Itching

http://www.nlm.nih.gov/medlineplus/ency/article/003217.htm
Itching

Alternative names Pruritus
Definition Itching is a tingling or uneasy irritation of the skin that makes you want to scratch the affected area.

Considerations Itching may occur all over the whole body (generalized) or only in a specific location (localized).

Common Causes There are many causes of itching. The following may cause localized or generalized itching:

1. Insect bites and stings
2. Sunburn
3. Hives
4. Parasites such as pinworm (Also see:body lice, head lice, pubic lice)
5. Dry skin
6. Aging skin
7. Contact dermatitis (poison ivy or poison oak)
8. Contact irritants (such as soaps, chemicals, or wool)
9. Atopic dermatitis
10. Rashes (may or may not itch)
11. Superficial skin infections such as folliculitis and impetigo
12. Pityriasis rosea
13. Psoriasis
14. Seborrheic dermatitis

Generalized itching may be caused by:

• Childhood infections (such as chicken pox or measles)
• Allergic reactions
• Kidney disease
• Liver disease with jaundice
• Reactions to medications and substances such as:
• antibiotics (penicillin, sulfonamides),
• gold,
• griseofulvin,
• isoniazid, opiates,
  phenothiazines, or
• vitamin A
• Pregnancy
• Hepatitis
• Iron deficiency anemia

Home Care
For persistent or severe itching, see your health care provider for a precise diagnosis and specific treatment instructions.
In the meantime, you can take some steps to help deal with the itch:

1. Avoid scratching or rubbing the itchy areas. Keep fingernails short to avoid skin damage from scratching. Family members or friends may be able to help by calling attention to your scratching.
2. Wear cool, light, loose bedclothes. Avoid wearing rough clothing, particularly wool, over an itchy area.
3. Take lukewarm baths using little soap and rinsing thoroughly. Try a skin-soothing oatmeal or cornstarch bath.
4. Apply a soothing lotion after bathing to soften and cool the skin.
5. Use moisturizer on the skin, particularly in the dry winter months. Dry skin is a common cause of itching.
6. Apply cold compresses to an itchy area.
7. Avoid prolonged exposure to excessive heat and humidity.
8. Take part in activities that distract from the itching during the day and make you tired enough to sleep at night.
9. Try over-the-counter oral antihistamines such as diphenhydramine (Benadryl), but be aware of possible side effects such as drowsiness.
10. Try over-the-counter hydrocortisone cream on localized itchy areas.
11. Call your provider if itching is associated with other unexplained symptoms, is severe, prolonged, or cannot be easily explained.
12. Most itching does not require medical evaluation. Try to rule out the obvious causes of itching.
13. It is sometimes easy for a parent to discern the cause of a child's itching. Usually a simple visual examination will help you identify any bites, stings, rashes, dry skin, or irritation. Often the cause of itching is fairly obvious, such as a mosquito bite.
14. Recurrent itching without obvious cause, total body itching, and recurrent hives are all indications that the itching should be evaluated as soon as possible. Such itching may be a symptom of an underlying disease or possibly serious condition.

What to expect at your health care provider's office
Your health care provider will obtain your medical history and perform a physical examination.
Medical history questions documenting itching may include the following:

• How long have you had this itch?
• Does it itch all the time?
• Does it seem to get worse, and has it spread?
• What do you think caused this itch?
• Have you ever had this kind of itch before? What caused it then?
• Do you recall any irritant that you recently came in contact with?
• Do you have any allergies or sensitivities?
• What medications are you taking?
• Have you started using any new products recently? What was it?
• Have you used any new soaps, fabric softeners, perfumes, deodorants, fabrics such as wool, or chemicals?
• Have you been around animals?
• Have you eaten shellfish or nuts recently?
• Have you had insect bites recently?
• Do you use lotions on your skin?
• Have you been in the sun recently?
• What part of your body itches?
• Is it all over your body (generalized itch)?
• Is the itch limited to a specific area? What area?
• What does the skin that itches look like?
• Is there a rash? If so, are there blisters or scales?
• Are you being treated for other medical conditions?
• What other symptoms do you have?
• If there is no localized infection or skin lesion, diagnostic studies such as blood tests, skin biopsies, or x-rays will focus on finding a systemic (whole body) cause.
• Prescribed medications may include topical corticosteroids, antihistamines, or tranquilizers.

http://www.nlm.nih.gov/medlineplus/ency/article/000285.htm

Sclerosing Cholangitis

Digestive system

Bile pathway
Alternative names Primary sclerosing Cholangitis
Definition Sclerosing Cholangitis is an inflammation of the bile ducts of the liver without a specified cause.

Causes, incidence, and risk factors
The bile ducts within and outside the liver become narrowed and scarred. The cause is unknown. The disease is associated with inflammatory bowel disease (Crohn's disease and ulcerative colitis), and genetic factors may may also be responsible. The disease is progressive and most patients develop biliary cirrhosis, persistent jaundice, and liver failure. The diagnosis is made, in part, by eliminating other diseases of the biliary system -- for example, by absence of stones in the gallbladder or biliary system. The disease occurs more often in men. This disorder is rare in children.

Symptoms

1. Jaundice
2. Itching
3. General discomfort, uneasiness, or ill feeling (malaise)
4. Loss of appetite
5. Indigestion
6. Enlarged liver
7. Enlarged spleen

Signs and tests

Tests that show Cholangitis:

1. ERCP (endoscopic retrograde cholangiopancreatography)
2. PTC (percutaneous transhepatic cholangiogram)
3. Liver biopsy
4. Abdominal CT scan
5. MRCP (abdominal MRI/magnetic resonance cholangiopancreatography)
6. Abdominal ultrasound
7. Blood tests that reveal abnormal function:
   Elevated liver enzymes (liver function tests)

Treatment
Endoscopic balloon dilation of strictures may relieve symptoms. Endoscopic stent (drain or tube) placement for major strictures may be a possibility. Liver transplantation prior to liver failure is a possibility in some cases. The medications cholestyramine and ursodiol may be used in some circumstances, although medications have not been effective in improving the prognosis. Antibiotics are used for infections within the bile ducts.
Expectations (prognosis)

Prognosis is variable. Some patients develop recurrent infections of the bile ducts. Some patients have progressive chronic liver disease with ascites and varices. Patients have an increased risk of developing cancer of the bile ducts (cholangiocarcinoma), and liver transplant may become necessary.

Complications

1. Liver failure
2. Cholangitis (infection of the biliary system)
3. Cholangiocarcinoma
4. Vitamin deficiencies

Calling your health care provider

Call your health care provider if persistent jaundice and itching are present.~