Excessive body odor

Disease Description (Causes and Symptoms)

• Definition: Pruritus is an unpleasant sensation (itching) that creates the urge to scratch or rub the skin. It is a symptom that occurs in various skin diseases and systemic diseases.
• Main causes:
  • Skin diseases: atopic dermatitis, contact dermatitis, urticaria, prurigo nodularis, scabies, lichen simplex chronicus (lichenification), insect bites, nummular eczema, etc.
  • Systemic diseases (causing generalized pruritus): chronic kidney disease, primary biliary cirrhosis, biliary obstruction, cholestasis, diabetes mellitus, hyperthyroidism or hypothyroidism, hematologic cancers (lymphoma, leukemia), HIV, etc.
  • Drug-induced: Some medications (e.g., opioids, certain antibiotics and anticancer drugs) may cause pruritus.
  • Other: Dry skin (aging and environmental factors), psychological stress, changes in temperature, etc.
• Pathophysiology (briefly): Pruritic signals originating at the peripheral ends of the skin are transmitted to the central nervous system through C fibers. Skin barrier damage, inflammatory cytokines, bile acids, uremic substances, and hormonal imbalances amplify pruritic signals.
• Main symptoms: Localized or generalized itching, sleep disturbance (worsening at night), and skin damage, oozing, hyperpigmentation, and lichenification (thickening of the skin) caused by repeated scratching.

Treatment Methods

• Treatment of the cause
  • When possible, diagnose and treat the underlying skin disease (such as atopic or contact dermatitis) or systemic disease (hepatic, kidney, endocrine, or hematologic disease).
  • If a medication is suspected to be the cause, consider discontinuing or replacing the causative medication.
• Symptom relief (topical and systemic)
  • Moisturizers (emollients): The basic treatment for correcting dry skin. Apply immediately after bathing.
  • Topical medications: If inflammatory skin lesions are present, use topical corticosteroids (prescribed by a doctor).
  • Cooling agents: Provide immediate relief with calamine lotion, 1% menthol, etc.
  • Antihistamines: Both nonsedating and sedating antihistamines are used to relieve symptoms (especially when sleep is disturbed).
  • Phototherapy: Consider for chronic generalized pruritus or refractory cases (e.g., narrowband UVB).
  • Systemic medications (for severe or refractory cases):
    • Neuroactive medications such as antidepressants (e.g., mirtazapine) or anticonvulsants (gabapentin, pregabalin).
    • Opioid receptor modulators (e.g., naloxone) or other medications (such as cholestyramine and rifamycin for cholestatic pruritus) — selected according to the underlying cause.
  • Treatment of infection and injury: Antibiotic treatment if a secondary bacterial infection occurs due to scratching.
• Lifestyle management and nonpharmacological treatment
  • Wear thin, breathable clothing and avoid irritating fabrics such as wool.
  • Maintain appropriate indoor humidity and avoid excessive bathing (hot water and frequent showers).
  • Limit caffeine, alcohol, and carbonated beverages (such as cola), as they may aggravate symptoms.
  • Correct scratching habits (keep fingernails short, apply cold compresses, rub with the palms, etc.).
  • Manage stress (psychological factors may aggravate symptoms).
• Precautions, risk of complications, and points to note for self-care
  • Avoid excessive scratching as much as possible because it can cause skin damage, infection, hyperpigmentation, and lichenification.
  • If new systemic symptoms (fever, weight loss, jaundice, enlarged lymph nodes, etc.) occur, immediate evaluation is necessary.
  • Long-term medication use (e.g., systemic medications or phototherapy) requires attention to side effects and monitoring (consult a doctor).
  • Chronic pruritus of unknown cause can reduce quality of life and cause sleep disturbance, so active management is necessary.

Checklist Before an Outpatient Visit (Including Items to Bring and Sample Questions)

• Items to bring (recommended)
  • A list of all medications and supplements currently being taken (including doses and times of administration).
  • A summary of past medical history and recent hospitalization or surgery records.
  • Copies of recently performed test results (blood tests, liver and kidney function tests, thyroid tests, chest X-ray, etc.), if available.
  • A symptom diary recording the location, frequency, and changes in the intensity of the itching (especially worsening at night and triggering factors).
  • Notes on symptoms accompanying the itching (fever, weight changes, jaundice, urinary symptoms, etc.).
• Useful information when visiting an outpatient clinic
  • When the itching began and how it has progressed (acute vs. chronic, localized vs. generalized).
  • Whether any recently started medications or new cosmetics or detergents have been used.
  • Environmental factors that relieve or worsen the itching (temperature, food, stress, etc.).
• Sample questions (including questions patients can ask doctors during an outpatient visit)
  • "What are the possible causes of the itching? What additional tests are needed?"
  • "What are the expected effects and side effects of the medication you are prescribing?"
  • "What points regarding moisturizers, showering methods, and lifestyle habits must I follow?"
  • "If it persists, when should more active treatments (phototherapy, systemic medications, etc.) be considered?"
  • "What symptoms (warning signs) require an urgent visit to the hospital?"

General Sample Questions to Ask a Doctor

• How likely is it that this itching is related to a specific medical condition (such as liver, kidney, or hematologic disease)?
• What is the expected duration of the medication you plan to prescribe, and when should it be discontinued? How will monitoring be performed during long-term use?
• What can I try immediately to improve sleep disturbance caused by the itching?
• What should I do to prevent and treat skin damage (infection) caused by the itching?

Examples of Disease-Specific Questions

• What tests should be prioritized to determine whether my itching is related to liver (bile) or kidney disease?
• When chronic pruritus has caused lichenification (thickening) of the skin, what specific treatments (topical medications or rehabilitation methods) can restore it or prevent further worsening?

(If necessary, preparing test results or a symptom diary and consulting a specialist can help establish a diagnosis and treatment plan.)