(Part 2)

ITCHINESS or pruritus is “an unpleasant sensation that provokes the desire to scratch”. It is the most common symptom in children with skin problems. The skin around the itch site is quite sensitive that any form of stimulus however mild, may form a new area of itching which provokes scratching, which in turn incite to produce itching. This is known as the itch-scratch process. In children the most common cause of itching is some form of skin problem in more than 90 percent of cases.

"The Manny Pacquiao Blog". Click here for stories and updates on the Filipino boxing champ.

Sometimes itchiness can be a manifestation of a systemic illness.

The common pediatric skin problems that cause itching are atopic dermatitis, contact dermatitis, urticaria or hies, prickly heat, infections/infestations and dry skin. Already discussed are atopic dermatitis, contact dermatitis and urticaria.

Prickly Heat

Prickly heat or heat rashes are skin eruptions caused by inflammation of the sweat glands. The eruptions are made up of small raised red spots which are itchy. This disorder is the result of blockage of the ducts of sweat glands with resultant retention and leakage of sweat into surrounding skin causing itchiness. They are found in the face, neck, back, chest and thighs. This disorder is commonly found in infants and obese people during hot, most weather.

Infections of the skin can cause mild to moderate itchiness. Infection may be caused by fungal, bacterial or viral microorganism such as chicken pox, etc.

Infestations with parasites such as scabies, lice or pinworms also cause pruritus. Scabies is infestation of the skin with itch mites causing severe itchiness, worse at night. The female mite tunnels in the skin and lay her eggs. The intense itching is caused by the mite’s secretions. Commonly infected areas are the groins, external genetalia and the skin between the digits of the hands and feet. Infestations with lice-head, body or genitalia are intensely pruritic. Head lice are common in children. Body lice are common in children with poor hygiene.

Parasitic infestations with pinworms are a cause of intense pruritus around the anus, worse at night and early hours of the morning. Pinworms live in the upper part of the large intestines. The female worm goes out from the large intestine through the anus and deposits its eggs and dies. This is the cause of itching during night and early morning.

Dry Skin

Dryness of the skin medically termed as xerosis is one of the common cause of pruritus in children. Dry skin is often covered with fine scales, sometimes cracked, maybe the result from excess bathing with or without strong detergents or in hot and moist weather. The cause is unknown. Dry skin is one cause of intense skin itching in the absence of skin rash. Dry skin as a sole cause of itching is more common in adults.

Systemic Disease

Systemic illness as a cause of pruritus occurs in about 10-50 percent in adults. Although not common, pruritus in children may also present as a sign of an underlying systemic illness. Itchiness in systemic diseases are often generalized such as those found in chronic kidney failure, liver disease, thyroid problems, systemic drug reactions or cancer.

Pruritus in chronic kidney failure ranges from 20-30 percent. Itchiness is noted more in patients not dialysed. Probably the pruritus is due to dryness of the skin seen in these patients. (To be continued)