"Doctor, I itch all over"

Itching, known as pruritis in medical jargon, is defined as an unpleasant sensation of the skin that provokes the urge to scratch. Most often, itching involves a small area of the skin affected by a localized condition, such as poison ivy, eczema, or insect bites. On occasion, the itching is generalized, affecting most of the body. If a rash is present with this generalized pruritis, doctors may be able to determine the cause without difficulty. In some cases, however, generalized itching can occur with no obvious rash or cause, creating a puzzling situation for patients as well as doctors. Today’s Health Tip looks at some of the reasons for "itching all over".

Dry skin is the most common cause for itchy skin without an obvious skin rash.Typically, this occurs in the wintertime because of low humidity levels, but spending much of the day in an air-conditioned environment can lead to dry skin also. Bathing too often or use of certain soaps are frequent contributors to dry skin as well.

Irritation from clothing is another common cause for generalized itching. This can be due to the fabric itself, with wool being a common irritant, or to the detergents or chemicals contained in cleaning products. These substances can wear down the oily, protective layer on the skin’s surface and lead to irritant contact dermatitis.

Occasionally, the presence of an internal disease can be responsible for generalized itching. Some of these illnesses are:

• Celiac disease. This condition is caused by an inability to tolerate gluten, most commonly found in wheat products. Itching in celiac disease is often associated with a skin condition called dermatitis herpetiformis (DH). In DH, clusters of small blisters that resemble a herpes virus rash are seen on various areas of the body. Instead of being due to a virus, however, DH is thought to stem from an immune reaction triggered by gluten.
  
  
• Kidney failure. The itching in end-stage kidney disease may be due to a buildup of toxins in the blood (uremia) or to an excess of a hormone excreted by the parathyroid gland. In kidney failure, the skin may appear entirely normal except for the repeatedly scratched areas.
  
  
• Chronic liver disease. One liver condition in particular, known as primary biliary cirrhosis (PBC), is associated with itching. PBC is caused by progressive inflammation and destruction of the small bile ducts within the liver. Characteristically, the itching in PBC begins in the palms of the hands and soles of the feet, later spreading to involve the entire body.
  
  
• Lymphoma. Itching in this lymph node cancer is most commonly seen in a type called Hodgkin’s disease. The itching may occur long before other manifestations, such as enlargement of lymph nodes, are present.


• Thyroid disease. Both hypothyroidism (inadequate thyroid hormone) as well as hyperthyroidism (excessive thyroid hormone) can lead to generalized itching.


• Iron deficiency. Fatigue due to anemia (low blood count) is the most common symptom of iron deficiency. Occasionally, generalized itching, brittle nails, swelling or soreness of the tongue, and cracks in the sides of the mouth can occur also.

Medication-related pruritis. Drugs are one of the most common causes for generalized itching. Some of the medications that are associated with generalized itching are aspirin, opioid pain relievers, and antibiotics. Opioids include codeine, hydrocodone, and oxycodone. With a medication allergy, a rash or hives may be present. Antibiotics are occasionally responsible for more severe reactions, such as wheezing and swelling of the lips, tongue and face. Other, less likely medications that have been associated with generalized itching include those used to treat high blood pressure (hydrochlorothiazide, ACE-inhibitors), gout (allopurinol), and high cholesterol (simvistatin, atorvastatin, lovastatin, others).

How is the cause of generalized itching determined? In addition to a general physical examination, tests for generalized pruritus may include a complete blood count, kidney function, liver function, thyroid function, iron level, and a chest x-ray (looking for evidence of lymphoma).

How is generalized itching treated? The best way to treat generalized pruritis is to address the underlying cause of the itching. For example, if iron deficiency anemia is responsible, iron replacement should take care of the problem. Non-specific treatments for pruritus, used while evaluating for the underlying cause, include skin moisturizers, topical steroid creams, and oral antihistamines.

Should you be tested for type 2 diabetes?

There are two main types of diabetes. Type 1 diabetes is usually diagnosed in childhood and requires treatment with insulin injections. When initially diagnosed, most Type 1 diabetics have distinct, and sometimes severe symptoms. Type 2 is known as "adult onset" diabetes and constitutes over 90% of the cases. In Type 2 diabetes, the pancreas doesn’t make enough insulin to keep blood glucose levels normal, often because the body becomes resistant to the effects of insulin. Unlike Type 1 diabetes, a large number of people with Type 2 diabetes (or its predecessor, prediabetes) are unaware that they have the condition. The number of people with Type 2 diabetes is increasing at an alarming rate, thought to be due to increasing rates of obesity and lack of exercise. Even among children, Type 2 diabetes is becoming all too common. Since it is becoming increasingly prevalent and is often "silent", what are the reasons that someone should consider being tested for Type 2 diabetes?

Do you have symptoms of diabetes? Symptoms of Type 2 diabetes usually develop very slowly. When symptoms are present, they usually include one or more of the following:

• Being frequently or constantly thirsty
  
• Having to urinate more often than usual
  
• Numbness or tingling in the hands or feet
  
• Frequent yeast infections
  
• Blurred vision
  
• Delayed healing of cuts or sores
  
• Fatigue

Clearly, when symptoms of diabetes are present you need to be tested. Treatment not only helps to address the symptoms, but will also help prevent long-term complications. These include heart disease, nerve damage, kidney failure, blindness, and skin problems, including bacterial and fungal infections.

