A 50-year-old man from Wayanad, Kerala, walked into a hospital recently, complaining of intense itching episodes.
“Generalised itching was his only symptom. During a routine examination, we did not find any lesions on his skin or any other physical signs,” says Dr Jayadev Betkerur, professor, department of dermatology, Dr Moopen’s Medical College, Wayanad, Kerala.
The doctors then asked him to undergo a blood and urine test and a kidney function test (KFT). “The results showed elevated levels of urea and creatinine which was causing the itching. He was suffering from Chronic Kidney Disease (CKD) and had not realised it for many years,” says Dr Betkerur.
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This, Dr Betkerur says, was a case of uremic pruritus, a common symptom of CKD in which itching or pruritus occurs without any rashes or other physical signs on the skin.
Itching is commonly associated with several skin-related allergies and conditions. But when it occurs without any physical signs on the skin, it could indicate an underlying condition, say doctors.
What causes itching without rashes?
“Some of the common reasons for itching without rashes are old age, polypharmacy (common among the elderly where they take several medications simultaneously) and generalised dryness of the skin, especially during winters or it could be psychogenic (occurs without any reason). If it occurs because of the way skin changes as you grow older, it is called senile pruritus,” he says.
Apart from these, there can be some systemic causes that can induce generalised itching without rashes, Dr Betkerur adds.
Urticaria, eczema, psoriasis, chickenpox are just a few of the skin allergies and infectious diseases that cause itching episodes with rashes. However, when a long-standing itch is the only symptom you’re experiencing, according to the American Academy of Dermatology Association (AAD), it can be a sign of:
- Blood Diseases (like Hodgkin’s lymphoma)
- Diabetes
- Kidney Disease (people who are close to needing/currently receiving dialysis)
- Liver Disease (hepatitis C, liver cirrhosis, obstructed bile duct)
- HIV
- Overactive Thyroid Gland
Dr Betkerur adds that the most common cause could be jaundice, as elevated levels of bilirubin and liver functions may be impaired. Endocrine conditions such as hyperthyroidism and certain haematological conditions like anaemia can also cause generalised itching without rashes.
Where it itches matters
The AAD says that widespread itching without rashes on the back, arms and legs indicate an advanced kidney disease. When an underlying liver disease such as liver cirrhosis or hepatitis C is causing the unexplained itching, rashes usually first appear on the palms and soles before spreading to other parts of the body.
Itching without rashes: Diagnosis and Treatment
Dr Rashmi Sarkar, President of Indian Association of Dermatologists, Venereologists and Leprologists (IADVL), 2022 says that a dermatologist may be the first specialist that a person suffering from itching without rashes may consult.
“If the itch is longstanding, to rule out any systemic causes, a clinical diagnosis may be done like checking the blood sugar, complete blood count and thyroid stimulating hormone. A liver and kidney function test may also be prescribed.”
In the case of itching without rashes, a proper medical history of the patient is taken, followed by ruling out common causes for generalised itching without rashes. “We then investigate them for any indications of more serious problems,” says Dr Betkerur.
Dr Ramadas, senior dermatologist at Kamineni Hospitals, Hyderabad says that when some people complain of itching without any physical manifestations or rashes, antihistamines and emollients are often prescribed to offer some relief from the itching.
“Management of the itch depends on the cause and intensity of the itching. With senile pruritus, for instance, there isn’t much that we can do except offer relief. In the case of the 50-year-old man who was diagnosed with CKD, emollients (moisturisers) were prescribed which he had to apply two to three times daily to get some relief from the itching along with treating the CKD. Antihistamines can also be prescribed in consultation with nephrologists,” he says.
Takeaways
- When your skin itches but you are unable to spot any indications of it on your skin, it can be a sign of an underlying disease.
- Avoid hot water bath, keep skin moisturised and ensure general measures of hygiene practice in case of itching without rashes.
- Blood, kidney and liver-related diseases, HIV and an overactive thyroid gland are some of the causes of itching without rashes on your skin.
