ASK THE GP: Why do I feel so itchy all the time? 

ASK THE GP: Why do I feel so itchy all the time? Dr Martin Scurr answers your questions

For a while now I’ve had awful, constant itching on my hands, shoulders, neck and scalp. I have tried aloe vera, E45 and Oilatum lotion, but it hasn’t eased.

My skin doesn’t feel dry and I don’t use any perfumed cos-metics. I’ve had a blood test and my kidneys are showing wear. I am 87 and I take levothyroxine, but I don’t take any vitamin supplements and wondered if I am lacking something in my diet?

Mary Carr, Staines, Middx.

Itching is a very common problem, but is not actually a disease in itself: it is the result of an underlying complaint which may or may not relate to the skin. Medically, itching is referred to as pruritus, and it is a symptom that deserves careful consideration, as when it becomes a chronic problem, it can be distressing.

In trying to reach a diagnosis, the first thing to consider is obviously a skin disorder: the most common cause of itching is atopic eczema — but this almost always begins in childhood. 

Common: Medically, itching is referred to as pruritus, and it is a symptom that deserves careful consideration, as when it becomes a chronic problem, it can be distressing

Another possible cause is psoriasis, an auto-immune condition that leads to the overproduction of skin cells, causing red, thickened patches of skin covered in silvery scales.

In 80 per cent of cases, this causes itching, but as you haven’t mentioned having the characteristic flaky patches of skin, this diagnosis seems unlikely in your case.

Itching is also related to a problem with the kidneys or the liver as a result of a build up of waste products under the skin. And various disorders of the bone marrow can cause itching. But any of these so-called systemic conditions related to the organs will normally cause other symptoms, so I think you would be aware of them.

Some people with depression may also experience itching — it’s not clear why.

Although you have a reduction in kidney function, this is not unusual in someone your age and so I think is unrelated to your itch. The fact that you take levothyroxine — which is prescribed for an underactive thyroid — may be a factor.

An under active thryoid gland can lead to a slowing in the turnover of cells in the skin, which can lead to the urge to itch.

However, I think the more likely cause is xerosis. This is, in effect, dry skin, but it is very common in older people and I say this even though you say you are not aware of excessive dryness, and even though the use of E45 and Oilatum — well-known emollients — does not appear to have helped.

I suggest avoiding factors known to aggravate pruritus such as traditional soaps, and swapping to gentler products, for instance Cetaphil cleanser or E45 emollient wash, which add oils back in. They also help maintain normal acidity of the skin (soap is more alkaline and can cause damage).

Also, avoid bathing or showering in very hot water, as it worsens the sensation of itch. Next, apply a moisturiser daily to help reduce water loss from the skin: put these on after a bath or shower for best effect. If the itching is not relieved with the above measures, it may be necessary to take medication to control it.

Oral antihistamines can be effective, though their efficacy hasn’t been formally proven in studies. Chlorphenamine (found in some forms of Piriton) is safe and inexpensive, but has the side-effect of sleepiness. There is also hydroxyzine (trade name Atarax), only available on prescription, but which is specifically designed for the relief of itchy skin.

I am sure your symptom is not due to malnutrition, but there should be careful assessment for a disorder that might be driving the pruritus and I hope your doctor has given this full consideration.

Is it a good idea to work through the pain in my right shoulder and neck to strengthen my muscles? Or is it better to rest it as I’m doing?

The pain is only a slight niggle, and I feel it when opening my front door which has an automatic door closure, recently installed as a fire prevention measure. I am a fit 72-year-old.

J. Claridge, Pinner.

The danger is that working through a niggling pain in an attempt to strengthen the shoulder muscles may risk worsening a developing problem.

The shoulder is a complex structure, consisting of a large ball sitting on a small shallow socket, which is part of the scapula or shoulder blade.

The shoulder joint involves three bones: as well as the scapula, there is the clavicle or collar-bone, and the ball at the top of the humerus, the long bone in the arm.

The whole structure depends upon a set of muscles and ligaments for stability, which give it great mobility, but means there is a potential for damage, either through accidental excessive strain, or (as is most frequent) repeated small strains.

Did you know? The shoulder is a complex structure, consisting of a large ball sitting on a small shallow socket, which is part of the scapula or shoulder blade

The main stability comes from the rotator cuff, a set of four muscles that clasp the head of the humerus to part of the scapula and shoulder pain is frequently due to an injury here.

For example, one of the muscles, supraspinatus, passes through a narrow space under the collar- bone where it is susceptible to being pinched — some repeated arm movements can cause trauma at this site.

I think you need an examination by an orthopaedic specialist with an interest in the shoulder, or a skilled physiotherapist, to reach an accurate conclusion of the cause of your pain — when you demonstrate the movement that causes the discomfort, it will provide a further clue. 

You may be referred for an X-ray, ultrasound scan or MRI. Treatment will obviously depend on the diagnosis but possible options include exercises, anti-inflammatory tablets or a steroid injection under a local anaesthetic, using ultrasound to ensure it goes into the right area in the shoulder.

So seek the opinion of your GP, rather than pushing on and causing more damage.


When I look at the way some parts of the NHS are now being run, I feel a sense of deep bewilderment.

Gone is common sense and compassion, eroded by the imposition of increasing layers of administration, so that at times it seems that the focus is not patient care any more, but box ticking.

Petty bureaucracy is playing a key part in the decline of patients’ experiences of the NHS, as the example of what recently happened to my sister-in-law demonstrates all too vividly.

Write to Dr Scurr 

To contact Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email [email protected] — including contact details. 

Dr Scurr cannot enter into personal correspondence.

His replies cannot apply to individual cases and should be taken in a general context.

Always consult your own GP with any health worries.

A gentle, mild-mannered woman in her 40s, she has a serious rheumatic disease, a form of chronic vasculitis, which causes painful swelling and inflammation to not just mutiple joints, but multiple systems including her kidneys, lungs and eyes.

Recently, she has started on an essential treatment to help alleviate the intense fatigue, pain and resulting lack of mobility her condition causes, but it has led to side-effects, including chronic daily headaches, which she quite rightly wanted to discuss with her medical team.

So she telephoned the rheumatology department of her local hospital to make an appointment to see the specialist rheumatology nurse.

The person on the phone asked for her hospital number, but she did not know it: she gave her name, date of birth, postcode, and would have been happy to provide her NHS number, passport number, tax code and car registration number. Yet she had no idea of her hospital number, no letter with it on — how, she reasoned, could she possible provide it?

Could you check it from the computer, she asked. The response: ‘Sorry, no, I can’t — it’s a question of data protection.’ And, as a result, she was told it would not be possible to make an appointment.

It’s only through persistence that she now has one, but it’s some weeks away.

It seems to me that while patients fall sick in record numbers, the NHS is being strangled by the poison ivy of bureaucracy. The systems introduced to make the NHS more efficient have had the opposite effect. The managers should take note.


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