From the Guidelines
Pruritus of the back can be caused by various factors, including dry skin, allergic reactions, skin conditions, fungal infections, insect bites, or contact dermatitis, and the most effective treatment approach should prioritize addressing the underlying cause to alleviate symptoms and improve quality of life. According to the British Association of Dermatologists' guidelines for the investigation and management of generalized pruritus in adults without an underlying dermatosis, 2018 1, pruritus can be defined as ‘the sensation that is relieved by scratching the skin’. The guidelines highlight that any tissue damage or inflammation can produce either localized or generalized pruritus.
Some key considerations for managing pruritus include:
- Using moisturizing lotions containing ingredients like ceramides or colloidal oatmeal to restore the skin barrier
- Applying over-the-counter hydrocortisone cream (1%) to reduce inflammation
- Using antifungal creams for fungal infections
- Oral antihistamines like cetirizine (10mg daily) or diphenhydramine (25-50mg every 4-6 hours) to reduce itching
- Avoiding hot showers, wearing loose cotton clothing, and using fragrance-free detergents
The British Association of Dermatologists' guidelines also provide recommendations for specific conditions, such as generalized pruritus due to iron deficiency, lymphoma, polycythaemia vera, solid cancers, uraemia, liver disease, neuropathy, and psychological and emotional factors 1. For example, in hepatic pruritus, rifampicin is considered a first-line treatment, while cholestyramine and sertraline are considered second-line and third-line treatments, respectively.
It is essential to consult a healthcare provider if itching persists beyond two weeks, is severe, or is accompanied by a rash or other symptoms, as it may indicate a more serious condition requiring prescription treatment. The guidelines emphasize the importance of addressing the underlying cause of pruritus to alleviate symptoms and improve quality of life, and healthcare providers can help determine the best course of treatment based on individual circumstances.
From the Research
Causes of Pruritus (Itching) of the Back
- Pruritus is a sensation that emanates from the skin and is transferred through peripheral nerve fibers to the central nervous system 2
- Primary skin disorders, such as atopic eczema, skin dryness, psoriasis, and urticaria, can elicit pruritus 2
- Certain systemic diseases can cause chronic pruritus, including end-stage renal disease, cholestatic liver disease, endocrine/metabolic diseases, and hematologic/lymphoproliferative diseases 2
- Atopic dermatitis (AD) is a chronic relapsing and remitting inflammatory skin disease that can cause intensely pruritic skin lesions due to a complex interaction of immune dysregulation, epidermal gene mutations, and environmental factors 3
- Histamine is a peripheral itch-inducing stimulus that can trigger pruritus, and antihistamines are often used to treat pruritus associated with AD, although their efficacy is not well established 4, 5
Factors that Exacerbate Pruritus
- Repeated scratching can trigger a self-perpetuating itch-scratch cycle, which can have a significant impact on the patient's quality of life 4, 3
- Damage to the epidermal layer of the skin can lead to increased transepidermal water loss and drying, resulting in a cycle of more itching and more scratching 4
- Certain medications, such as oral corticosteroids, can be prescribed for atopic dermatitis, but their use can have significant side effects and may not be the best long-term option 6