xerosis) can provoke thyroid gland and metabolic disorders.

As experts note, itching of the skin on the hands and all over the body can precede the appearance of a rash for some time, for example, when infected with the intradermal scabies mite (Sarcoptes scabiei) and the development of an infection such as scabies; with shingles - when burning, itching of the lower back without a rash and painful sensations occur several days before the Varizella zoster virus (VZV) manifests itself as a typical pustular rash. [ 1 ]

Among the most probable, experts consider the following reasons for the appearance of pruritus sine materia:

• presence of diabetes mellitus;
• kidney disease leading to terminal failure (especially in patients on dialysis);
• hepatitis, primary biliary cirrhosis of the liver, [ 2 ] primary sclerosing cholangitis, [ 3 ] as well as liver damage by parasites such as lamblia (Giardia intestinalis), [ 4 ] opisthorchis – Opisthorchis felineus (cat fluke) [ 5 ] or fasciola (Fasciola hepatica). [ 6 ] By the way, if a child has itchy skin without a rash, then the first thing to suspect is the presence of helminths.

Skin itching without a rash has the following symptoms:

• pancreatic diseases, including cancer;
• thyroid problems – thyrotoxicosis, hyperthyroidism;
• iron deficiency in the body (iron deficiency anemia) – causes itching of the face without rashes;
• refractory anemia or myelodysplastic syndrome; [ 7 ]
• erythremia or true polycythemia, associated with benign proliferation of blood cells; [ 8 ]
• HIV infection.

According to oncologists, the first signs of cancerous degeneration of tissues of various organs can manifest as itching in the area of regional lymph nodes. Such itching is called paraneoplastic and is observed in leukemia, lymphomas, plasmacytoma, as well as gallbladder and liver cancer, prostate carcinoma, lung adenocarcinoma and carcinoid syndrome.

Neurogenic or neuropathic is called:

• itching of the hands and feet without rash in multiple sclerosis; [ 9 ]
• itching of the upper chest and itching of the back without a rash in notalgia paresthetica, a hereditary form of chronic sensory neuropathy; [ 10 ]
• itching of the lower back without rashes in cases of damage to the nerve roots of the lumbar spinal cord in diseases of the spine.

In cases of stress, depression and mental disorders (psychosis, obsessive-compulsive disorder, schizophrenia), itching without any morphological changes in the skin is considered psychogenic or psychosomatic.

Itching without visible damage to the skin, caused by contact with water, is called aquagenic.

Pregnant women experience severe itching of the skin on the abdomen without rashes due to stretching of the skin and increased hormone levels; more information in the article - Itching during pregnancy.

In addition, itching of the skin without redness and rashes can also be caused by medications: opiates, statins, anticoagulants, some antihypertensive drugs, antimalarial drugs, antibiotics, oral contraceptives. And itching of the face without rashes can be the result of taking niacin (vitamin B3 or nicotinic acid).

Risk factors

Risk factors for the appearance of physiological itching without any elements of a rash (in the form of papules, vesicles, macules or pustules) include dry skin of the body, which may be associated with the use of too hot water for bathing, hereditary skin characteristics, and age-related xerosis.

Generalized pruritus without rash is common in the elderly.

Risk factors for pathological pruritus sine materia are endocrine, hematological, systemic, neurological diseases and mental conditions in which this symptom appears.

Pathogenesis

The general mechanism of itching is discussed in the publication – Pathogenesis of skin itching.

In addition to age-related physiological changes in the skin - deterioration of its hydration and decreased sebum production, itching all over the body without rashes after 65 years is associated with age-related sensory neuropathy, changes in the immune system and often unjustified use of several medications (polypharmacy).

Itching of the skin without a rash often affects the lower limbs of patients with diabetes, and its pathogenesis is associated with long-term hyperglycemia and poor blood circulation. Itching is often a symptom of damage to the nerve fibers of the skin - diabetic polyneuropathy. Read more - Itching in diabetes mellitus type 1 and 2.

Pruritus gravidarum is caused by elevated serum bile acid levels due to intrahepatic cholestasis in the late second or third trimester (called cholestatic hepatosis of pregnancy). Why it occurs in some pregnant women, causing itchy skin on the extremities and yellowing of the skin on the body, is not fully understood. This condition may have negative effects on the outcome of pregnancy.

Paraneoplastic pruritus is the result of the activity of proinflammatory cytokines released by immune cells in response to malignant cell transformation, and substances produced by tumor cells that can act directly on nerve endings and cause the release of histamine. And in pancreatic cancer (especially if the tumor formed in its head), obstruction of the bile ducts, stagnation of bile and subsequent accumulation of bile salts in the skin, causing itching, often occur. Other symptoms may include jaundice, abdominal pain, ascites, discolored feces.

