Does pancreatitis make you itch?

Quick Answer

Itching, also known as pruritus, is a common symptom in people with pancreatitis. The itching is often related to high bilirubin levels or opioid medications used to treat pancreatitis pain. Managing itching involves treating the underlying cause, such as changing pain medication, treating bile duct blockages, or administering bile binders. Antihistamines may provide temporary relief from itching.

What is Pancreatitis?

Pancreatitis is inflammation of the pancreas, an organ located behind the stomach. The pancreas produces enzymes that help digest food and hormones like insulin that regulate blood sugar.

There are two main types of pancreatitis:

  • Acute pancreatitis – sudden inflammation that develops over hours or days and usually resolves within a week with treatment.
  • Chronic pancreatitis – persistent inflammation causing permanent pancreatic damage over many years.

Common causes of pancreatitis include:

  • Gallstones blocking the pancreatic duct.
  • Heavy alcohol use over many years.
  • High blood lipids such as triglycerides.
  • Certain medications.
  • Injury to the pancreas.
  • Genetic factors.

Acute pancreatitis usually causes upper abdominal pain, nausea, vomiting, fever, and an elevated heart rate. Mild cases can be managed with rest, hydration, and pain medication. Severe cases may lead to bleeding, organ failure, and other serious complications.

Chronic pancreatitis also causes abdominal pain and leads to permanent destruction of the pancreas over time. This can impair digestion and cause diabetes due to the inability to produce insulin.

What Causes Itching in Pancreatitis?

Itching, known medically as pruritus, affects up to 70% of people hospitalized for acute pancreatitis. Chronic pancreatitis also commonly causes itching.

Several factors can contribute to itching with pancreatitis:

High Bilirubin

Bilirubin is a yellow pigment produced when old red blood cells break down. Normally, the liver filters bilirubin out of the bloodstream. But liver problems or bile duct blockages prevent bilirubin excretion into bile. The buildup of bilirubin in the blood causes jaundice and often severe full-body itching.

Pancreatitis sometimes impairs liver function or creates gallstones that obstruct bile ducts. This leads to a backup of bilirubin into the blood and subsequent itching.

Medications

Potent opioid pain medications like morphine are commonly used to treat the abdominal pain caused by pancreatitis. Opioids can cause mild itching in some people. The itching tends to increase with higher opioid doses.

Switching to a different type of opioid or lowering the dosage often controls opioid-induced itching. Drugs like naloxone may also help while allowing pain control.

Dry Skin

Chronic pancreatitis diminishes the pancreas’ ability to produce digestive enzymes. Poor digestion of fats can cause essential fatty acid deficiencies over time. This can lead to very dry, scaly skin that feels itchy.

Supplementing with essential fatty acids like omega-3s may help reduce this type of itching. Moisturizing creams can also soothe dry skin.

Nerve Damage

The recurrent inflammation of chronic pancreatitis can sometimes damage nerves in the skin. This neuropathic damage induces feelings of itching, tingling, numbness or pain.

Neuropathic itching tends to come and go randomly and may not respond to typical anti-itch treatments. Medications like gabapentin or amitriptyline may calm neuropathic itch signals.

Anxiety and Stress

Having chronic pancreatitis causes significant anxiety for many people. The disease also leads to depression in up to 40% of those affected. Anxiety and depression can both heighten sensations of itching without an obvious physical cause. Relaxation techniques, therapy, or anti-anxiety medications may help reduce stress-induced itching.

Treatments for Itching

The treatment approach depends on the underlying cause of itching:

Bile Duct Blockages

Gallstones stuck in the common bile duct can be removed through endoscopic or surgical procedures. This restores the flow of bilirubin into the small intestine and reduces jaundice and itching. Placing a temporary plastic tube called a stent in the bile duct also relieves blockages.

Medication Changes

If itching coincides with starting a new medication, stopping the drug may stop the itching. Switching opioid pain medications or using antihistamines often alleviates medication-induced itching.

Bile Binders

Bile acid sequestrants are medications that bind to excess bile components like bilirubin. This allows them to be excreted in the stool rather than build up in blood. Bile binders like cholestyramine (Prevalite) can quickly relieve itching caused by high bilirubin levels.

