From the Guidelines
Itchy skin and bruising can occur together due to several underlying conditions, and the most recent evidence suggests that liver disease, kidney disease, and blood disorders are common causes. Common causes include allergic reactions to medications or foods, liver disease (which affects clotting factors and causes bile buildup in the skin), blood disorders like leukemia or thrombocytopenia, kidney disease, vitamin deficiencies (particularly vitamins C and K), or autoimmune conditions such as vasculitis 1. Skin conditions like eczema or dermatitis can cause itching while separate factors like medication side effects (especially blood thinners like warfarin, aspirin, or clopidogrel) might cause bruising.
Causes of Pruritus and Ecchymosis
- Allergic reactions to medications or foods
- Liver disease (affects clotting factors and causes bile buildup in the skin)
- Blood disorders like leukemia or thrombocytopenia
- Kidney disease
- Vitamin deficiencies (particularly vitamins C and K)
- Autoimmune conditions such as vasculitis
- Skin conditions like eczema or dermatitis
- Medication side effects (especially blood thinners like warfarin, aspirin, or clopidogrel)
Treatment
Treatment depends on identifying the underlying cause. For temporary relief, over-the-counter antihistamines like diphenhydramine (25-50mg every 4-6 hours) or cetirizine (10mg daily) can help with itching, while cool compresses can soothe both symptoms 1. Moisturizers containing colloidal oatmeal or ceramides can help with dry, itchy skin. If symptoms persist beyond a few days, worsen, or are accompanied by other symptoms like fever, fatigue, or unexplained weight loss, medical evaluation is necessary as these could indicate more serious conditions requiring specific treatment.
Recent Guidelines
Recent guidelines suggest that bezafibrate or rifampicin can be used to treat moderate to severe pruritus in sclerosing cholangitis 1. Additionally, ensuring adequate dialysis, normalizing calcium-phosphate balance, controlling parathyroid hormone to accepted levels, correcting any anaemia with erythropoietin, and using simple emollients (for xerosis) can help manage uraemic pruritus 1.
Important Considerations
It is essential to note that sedative antihistamines may predispose to dementia and should be avoided, except in palliative care 1. Furthermore, cetirizine is not effective in uraemic pruritus 1, and BB-UVB is an effective treatment for many patients with uraemic pruritus 1.
From the Research
Causes of Pruritus (Itchy Skin)
- Pruritus is a common symptom in dry skin related to inflammatory skin diseases, normal aging, and systemic diseases such as chronic renal failure, and HIV 2
- Dry skin-induced itch is a histamine-independent pathway, and many mediators and receptors are responsible for itch and its hypersensitivity 3
- Histamine-independent itch may be elicited by various pruritogens, including proteases, cytokines, neuropeptides, lipids, and opioids, and their cognate receptors 4
- Dry skin is a key feature of intractable itch in atopic dermatitis 4
Causes of Ecchymosis (Bruising)
- There are no research papers provided to assist in answering this question
Associated Factors of Pruritus
- Female sex, body mass index, self-reported atopic dermatitis, presence of atopic dermatitis, self-reported psoriasis, presence of psoriasis, self-reported dry skin, self-reported asthma, renal impairment, and clinically relevant depressive and anxiety symptoms are significantly associated with itch 5
- Atopic dermatitis, psoriasis, and dry skin are common skin conditions associated with itch 5
- Renal impairment is an intriguing non-dermatological factor associated with itch in individuals with skin conditions 5