Are you at increased risk of having diabetes? Recommendations as to who should receive screening vary among experts. The U.S. Preventive Services Task Force believes that it is most important to screen those adults who have sustained blood pressure (either treated or untreated) greater than 135/80 mm Hg. This is because the combination of diabetes and hypertension is much more likely to cause vascular disease, leading to heart attacks and strokes. The American Diabetes Association (ADA), on the other hand , recommends screening in anyone 45 years of age or older, particularly in those who are overweight (body mass index of 25 or greater). The ADA goes on to say that screening should be considered in overweight people who are younger than 45 years of age if they have one or more additional risk factors for diabetes, which include hypertension, high cholesterol, a family history of type 2 diabetes, diabetes during a pregnancy, or having delivered a baby weighing more than 9 pounds.

Should children be screened for diabetes? Children who are overweight and have other risk factors for diabetes are also at risk for developing Type 2 diabetes. They should be tested every two years starting at age 10 or at the onset of puberty, whichever comes first.

What is the best way to screen for diabetes? The most commonly performed screening test is the fasting plasma glucose. The American Diabetes Association recommends this test for screening because it is easy to perform and less expensive than other screening tests. You are considered to have diabetes if your fasting glucose level is 126 mg/dl or higher (normal is a fasting glucose of less than 100 mg/dl.

What if the fasting glucose is between 100 and 126 ng/dl? Before developing type 2 diabetes, most people go through a stage known as "pre-diabetes". In these individuals, blood sugar levels are higher than normal but not high enough to say they have diabetes. The importance of detecting pre-diabetes is that the likelihood of developing Type 2 diabetes can be reduced by making changes in your lifestyle, such as losing weight and exercising regularly.

How often should screening be performed? The optimal screening interval is not known, but based on existing evidence, the American Diabetes Association, recommends screening every 3 years. Screening more often than this may be needed if someone has several risk factors or if they gain a great deal of weight.

How can I determine my risk for developing Type 2 diabtes? The American Diabetes Association offers an assessment tool called the Diabetes Risk Test. Follow this link and take this simple test. If you are at increased risk for developing pre-diabetes or Type 2 diabetes, see your doctor for screening.

Smokeless Tobacco, a safer alternative?

The most commonly used forms of smokeless tobacco are chewing tobacco and snuff. Chewing tobacco, also known as "chew", "spit", or spitting tobacco, is available as loose leaves, plugs, or twists. It is usually placed between the cheek and the lower lip and either chewed or held in place. The saliva generated by the tobacco may be swallowed or spit out. Snuff is a finely cut or powdered form of tobacco. Snuff users sometimes refer to the use of snuff as "dipping". In America, most snuff users place a pinch or pouch of moist snuff between the cheek and gum or behind the upper or lower lip. Dry forms of snuff, more commonly used in Europe, can be sniffed into the nose. Less popular forms of smokeless tobacco include a compressed powdered tobacco that is similar to small hard candies and a newer spit-less tobacco product called snus.

Why do people use smokeless tobacco? In a word---nicotine. Users report that the nicotine in smokeless tobacco, just like the nicotine in tobacco that is smoked, provides a pleasant, stimulant effect. Instead of the nicotine being absorbed through the lungs, however, the nicotine from smokeless tobacco is absorbed through the mouth and is then carried by the blood stream to the brain. In fact, the nicotine from smokeless tobacco stays in the bloodstream longer than nicotine absorbed with smoking.

What problems does nicotine cause? Nicotine is a highly addictive substance that leads to cravings, dependence on its use, and tolerance of its effects. Tolerance means that over time, more frequent use, or use of a stronger product, becomes necessary to achieve the same effects. As with cigarette smoking, once someone begins using smokeless tobacco, it can be very difficult to quit. In addition to its addictive potential, nicotine causes a short-term increase in blood pressure and heart rate, as well as causing blood vessels to narrow. This may be the reason that long-term users of smokeless tobacco have an increased risk of heart attack and stroke.

Is nicotine the only dangerous substance in smokeless tobacco? The National Cancer Institute has identified 28 cancer-causing substances in smokeless tobacco products produced in the U.S. These include nitrosamines, polonium–210, and aromatic hydrocarbons. Nitrosamines are formed during the growing, curing, fermenting, and aging of tobacco. They have been linked to the development of several types of cancer including cancer of the mouth, esophagus, and pancreas. Polonium–210 is a radioactive element found in tobacco fertilizer.

Are there other health concerns related to use of smokeless tobacco? In addition to an increased risk of developing heart disease and cancer, smokeless tobacco use can lead to gum disease (gingivitis), tooth decay, and to the development of precancerous white patches in the mouth called "leukoplakia". As with cigarettes, smokeless tobacco products can also cause staining of the teeth and bad breath.

Should smokeless tobacco be used to help a person quit smoking? There is no scientific evidence that using smokeless tobacco can help a person quit smoking. Furthermore, the American Heart Association advises consumers against the use of smokeless tobacco products for smoking cessation, since they are as addictive as cigarettes and can raise the risk of risk of fatal heart attack and stroke.

Is using smokeless tobacco less hazardous than smoking cigarettes? A number of years ago, the advisory committee to the Surgeon General concluded that the use of smokeless tobacco "is not a safe substitute for smoking cigarettes." Whether it is being smoked, chewed, or is allowed to sit in the mouth, there is no safe level of tobacco use.