Antihistamines

Antihistamines like diphenhydramine (Benadryl) block the action of histamine, a chemical involved in allergic reactions and itching. Antihistamines provide temporary relief by reducing itching and skin irritation.

Emollients

Applying thick moisturizing creams and ointments can soften dry skin and reduce itching. Creams containing colloidal oatmeal are particularly effective due to oatmeal’s anti-inflammatory properties.

Essential Fatty Acids

Getting more omega-3 fatty acids from fish oil, flax seeds or other sources may correct deficiencies that cause itchy, scaly skin.

Soothing Baths

Bathing in lukewarm water containing oatmeal powder or baking soda can temporarily relieve itchy skin. Avoid hot water which further dries out skin.

Steroids

Applying corticosteroid creams directly to itchy patches of skin reduces inflammation and itching. Oral steroids like prednisone may be used for short periods for severe full-body itching.

Antidepressants

Some tricyclic antidepressants like doxepin are potent anti-itch medications at lower doses. The neuropathic pain medications gabapentin and pregabalin also reduce itch signals.

Phototherapy

Controlled ultraviolet light treatment can improve some cases of severe itching not relieved by medications. However, phototherapy may increase skin cancer risk with repeated long-term use.

Home Remedies

Several remedies may help provide temporary itch relief at home:

  • Cold compresses – Apply cold cloths to itchy areas to soothe inflamed skin.
  • Aloe vera gel – The cooling gel from an aloe plant reduces itching and inflammation when applied to the skin.
  • Witch hazel – Wipe itchy areas with a cotton ball soaked in witch hazel to numb skin.
  • Apple cider vinegar – Add 2 cups apple cider vinegar to a warm bath and soak for 15-20 minutes to reduce itching.
  • Baking soda – Make a paste of baking soda and water and apply to itchy skin for temporary relief.

Certain foods may also help minimize itching:

  • Cold-water fish like salmon contain omega-3s to improve dry scaly skin.
  • Turmeric has anti-inflammatory properties that may reduce itchiness.
  • Probiotics help restore healthy gut bacteria to aid digestion and reduce inflammation.
  • Bananas provide moisture and nutrients to the skin when eaten.

When to See a Doctor

Contact your doctor if itching:

  • Becomes severe or widespread
  • Disturbs sleep or daily life
  • Occurs with other symptoms like jaundice or rash
  • Persists after trying over-the-counter anti-itch creams
  • Happens with new medications

Seek immediate medical care if you experience:

  • Worsening abdominal pain
  • Nausea and vomiting
  • Fever over 101°F (38°C)
  • Signs of dehydration like dizziness
  • Sudden shortness of breath

These could indicate an acute pancreatitis flare or other serious complication requiring hospital treatment.

Diagnosing the Cause

To determine what’s causing itching with pancreatitis, the doctor may:

  • Ask about your medical history and any recent medications.
  • Conduct a physical exam checking for rashes, jaundice, or skin damage.
  • Order blood tests to assess liver function and check levels of bilirubin, enzymes, triglycerides, and calcium.
  • Obtain a stool sample to test for fat content.
  • Do imaging tests like an abdominal ultrasound, CT, or MRI scan to visualize the pancreas and surrounding structures.
  • Refer you to a dermatologist for skin evaluation or possible skin biopsy.

Identifying the source of itching allows targeting treatment accordingly.

Conclusion

Itching is a common bothersome symptom affecting over half of people hospitalized for pancreatitis. The itching results from various factors including bile duct obstructions, certain medications, essential fatty acid deficiencies, neuropathic damage, and anxiety.

Treating the underlying cause of itching is key. This may involve procedures to unblock bile ducts, changing medications, supplemental essential fatty acids, moisturizers, anti-itch creams, antibiotics, and techniques to reduce anxiety.

Home remedies like oatmeal baths and cold compresses can temporarily relieve itching flare-ups. See your doctor promptly if itching becomes severe or you experience concerning symptoms that could indicate an acute pancreatitis attack. Appropriate diagnosis and management will help control uncomfortable itching while treating the pancreatitis.

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