As an allergist/immunologist, I see patients to help them diagnose and treat a variety of medical problems, ranging from allergies to lupus and other immune system disorders. Something that always surprises me in my job is how many of my patients are willing to “just live” with some of the symptoms they come to me with, like a seemingly basic rash or mild swelling from an allergic reaction. Even after living in discomfort for far longer than they should, it seems like they assume the symptom is pretty normal, so they don’t seek out an opinion from someone who could help.
A patient might come to me and say, “I have been feeling strangely itchy for a while now, but it’s probably nothing, right?” While it’s possible that body itchiness—the medical term for it is pruritus—with no rash may be related to something super minor, like dry air in the winter or skipping the moisturizer, there are also many other possible, lesser-known causes for feeling itchy that may require specialized treatment. And you should never just dismiss a very persistent symptom—even if it seems like no big deal—without a proper workup.
Below are some reasons you may be feeling itchy, even when there is no rash present.
Dry skin, as you probably know, is an obvious reason to be itchy. But the appearance of your skin when you feel itchy, before you touch it and make it red by scratching, can help you figure out if you’re dealing with normal dry skin that really just craves moisture, or something else.
Typical (untouched) dry skin tends to appear ashy. Now, if you are itchy in spots that do coincide with a visible rash, you may be dealing with another skin issue, such as psoriasis, eczema, or contact dermatitis (which is when the skin reacts after coming in contact with a substance that irritates it, like a detergent). If you have a rash that’s not going away, see your doctor, who can refer you to an allergist and/or dermatologist if necessary.
Back to dry skin: Staying hydrated and not overwashing can help address the dryness and, in turn, stop the itch. And don’t forget to moisturize. Moisturizers act as a barrier to seal in moisture and also hydrate the skin, but some formulas work better than others for dry skin. You’ll want to choose a heavier moisturizer, like an oil-based cream, which will more effectively lock in moisture.
A little shopping hint: Heavy-duty creams are often sold in tubs versus pump bottles because they can be too thick to pump out—so look for tub packaging.
If you have noticed that your body itchiness began after starting a new medication, then that may be the culprit. Certain medications like statins (which are used for cholesterol), blood pressure-lowering medications, and opioids are all known to naturally evoke an itchy sensation that’s not necessarily accompanied by any skin lesions. The exact mechanisms behind drug-induced pruritus for different medications are not entirely clear and may depend on the specific drug. Itchiness in general isn’t a topic that’s considered well-studied at this point.
In some cases, the itchiness will clear up spontaneously if you stop taking the drug. Speak with your doctor if the onset of your itchiness may correlate with a new medication you’re taking. They can consider switching you to a different medication, if it’s an option in your individual case.
Body itchiness is a well-known symptom related to hyperthyroidism and hypothyroidism. But itchiness would likely occur in addition to other common thyroid-related symptoms, including changes in weight and/or appetite and fatigue. Your primary care physician or an endocrinologist can do a blood test to check for any abnormality of your thyroid function and possibly a physical examination of your thyroid gland to check for swelling or tenderness.
Pruritus can be a sign of kidney disease, and it usually shows up when the disease is in an advanced stage. The kidneys are responsible for filtering the blood and removing excess fluid and toxins from the body; but when they no longer function properly, the blood may be filled with abnormally high amounts of waste that they couldn’t filter out (this is called uremia).
As I’ve mentioned, the pathology of pruritus as it relates to different health conditions is far from understood. But with kidney failure, it’s possible that pruritus has to do with inflammation or an imbalance of electrolytes and nutrients in the blood, as the National Kidney Foundation explains.
Take note of where you feel itchy on your body, like whether it’s all over or more localized. People with itchiness tied to kidney disease generally feel the most itchy on their back, but it’s also not unusual for them to feel itchy on the head, abdomen, and arms as well.
Cholestasis is a condition that occurs when there’s an issue with the flow of bile (a digestive fluid) in the body, and it can be tied to certain liver or pancreatic diseases or occur when there’s a problem with the bile duct. When cholestasis happens, waste product known as bilirubin gets into the bloodstream.
This action can cause itchiness, possibly due to the bilirubin building up in the skin.
Cholestasis can also occur during pregnancy (especially in the third trimester), as SELF reported previously. Cholestasis of pregnancy can be dangerous or even life-threatening to the baby—so it’s crucial to get any persistent itchiness checked out right away by your physician if you are pregnant. (Itchiness is the main symptom used to diagnose cholestasis of pregnancy, but other signs may include jaundice, nausea, and loss of appetite, per the Mayo Clinic.)
Treatment for cholestasis depends on the underlying cause, but there are medications that can help alleviate itchiness that your doctor may prescribe.
A pinched nerve, which is when there’s pressure put on a nerve by bone or cartilage or other tissues around it, can stimulate a tingly sensation or numbness that some people may describe as itchiness. The itchy feeling may not occur directly where the pinched nerve is located; for instance, if you feel tingly near the upper forearm area, it could be due to nerve compression in the neck. You may also be dealing with brachioradial pruritus, which is characterized by a tingling or “burning” in the shoulder, neck, or forearm. (The cause is unknown but may have to do with sun exposure.)
Cold compresses applied to the area may be helpful to temporarily relieve the discomfort, but the itchiness may persist as long as the nerve issue itself does.
Other conditions involving the nervous system—shingles, multiple sclerosis, and diabetes, to name a few—can also trigger an itching or tingling, too. This is what experts refer to as “neuropathic itch,” but research that helps explains why this phenomenon occurs is limited.
Cancer is not as common of an etiology when it comes to itchiness without a rash, but certain types of cancer including lymphoma, pancreatic cancer, and blood cancers are linked to this symptom. Unusual body itchiness in some cases can even help lead to a cancer diagnosis. (Some people deal with pruritus as a side effect of cancer treatment, like chemotherapy, but it can also be due to the cancer itself.)
People with human immunodeficiency virus (HIV) can deal with itchiness without (or with) a rash on the body, too. This can be due to the virus itself, or a side effect of medication.
Body itchiness can wax and wane. But if you’ve noticed an itchy sensation for two weeks or longer, have any other symptoms, or if you’re feeling really uncomfortable and don’t want to wait, bring it up with your doctor. Sometimes you can fix itchiness on your own (using over-the-counter treatments for dry skin or an antihistamine, perhaps). But in some cases, like if you’re dealing with a thyroid disorder, you need to treat the underlying medical condition, not just the itchy sensation.
In preparation for your appointment, it’s important to take note of whether or not you notice a rash before you feel itchy, or if you are itchy and then you develop redness or a rash from scratching. Though this detail seems minor, as an allergist/immunologist, it actually dramatically changes the way I will try to pinpoint the cause, and what type of other specialist I might loop you in with.
The bottom line: You deserve to feel well and be comfortable. And body itchiness is probably not something that you’d call comfortable—it’s frustrating and can mess with your ability to sleep, not to mention your overall quality of life. So, treat ongoing itchiness as a symptom that deserves proper medical attention.
Ratika Gupta, M.D., is a board-certified allergist/immunologist and internal medicine physician based in New York.
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