ITCHING

also called Pruritus, a stimulation of free nerve endings, usually at the junction of the dermis and epidermis of the skin, that evokes a desire to scratch. It has been suggested that an itch is a subthreshold sensation of pain; however, although both itch and pain sensations share common nerve pathways, they are generally considered distinct sensory types. Itching evokes a range of sensations, from a tickling that is easily relieved to pathologic itching, which generally indicates a dermatologic or systemic disease. The release of histamine from cells in the epidermis is usually considered to incite most sensations of itching. Scratching may temporarily relieve itching by interrupting the rhythm of nerve impulses or by inflicting transitory damage to the nerves. Persistent scratching produces redness, papules, and crusting of the skin. Itching associated with skin lesions (such as vesicles and papules) generally indicates a dermatologic disease. Generalized itching without skin lesions can occur in systemic diseases such as those that occur in metabolic and endocrine conditions, malignant cancers, drug reactions, and renal, blood, and liver diseases. Excessive drying of the skin caused by pregnancy, old age, or weather often produces itching. A psychological cause for itching is considered only after all other possibilities have been sufficiently excluded. No generally accepted therapy exists for the relief of itching, although many have been suggested. Topical anesthetics and other drugs usually have temporary or minor effects. Emollients, applied and blotted dry, may be helpful when applied to wet skin. Antihistamines may also be helpful. At present the choice of therapy usually depends on the underlying cause of the itching, and the focus is primarily on curing the underlying disease rather than the symptom.