In some cases, non-eruptive pruritus—especially aquagenic pruritus—may appear months before cancers such as non-small cell lung cancer or lymphoma are diagnosed. Intense pruritus in polycythemia vera always begins after exposure to water.

The mechanism of psychogenic itching in patients with CNS disorders and mental health problems is due to acetylcholine activation of the sensory area of the anterior cerebral cortex, additional motor areas and the inferior parietal lobe.

And itching during stress – with the effect of adrenaline on β2-adrenergic receptors – is mediated by the activation of the hypothalamic-pituitary system and the release of neurotransmitters (neuropeptides, neurotrophins, lymphokines) from nerve endings and dermal cells, as well as increased release of histamine by skin mast cells.

Diagnostics itching without rashes

Because the etiology of pruritus is heterogeneous, diagnosing the underlying condition can be challenging in some cases.

More information in the material - Diagnosis of skin itching

The medical history (including the list of medications taken) and family history are of key importance. Also necessary is an examination of the skin (as well as nails and hair); palpation of the lymph nodes, liver, spleen.

Systemic studies include blood tests: complete clinical, HIV, sugar level, thyroid-stimulating hormone level, hematocrit and ferritin level, bilirubin, alkaline phosphatase and transaminase levels, urea and creatinine levels, antibodies (IgE, IgG, IgM), PCR analysis for VZV DNA. General urine analysis and coprogram are taken. Other laboratory tests may be required in any combination.

Instrumental diagnostics may include various X-ray examinations, ultrasound of the thyroid gland, liver and gallbladder, etc.

Differential diagnostics play a major role, considering the localization of itching, its nature and triggers, as well as the presence of other symptoms.

Treatment itching without rashes

In each specific case, treatment of itchy skin should be aimed at the underlying disease associated with it.

Iron deficiency anemia can be treated by taking ferrous sulfate supplements and eating more foods rich in this micronutrient (red meat, eggs, legumes, green leafy vegetables, nuts, etc.).

If a parasite infestation is detected, anthelmintic drugs are used, see – The best tablets for worms.

In therapy aimed at relieving/reducing itching, oral medications can be used. First of all, these are Fenkarol, Loratadine (other trade names are Lotaren, Claritin), Terfenadine (Trexil), Fexofenadine and other antihistamines.

For neurogenic pruritus and pruritus associated with chronic kidney disease, anticonvulsants such as Gabapentin (Gabagama, Gabalept, Gabastadin) or Pregabalin may be prescribed.

In cases of paraneoplastic and psychogenic itching without rashes and itching in cholestasis, the use of antidepressants of the group of selective serotonin reuptake inhibitors is practiced - Paxil (Paroxetine), Sertraline (Sertraloft, Asentra), as well as tricyclic antidepressants that act on histamine H1 receptors (Doxepin or Mirtazapine).

The drug of the calcineurin inhibitor group Cyclosporine has an immunosuppressive effect and is used for generalized itching (contraindicated for pregnant women). The standard daily dose is 2.5 mg per kg of body weight (divided into two doses). The list of its side effects includes headache, nausea, vomiting, abdominal pain, convulsions, kidney dysfunction, and changes in the blood.

It is recommended to take vitamins of group B, as well as A, E, D.

Depending on the etiology of the itching, the doctor may recommend topical agents: anti-itch ointment (including those with corticosteroids, which can be used for no more than two weeks in a row) or anti-itch creams - especially moisturizing and "cooling" ones due to the menthol content.

Physiotherapy treatment includes phototherapy (UV), which is most effective for itchy skin in the elderly.

Folk treatment consists of external application of a mixture of castor oil with menthol (in a ratio of 3:1) or turmeric powder (2:1), massage of the itchy area of skin with an ice cube, as well as lukewarm baths with ground and steamed oatmeal or Epsom salt.

You can also try herbal treatment: in the form of cool compresses with decoctions of chamomile flowers, peppermint or lemon balm, anise seeds or comfrey root.

Complications and consequences

Immediate consequences and complications – secondary skin damage due to scratching: eczematous changes (open wounds and scabs), lichenification (thickening of the skin at the site of scratching), excoriation (scratches), hyperpigmentation (appearance of brown spots), hypopigmented atrophic scars.

These injuries can be painful and can also become infected.

Prevention

Prevention of dry skin is drinking enough fluids, avoiding washing with too hot water and using moisturizing creams. More details - Moisturizing creams for dry and flaky skin.

But real prevention of most of those diseases and conditions in which skin itching without rashes appears, as doctors note, is practically impossible.

Forecast

The prognosis for itching without rash with dry skin is certainly positive - if you take proper care of it, and itching in pregnant women, since it goes away after childbirth. And also in cases of stopping the use of a drug that causes skin itching without rashes.

In other cases, everything depends on the nature of the underlying disease and the success of its treatment.