Itchy skin is a very common symptom that can affect a patient's sleep when severe, leading to a decline in quality of life.
Pruritus disorders can be classified as cutaneous, systemic, neurologic, or psychiatric causes of pruritus. Cutaneous pruritus is usually accompanied by skin manifestations suggestive of the presence of a primary dermatosis. Patients may also present with secondary manifestations of pruritus, such as skin breakage due to scratching, licheniform skin, and hyperpigmentation of the skin.
If the skin itch occurs, if you do not seek medical treatment in time, the more itchy and scratched, the more you scratch, the more itchy, forming a vicious circle.
Why does the skin feel itchy when it is uncomfortable?
First, understand the structure of the skin. The skin is divided into three parts: epidermis, dermis and subcutaneous tissue.
The emulsifying membrane is a sebaceous gland that secretes sebum to fuse sweat, forming a protective film on the surface of the skin.
Sebum metabolism produces fatty acids, which effectively inhibit the growth of bacteria and microorganisms.
When the sebaceous membrane is destroyed, some irritating elements will enter the epidermis layer, stimulating the nerves in the dermis layer and causing itching.
The more you scratch, the more itchy you get, the more you get, and the more you scratch, the more you itch, the more you scratch
What are the causes of itchy skin?
Dry skin in winter is one of the causes of itching.
Not only does the skin act as a barrier, but it can also help us spot some of the diseases within the body.
1. Decreased sebaceous gland function
The sebaceous glands are relatively high at birth and begin to decline after half a year of age. Sebaceous gland secretion begins to rise during puberty, declines at the age of 50 in men and gradually weakens after the age of 40 in women. After the function of the sebaceous glands decreases, the secretion of sebum decreases, the formation of emulsifying membrane is slow, and the skin is prone to dryness and itching.
2. High blood sugar
Long-term high blood glucose can lead to poor microvascular circulation, changes in skin condition, and increased sensitivity. The number of "sugar friends" with skin problems accounts for about 30% of the total number of patients.
3. Chronic kidney disease
Patients with severe renal insufficiency often experience itching.
4. Hepatobiliary diseases
Problems occur in the liver and bile ducts, resulting in an increase in the content of lipid salts in the blood, an increase in bile pigment in the blood, irritation of nerve endings leading to itching of the skin.
5. Tumor
Hodgkin's lymphoma is one of the most common malignancies in young people, common in cervical lymph nodes and supraclavicular lymph nodes. Because the resistance of the entire immune mechanism decreases, exogenous allergens are prone to irritation of the skin and the appearance of pruritus.
Why do people with liver disease experience itchy skin?
Many patients with chronic liver disease develop skin itching, with skin itching occurring in 60-70% of patients with primary biliary cholangitis and primary sclerosing cholangitis, 20-50% of patients with jaundice, 10% of patients with viral hepatitis, 18% of patients with cirrhosis, and women with intrahepatic cholestasis during pregnancy.
In patients with liver disease, pruritus is usually associated with cholestasis, such as primary biliary cholangitis, primary sclerosing cholangitis, obstructive common bile duct stones, cholangiocarcinoma, and chronic viral hepatitis. However, not every patient with liver disease will experience itching symptoms, and the specific cause of itching is currently unknown.
Clinically, skin itching is one of the complications of cholestasis, which can occur in patients with cholestasis of any cause. But not all patients with cholestasis develop itching.
The pathogenesis of pruritus in cholestasis is unknown, but several hypotheses have been proposed, including: accumulation of bile acids, increased endogenous opioid peptide production, and elevated hemolytic phosphatidic acid levels.
If the patient's liver function decreases, bile secretion disorders, and bile stasis occurs, the bile acid in the bile combined with bilirubin and the like returns to the bloodstream, flowing throughout the body with blood circulation, when the bile salt is deposited in the skin, stimulating the sensory nerve endings in the skin, so that the patient feels itchy throughout the body.
Manifestations of itchy skin in patients with liver disease?
Pruritus in patients with cholestasis may be systemic or localized (especially in the palms and soles of the feet).
The intensity of the itching varies and can be aggravated and reduced spontaneously. Its severity is not related to the severity of the underlying liver disease.
Pruritus often worsens at night and may also be exacerbated by psychological stress. Women may also experience worsening of symptoms during premenstrual periods. Cool temperatures often improve itching.
Long-term scratching may result in skin breakage, folliculitis, nodular pruritus, and lichenidosis.
Pruritus can seriously affect a patient's quality of life, leading to sleep deprivation and mood disorders (suicidal ideation in some patients).
How is skin itching treated in patients with liver disease?
The treatment of itching depends on the severity of the symptoms.
If symptoms are mild, nonspecific treatments (e.g., e.g., emollients) may be helpful.
Moderate to severe pruritus is treated with medication (e.g., cholestyramine).
Severe, refractory pruritus may require liver transplantation.
Mild itching — If mild itching is mild, treatments such as warm baths and emollients may be helpful. Antihistamines may also be effective, especially in patients with insomnia. However, when the itching is moderate to severe, these measures are often ineffective.
Moderate to severe itching
General Approach — For patients with moderate to severe pruritus, we begin pharmacotherapy if non-specific treatment measures are ineffective.
How can people with liver disease relieve itching?
Skin itching caused by liver disease is stubborn and is generally not relieved on its own or by scratching.
When patients with liver disease develop skin itching, the following points should be noted:
1) Pay attention to avoid eating spicy and irritating foods in your diet, do not drink alcohol, drink strong tea, and eat more foods with live serum heat effects, such as celery, hawthorn, chrysanthemum and other foods.
2) When the skin itching is unbearable, try to avoid scratching hard, cut the nails short, gently scratch after putting the gloves into the gloves; use a warm and hot shower to reduce the itching, and avoid alkaline shower supplies such as soap.
3) Do more activities of interest, such as listening to music, reading, etc. to distract attention and reduce scratching.
Clinically, it can be combined with traditional Chinese medicine and traditional Chinese medicine external treatment to alleviate skin itching.
The immediate cause of the itching is difficult to determine, but there are many self-treatment and preventive measures that can help patients.
For example, patients can minimize pruritus by:
1. Moisturize the skin
2. Take a cool bath
3. Wipe the affected skin area with a damp cold cloth
4. Keep away from heat sources
5. Wear loose clothes
6. Avoid scratches as much as possible