Barely Scratching the Surface

I tching or pruritus is an unpleasant sensation that evokes the desire or reflex to scratch. Itching in people with diabetes for the most part suggests a skin condition such as psoriasis, eczema, sunburn, athlete’s foot, hidradenitis suppurativa, pruritus vulvae from monilial infections, xerosis and diabetic eczema, necrobiosis diabeticorum, allergies to medications, drug eruptions, and many other conditions. Most are inflammatory disorders. In addition, there are generalized medical conditions that need to be excluded such as obstructive jaundice (bilirubin is a skin irritant at high concentrations), polycythemia that can cause generalized itching, myxedema, hypoparathyroidism, uremia, iron deficiency anemia, and malignancy or systemic internal cancers such as lymphoma or Hodgkin’s disease (1). When all have been considered and excluded, the question that needs to be answered is, Does the itching derive from a peripheral or a central mechanism?