Itchiness of the skin may at times occur without a rash. It can happen to any person of any age but when it occurs in the elderly and tends to be persistent, it is then known as senile pruritus. Itching can be intense enough to cause significant discomfort to a person, affect sleep and impact on the psychological state of the sufferer. In the elderly there is the added risk that constant scratching can damage the skin and lead to secondary skin infections. Understanding the nature of senile pruritus and other causes of skin itching is important in managing it adequately and improving the quality of life for the elderly sufferer.
There is no known cause for senile pruritus. In fact a diagnosis of senile pruritus should only be made once other possible causes of itchy skin without a rash has been excluded. Age-related changes in the skin especially drying of the skin is one of the leading causes but even with good skin care and the use of emollients (barrier creams), itching tends to persist in senile pruritus. The other factor is the general health status of a person and daily nutrition, both of which are affected to some degree with advancing age.
Skin health involves personal hygiene and good skin care. With regards to hygiene, it is sometimes a consequence of infrequent bathing but can equally be caused by overzealous washing. Bathing too frequently, scrubbing the skin with coarse bathing accessories and using strongly scented and antiseptic soaps all contributes to an itchy skin. Not using a sunscreen when outdoors and inadequate or infrequent moisturizing particularly in harsh environmental conditions – hot and strong sunlight, cold and dry climates.
Another significant cause of skin itching without a rash is as a side effect of using certain medication. This is known as an iatrogenic cause. The elderly are more likely to have certain chronic diseases and are therefore more likely to be using chronic medication and combinations of drugs simultaneously. Itchy skin is one of the more common side effects of most drugs.
Sometimes the drug interaction of two or more drugs causes symptoms such as itchy skin which are not well documented for each drug on its own. It is difficult to isolate specific drugs that may cause itchy skin due to the prevalence of this side effect or possibility of drug interaction. It is known that pain relievers, aspirin, antibiotics and antifungal drugs are more likely to cause itchy skin. There is some evidence that even certain nutritional supplements are likely causes.
Various skin diseases can affect the elderly or may be chronic and have started earlier in life. These skin diseases may go through phases where there is no skin rash present. However, itching of the skin can be continuous and even severe. Eventually a skin rash erupts and may then resolve again with or without treatment. It is therefore important for the elderly to inform their doctor of their previous history of skin diseases especially conditions such as atopic dermatitis, psoriasis, and known drug allergies that caused skin symptoms on previous occasions.
Systemic causes refers to diseases that affect one or more organs in the body or even the entire body and is not specific to the skin. Some systemic causes that can cause intense itching of the skin even without a skin rash includes :
Psychogenic itching is the term for psychological causes of an itchy skin. Sometimes it is just imagined while at other times it is linked to mental health disorders such as depression and dementia. The elderly especially those who tend to live alone or have disabilities are also less likely to be able to bathe themselves, clean bed linen or clothing frequently or may have very close contact with pets all of which can contribute to skin itching.