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I Have A Very Painful Chronic Itching That Started A Few Years Ago
Question: Hello, I have a very painful chronic itching that started a few years ago and has gotten progressively worse. I have been to 3 allergists and been checked out and had allergy tests and autoimmune tests from them. The last allergist took an aggressive approach and put me on Xyzal, Allegra, Singular, Benedryl, and Pepid A/C all at that same time and nothing helps. I have had full blood workup in my annual physical a week ago and all is fine. I have been checked out by 2 dermotologists and even tried Gabapentin to no avail and UV light therapy. The itching is all over the body and painful and under the skin. I am going in for an full stomach ultrasound next week to check the liver but my liver bloodwork is fine. I tool Haldol (3Mg XXXXXXX down to 1Mg) for 25 years for Tourette's and am off it now. All I take is Metform, Provocal, Ambien and Losartan/HCT (100/25) and have tried stopping each medication one at a time for 2 weeks and that didn't help. Is it possible that I could have an allergy to sulfa in Losartan even though I took 5 allergy drugs at once, or do you have any other thoughts. I am at my wits end and so is my internist, it is becoming hard to live day to day with the itching, burning and pain all over my entire body. I need some hope and direction please.
Brief Answer:
Please see the detailed answer below.
Detailed Answer:
Hi,
Thank you for the query. I can understand your concern. According to your statement, you have been suffering from painful chronic itching for few years.
Such type of painful chronic itching may result from some skin conditions like dry skin or xerosis, eczema, psoriasis or parasitic infestation, underlying health conditions like liver diseases, kidney diseases, anemia, diabetes, thyroid dysfunction, multiple myeloma or lymphoma, neurological disorders like multiple sclerosis, irritation or allergic reactions like wool, cosmetics, soap, perfumes or any other using chemicals, psychiatric conditions like anxiety, depression or obsessive compulsive disorder etc.
It is also possible that you may be allergic to sulpha group of antihypertensive drugs, foods or clothings.
You may undergo some investigations like CBC, kidney function tests, thyroid function tests along with your ultrasound. If possible, then biopsy can be taken from the painful chronic itchy skin may help to confirm the diagnosis.
In the meantime, bathe in plain lukewarm water for 20 minutes and then apply triamcinolone ointment to the wet skin. You can apply tacrolimus or topical anesthetics too. Take steroid in the form of injectable for few days and then take them orally. You can take antihistamines too. Antidepressants like fluoxetine, sertraline or doxepin may be helpful in easing some types of chronic itch.
Take care. Hope I have answered your question. Let me know if I can assist you further.
Regards,
Dr. Zubayer Alam, General And Family Physician,
Please see the detailed answer below.
Detailed Answer:
Hi,
Thank you for the query. I can understand your concern. According to your statement, you have been suffering from painful chronic itching for few years.
Such type of painful chronic itching may result from some skin conditions like dry skin or xerosis, eczema, psoriasis or parasitic infestation, underlying health conditions like liver diseases, kidney diseases, anemia, diabetes, thyroid dysfunction, multiple myeloma or lymphoma, neurological disorders like multiple sclerosis, irritation or allergic reactions like wool, cosmetics, soap, perfumes or any other using chemicals, psychiatric conditions like anxiety, depression or obsessive compulsive disorder etc.
It is also possible that you may be allergic to sulpha group of antihypertensive drugs, foods or clothings.
You may undergo some investigations like CBC, kidney function tests, thyroid function tests along with your ultrasound. If possible, then biopsy can be taken from the painful chronic itchy skin may help to confirm the diagnosis.
In the meantime, bathe in plain lukewarm water for 20 minutes and then apply triamcinolone ointment to the wet skin. You can apply tacrolimus or topical anesthetics too. Take steroid in the form of injectable for few days and then take them orally. You can take antihistamines too. Antidepressants like fluoxetine, sertraline or doxepin may be helpful in easing some types of chronic itch.
Take care. Hope I have answered your question. Let me know if I can assist you further.
Regards,
Dr. Zubayer Alam, General And Family Physician,
Above answer was peer-reviewed by :
Dr. Raju A.T
Hello, one more question. If I had a sulfa allergy, would taking these 5 drugs solve that Xyzal, Allegra, Singular, Benedryl, and Pepid A/C. The reason I ask is yes, I take Losartan/HCTZ 100/25Mg for blood pressure and I was told it had sulfa in it, but a couple of months ago i took those 5 allergy medications listed above all at once and still had the itching, so I am not sure if they work on something like an allergy to sulfa. If they don't really solve for that allergy, then I can ask to be put on another blood pressure medication perhaps?
Brief Answer:
Please see the detailed answer below.
Detailed Answer:
Hi,
Thank you for joining again. You should not take Losartan HCTZ if you are allergic to losartan potassium/ hydrochlorothiazide or any of the non-medicinal ingredients in the formulation are allergic to any sulfonamide derived drugs or sulfa drugs; most of them has a medicinal ingredient that ends in -Mide.
