Why do I feel so very itchy all of the time?

FOR a while now I’ve had an awful, constant itching on my hands, shoulders, neck and scalp. My skin doesn’t feel dry and I don’t use any perfumed cosmetics. I’ve had a blood test and my kidneys are showing wear. I am 87 and I take levothyroxine. Am I lacking something in my diet?

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 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. Another possible cause is psoriasis, an auto-immune condition that leads to the overproduction of skin cells but you have no reddening or dryness of the skin.

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. 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.

Although you have a reduction in kidney function, this is not unusual in someone your age.

The fact that you take levothyroxine — which is prescribed for an underactive thyroid — may be a factor. An underactive thryoid gland can lead to a slowing in the turnover of cells in the skin, causing itching.

However, I think the more likely cause is xerosis. This is, in effect, dry skin, but it is very common in older people. 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). 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.

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.

There is also hydroxyzine (trade name Atarax), only available on prescription, but which is specifically designed for the relief of itchy skin. 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?

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 repeated small strains.

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 collarbone 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.

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