Itching, medically referred to as pruritus, is a common sensation that can range from mildly irritating to severely distressing.
While occasional itching is often harmless and linked to minor irritants like dry skin or insect bites, persistent or unexplained itching in specific areas of the body may signal underlying health issues. This symptom can be associated with systemic diseases, dermatological conditions, hormonal changes, or even neurological and psychiatric disorders.
For instance, itching without a visible rash could be a sign of internal conditions such as liver disease, kidney dysfunction or thyroid imbalances. According to the Mayo Clinic, systemic illnesses like anaemia, diabetes and certain cancers can also manifest as generalised itching.
Similarly, localised itching, such as on the palms or soles, might indicate conditions like carpal tunnel syndrome, food allergies or even bile duct-related pathologies. Hormonal fluctuations, particularly during menopause, can exacerbate skin sensitivity and trigger itching.
Some research shows that oestrogen fluctuations during perimenopause and menopause can worsen allergic reactions, leading to symptoms like itchy skin, rashes and eczema. Moreover, itching can sometimes be linked to neurological or psychiatric conditions.
Disorders such as multiple sclerosis, anxiety or depression may present with pruritus as a secondary symptom. In rare cases, severe itching without an apparent cause may even point to life-threatening conditions, underscoring the importance of timely medical evaluation.
Understanding the potential causes of itching and recognising when it might indicate a deeper health issue is crucial. Persistent or unexplained itching should not be ignored, as it may require thorough clinical evaluation to identify and address the underlying cause.
This article delves into the various medical conditions associated with itching, offering insights into its diagnostic significance and management strategies.
Persistent itching without a rash
Persistent itching lasting more than six weeks without a visible rash can be a sign of an underlying systemic condition. Unlike itching caused by dermatological conditions, this type of pruritus may be linked to internal health issues such as kidney disease, liver dysfunction, or thyroid disorders.
For example, chronic kidney disease (CKD) is associated with uremic pruritus, which can severely affect a patient’s quality of life. Similarly, liver diseases like cholestasis can lead to bile salt accumulation, triggering intense itching.
If the itching persists and is not clearly linked to external factors like dry skin or allergens, it is crucial to consult a healthcare provider to rule out systemic conditions.
Itching accompanied by jaundice
Itching combined with jaundice (yellowing of the skin or eyes) is a red flag for liver-related conditions, such as hepatitis, cirrhosis or bile duct obstruction. This type of itching is often generalised and worsens at night.
The presence of jaundice indicates a buildup of bilirubin in the bloodstream, which can irritate nerve endings and cause pruritus. Patients experiencing this symptom should seek immediate medical evaluation, as untreated liver conditions can lead to severe complications, including liver failure.
Severe itching with signs of anaphylaxis
Sudden-onset severe itching, particularly when accompanied by symptoms of anaphylaxis, requires emergency medical attention Anaphylaxis is a life-threatening allergic reaction that can occur within minutes of exposure to an allergen, such as certain foods, insect stings or medications.
Symptoms include difficulty breathing, swelling of the lips, face, or throat, rapid heart rate, dizziness and fainting. If these symptoms are present, immediate administration of epinephrine (adrenaline) and emergency care are essential to prevent fatality.
Itching with mental status changes
Itching accompanied confusion, disorientation or mood swings, may indicate a neurological or systemic issue. Conditions like hepatic encephalopathy, which occurs due to liver dysfunction, or uremic encephalopathy, linked to kidney failure, can present with these symptoms.
Additionally, neurological disorders such as multiple sclerosis or neuropathic itch caused by nerve damage may manifest with altered mental states. Patients experiencing these symptoms should seek immediate medical evaluation to determine the underlying cause and initiate appropriate treatment.
Itching during pregnancy
Severe itching during pregnancy, especially in the third trimester, can be a symptom of intrahepatic cholestasis of pregnancy (ICP). This condition occurs due to impaired bile flow and can lead to complications for both the mother and baby, including preterm birth or stillbirth.
Itching associated with ICP is often most intense on the palms and soles and may worsen at night. Pregnant individuals experiencing severe or persistent itching should consult their obstetrician promptly for evaluation and management.
Itching with rapidly spreading rash
A rapidly spreading rash accompanied by intense itching could indicate a severe allergic reaction, infection or autoimmune condition. For example, conditions like Stevens-Johnson syndrome or toxic epidermal necrolysis often present with widespread rash, blistering and skin peeling, requiring immediate hospitalisation.
Similarly, infectious diseases such as chickenpox or measles can cause rashes that spread quickly and are highly contagious. Patients with these symptoms should visit an emergency room for prompt diagnosis and treatment.
Itching with fever or systemic symptoms
Itching accompanied by fever, chills or body aches may indicate an underlying infection or inflammatory condition. For instance, scarlet fever, caused by group A Streptococcus, presents with a characteristic “sandpaper-like” rash and fever.
Other conditions, such as shingles (herpes zoster), can cause localised itching and pain along with flu-like symptoms. In these cases, medical attention is necessary to identify the cause and initiate appropriate therapy.
Chronic itching resistant to topical treatments
Chronic itching that does not respond to topical treatments, such as hydrocortisone or antihistamines, may be neuropathic in origin. Neuropathic itch often presents with sensations like tingling, burning or stinging and is linked to nerve damage or dysfunction.
Conditions such as postherpetic neuralgia, caused by shingles, or peripheral neuropathy associated with diabetes, can lead to this type of itching. Patients experiencing these symptoms should consult a neurologist or dermatologist for specialised care.
Itching interfering with sleep or daily life
Severe itching that disrupts sleep or daily activities can significantly impact quality of life and may indicate an underlying medical issue. For example, pruritus associated with eczema or psoriasis can cause intense discomfort, leading to sleep disturbances and emotional distress.
In such cases, patients should seek medical advice to explore advanced treatment options, including systemic medications or phototherapy.
Itching with signs of infection
Itching accompanied by signs of infection, such as redness, swelling, warmth or discharge, requires prompt medical evaluation. These symptoms may indicate cellulitis, an infection of the skin and underlying tissues, or an abscess.
Left untreated, skin infections can spread to deeper tissues or the bloodstream, leading to severe complications. Patients with these symptoms should visit a healthcare provider or emergency room for appropriate management.
Widespread itching without a rash
Widespread itching without a visible rash can be a symptom of systemic conditions, such as iron deficiency anaemia, diabetes or certain cancers like lymphoma. For instance, Hodgkin’s lymphoma is often associated with generalised pruritus due to the release of inflammatory mediators.
Patients experiencing this symptom should undergo a thorough medical evaluation, including blood tests and imaging studies, to identify the underlying cause.
Seek treatment if necessary
The research highlights that persistent itching, particularly without a visible rash, can serve as a critical indicator of underlying systemic, neurological, hematological, autoimmune or dermatological conditions.
The findings emphasise the importance of recognising persistent itching as a potential sign of serious health issues, particularly when accompanied by systemic symptoms like jaundice, fever or mental status changes.
Early evaluation by healthcare professionals is crucial to identify and address the root cause, as untreated conditions like cholestasis, CKD, or cancer can lead to severe complications.
Future research should focus on refining diagnostic tools to differentiate between benign and serious causes of itching, and on developing targeted therapies for conditions like uremic pruritus or neuropathic itch.
By Datuk Dr Nor Ashikin Mokhtar
Published in Star Newspaper, 16 Jun 2025