Even sulfa preparations may be found in soaps and cosmetics. But there is no definitive test that can determine that you are allergic to the sulfa group. You can stop all drugs for few days and after that just start your Losartan HCTZ, if your painful itching reappears, then you are allergic to sulfa containing drugs.
Or, you can consult your doctor and share your thinking about sulfa groups of medications with him. Your doctor then will definitely change your antihypertensive medications. Even, your doctor can advise doing some investigations that have been already mentioned to detect the exact underlying causes for your present sufferings. You can also try to use the above mentioned that I have already mentioned, which may help to subside your painful itching.
Take care. Hope I have answered your question. Let me know if I can assist you further.
Regards,
Dr. Zubayer Alam,
General And Family Physician,
Please see the detailed answer below.
Detailed Answer:
Hi,
Thank you for joining again. You should not take Losartan HCTZ if you are allergic to losartan potassium/ hydrochlorothiazide or any of the non-medicinal ingredients in the formulation are allergic to any sulfonamide derived drugs or sulfa drugs; most of them has a medicinal ingredient that ends in -Mide.
Even sulfa preparations may be found in soaps and cosmetics. But there is no definitive test that can determine that you are allergic to the sulfa group. You can stop all drugs for few days and after that just start your Losartan HCTZ, if your painful itching reappears, then you are allergic to sulfa containing drugs.
Or, you can consult your doctor and share your thinking about sulfa groups of medications with him. Your doctor then will definitely change your antihypertensive medications. Even, your doctor can advise doing some investigations that have been already mentioned to detect the exact underlying causes for your present sufferings. You can also try to use the above mentioned that I have already mentioned, which may help to subside your painful itching.
Take care. Hope I have answered your question. Let me know if I can assist you further.
Regards,
Dr. Zubayer Alam,
General And Family Physician,
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
One final question, I just had a complete annual exam last week with the standard bloodwork they do every year. My blood test for The alanine aminotransferase (AST) was 17 so well within normal range (13-39) and the The alanine aminotransferase (ALT) test was 20, again, well within normal range (7-52). What is the likelyhood that I still have a liver issue given these tests came out fine. I have an upcoming stomach ultrasound to just be sure, but would it be unusual if my 2 liver tests were fine that there is still a real problem with the liver?
Brief Answer:
Please see the detailed answer below.
Detailed Answer:
Hi,
Thank you for joining again. In some hepatic diseases, ALT, AST or other liver function tests may stay normal.
Liver cirrhosis can be presented without raising enzymes. Primary biliary cirrhosis is a chronic cholestatic liver disease and its main presentation is severe itching. In primary biliary cirrhosis ALT or AST can remain normal. Again, primary sclerosing cholangitis is the disease of progressive inflammation and scarring of the bile ducts of the liver may present with normal ALT or AST level. Chronic liver disease or CLD may present with normal ALT or AST values.
So, normal AST and ALT levels never exclude the presence or pre existing liver disease. But I have never tried to predict that you are a patient of any type of liver disease. Ultrasound is one of routine investigation that can be done to detect the causes of itching and excluding liver diseases that may cause painful serious itching.
I have already mentioned some other tests which also may help to find out the exact causes of chronic itching. Your doctor also may suggest to undergo those tests in the near future. I have also already mentioned some remedies that may help to reduce your itching and you can try to apply those.
Take care. Hope I have answered your question. Let me know if I can assist you further.
Regards,
Dr. Zubayer Alam, General And Family Physician,
Please see the detailed answer below.
Detailed Answer:
Hi,
Thank you for joining again. In some hepatic diseases, ALT, AST or other liver function tests may stay normal.
Liver cirrhosis can be presented without raising enzymes. Primary biliary cirrhosis is a chronic cholestatic liver disease and its main presentation is severe itching. In primary biliary cirrhosis ALT or AST can remain normal. Again, primary sclerosing cholangitis is the disease of progressive inflammation and scarring of the bile ducts of the liver may present with normal ALT or AST level. Chronic liver disease or CLD may present with normal ALT or AST values.
So, normal AST and ALT levels never exclude the presence or pre existing liver disease. But I have never tried to predict that you are a patient of any type of liver disease. Ultrasound is one of routine investigation that can be done to detect the causes of itching and excluding liver diseases that may cause painful serious itching.
I have already mentioned some other tests which also may help to find out the exact causes of chronic itching. Your doctor also may suggest to undergo those tests in the near future. I have also already mentioned some remedies that may help to reduce your itching and you can try to apply those.
Take care. Hope I have answered your question. Let me know if I can assist you further.
Regards,
Dr. Zubayer Alam, General And Family Physician,
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Above answer was peer-reviewed by :
Dr. Prasad
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