Why persistent itching without an obvious cause is a symptom you shouldn’t ignore

There isn’t a single person in this world who would say that they haven’t experienced what severe itching feels like. All of us have felt severe itching from time time,, and in most cases, it would have been caused by dry skin, allergies, insect bites or eczema. In such cases, the itching, though tiresome is temporary and harmless. But if the itching continues for weeks together without an identifiable cause or rash, it could be more than just a skin problem. Sometimes, the body gives us a signal of underlying medical condition through persistent itching.

The itching-liver link

If an individual has an itching problem for more than six weeks, then he/she is said to have a condition called chronic pruritus. Research indicates that about 15% – 20% of adults face chronic itching problems at some point in their lives. Of these 10% – 50% with unexplained itching may have an underlying systemic illness — that is why one should not just ignore itching; it is important to get medical help.

Unexplained itching is closely associated with liver diseases. The liver helps in filtering toxins and creating bile that helps in the digestion and absorption of fats. In diseases such as cholestasis, bile duct obstruction, chronic hepatitis and primary sclerosing cholangitis, bile acids are accumulated in the bloodstream and stimulate nerve endings in the skin. This can result in constant itching without any visible rash. This kind of itching occurs particularly on the palms of the hands and soles of the feet and gets worse at night. In some people, itching will start at least a few months before other symptoms of liver disease become visible.

Kidney, thyroid and other links

The kidneys are another important organ that are closely related to chronic itching. About 40% – 70% of dialysis patients suffer from moderate to severe itching problems. The accumulation of waste products, chronic inflammation, nerve dysfunction, and disturbances in calcium and phosphorus balances are believed to be the causes, even though research is attempting to determine the exact cause. Kidney issues-related itching is persistent, and severe enough to interfere with sleep.

Similarly, changes in the thyroid gland can also lead to severe itching. In case of hyperthyroidism, blood flow to the skin increases drastically, altering nerve sensitivity. In case of hypothyroidism, affected peoplel have dry and rough skin that becomes itchy. In most cases, patients can see improvement in their itching problems with the treatment for thyroid disorders.

Individuals with certain types of blood disorders may also experience constant itching issues. If individuals get severe itching after taking a warm shower, they may be suffering from polycythemia vera, and it is advisable to seek a doctor.

Severe and constant itching may also be experienced by people with iron deficiency anaemia, leukaemia, Hodgkin’s lymphoma, multiple myeloma, diabetes mellitus, people living with HIV, those with, neurological disorders such as multiple sclerosis, and pregnancy-related liver disorders. About 30% of people with Hodgkin’s lymphoma face itching well before they are diagnosed with it, research indicates.

When to get help

Itching, especially when takes place with weight loss, fatigue, night sweats or enlarged lymph nodes, should not be ignored.

When people experience severe itching without any obvious cause, they should undergo a proper medical examination. They should take a complete blood count, liver and kidney function tests, thyroid function tests, and tests for blood glucose and iron levels. These tests will help people both in identification of potential causes and enable beginning treatment at an early stage.

What you should know

People think of itching as a mere inconvenience and often purchase over-the-counter creams or antihistamines for relief. These medications may reduce the symptoms and provide relief, but they will not address the underlying cause if there is e an internal medical condition present. By delaying seeing a doctor, individuals may be actually postponing a diagnosis and the benefits of early treatment. Early diagnosis not only improves treatment outcomes but may also prevent complications associated with the underlying disease.

(Dr. Melissa Sathyan is an internal medicine consultant at Rela Hospital, Chennai. drmelissa@relainstitute.com)