Itchy skin with no rash can cause significant discomfort to a person and also may create confusion for general physician. Every individual can experience itchy skin without rash when he/she is suffering from stress and anxiety or excess dryness of the skin. But there are several other conditions that should be focused when it comes to itchy skin no rash. Underlying acute and chronic medical conditions should always be ruled-out when no other definitive cause of itchy skin can be found. This article review few causes of itchy skin with no rash. There might be several other causes of itchy skin without rash that might have not been discussed here, but we have tried our best to include most common.
Chronic Kidney Disease
It is estimated that up to 50% of the patients with chronic renal failure experience generalized itching. Individual may develop secondary skin lesion as a result of intense scratching like prurigo nodularis, nummular eczema etc.
Cholestasis
Cholestasis is not a disease; it’s a symptom of several hepato-billary conditions. Itching associated with cholestasis starts with the hands and legs and becomes generalized. The itching may be due to bile salts in the skin as a result of biliary obstruction and raised level of opioid peptides.
Endocrine Disease
Several endocrine disorders are associated with itching without rash. Disease like hypothyroidism where skin is excess dry and thyrotoxicosis are associated with generalized itching. Itching can also be the manifestation of diabetes neuropathy.
Hematologic Disease
Itching is associated with several blood disorders. Around 50% of patients with polycythemia vera manifests generalized itching especially after contact with water (often termed as “bath itch”). Itchy skin without rash is often presenting symptoms in Hodgkin disease. Other diseases that can have itchy skin with rash are leukemias, cutaneous mastocytosis.
HIV Infection
Itching can also occur in primary infection of HIV which may or may not be associated with skin rash and infection. Itching in HIV may be associated with internal cause like, renal disease, hepatic disease, drug reaction or lymphoma.
Senile Pruritus
Itchy skin in elderly people especially over 70 years is always a common finding. Although exact cause can’t be found, excessive dryness may be one reason. Sometimes itching may also be provoked when contact with water. Itching is usually worsen during night and aggravated by hot water.
Aquagenic Pruritus
Itchy skin without rash can also occur due to contact with water, either cold or hot. This itching may last for an hour or so and may not be associated with skin rash. The exact cause for this condition is unknown.
Notalgia Paresthetica
Notalgia paresthetica is a common localized itch of mid-back skin especially in infrascapular region. Itching may be associated with tingling, pricking or numbness of the area affected. Notalgia paresthetica is thought to be cutaneous sign of an underlying degenerative cervical spine disease. The itching may be due to the entrapment of spinal nerves that supply sensation to upper-back. Although topical therapy might help decrease the sensation, systemic or detail spinal examination may be required for further management of notalgia paresthetica.
Brachioradial Pruritus
Commonly seen in middle aged individual, brachioradial pruritus is localized itching on the outer surface of the upper arm, elbow, and forearm. It has been suggested that brachioradial pruritus is cause by nerve damage due to cervical spine abnormalities. Prolonged long-term exposure to sun has also been suggested in the etiology of brachioradial pruritus.
itchy skin no rash
Below are the summary lists of disease that can be associated with “itchy skin no rash”
Metabolic, endocrine conditions
Hyperthyroidism
Hypothyroidism
Pregnancy related
Malignant neoplasms
Lymphoma, myeloid and lymphatic leukemia,
myelodysplasia
Multiple myeloma
Hodgkin disease
Other cancer (rare)
Infestations
Scabies
Pediculosis
Hookworm
Onchocerciasis
Ascariasis
Renal disease
Renal failure
Hepatic disease
Obstructive biliary disease
Intrahepatic cholestasis
Hematologic disease
Polycythemia vera
Paraproteinemia, iron deficiency
Psychogenic states
Acute
Periods of emotional stress
Chronic
Delusions of parasitosis
Psychogenic pruritus
Neurotic excoriations
Anorexia nervosa
Other miscellaneous conditions
Senile pruritus
Xerosis
Fiber glass exposure
Factitious urticaria
Brachioradial pruritus
Notalgia paresthetica
Aquagenic pruritus
Drugs
Asymptomatic drug sensitivities
Aspirin, alcohol, dextran, polymyxin B, morphine, codeine, scopolamine, tubocurarine etc..
References
Fitzpatrick’s Color Atlas & Synopsis of Clinical Dermatology, sixth Ed
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