Skin protectants: Zinc oxide, the primary ingredient in diaper rash cream, is a common skin protectant in anti-itch cream. You may also see petrolatum on the label, which helps seal moisture into the skin (though it may leave you feeling greasy since it’s not highly absorptive). In addition to being effective for relieving itch from bug bites, the cream also works to relieve minor symptoms related to poison ivy, a skin rash, or allergic reaction, among other minor skin ailments that cause itchy skin. Secondary hyperparathyroidism which also occurs in dialysis patients leads to microprecipitation ( deposition) of calcium and magnesium salts in the skin, triggering mast cell degeneration, releasing serotonin and histamine. Other dermatological and general metabolic causes of itch may need to be excluded e.g. eczema, scabies, drug-induced reactions, iron deficiency, and thyroid disease. What is the differential diagnosis for uraemic pruritus?

Uraemic pruritus arises in patients undergoing dialysis is due to a combination of xerosis (dry skin), secondary hyperparathyroidism, peripheral neuropathy (nerve changes) and inflammation.

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Hepatogenic pruritus is more common in intrahepatic than extrahepatic cholestasis. Examples of intrahepatic cholestasis are that associated with chronic viral hepatitis, primary biliary cirrhosis, pregnancy-related cholestasis. Extra- hepatic cholestasis is associated with pressure on the bile ducts, eg from pancreatic tumours or pseudocysts. Some women find that products with strong perfumes can irritate their skin, so you could try using unperfumed lotion or soap.

Depending on what is found to be causing your itch, you may be referred to a hospital specialist for a further assessment and specific treatment. How to reduce itching If you or your children need to use an emollient regularly, it's a good idea to keep some in small pots or tubes at home, school or work. How to use emollients How to use emollients on your skin A careful examination can identify dermatological causes for the itch (eg scabies, lichen simplex, pemphigoid) or evidence of chronic skin changes related to the itch. In dermatological causes of pruritus, primary skin lesions will usually suggest the diagnosis. Patients without primary skin lesions and little evidence of chronic scratching should be investigated for systemic, neuropathic and psychogenic causes.

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Uraemic pruritus can be very unpleasant; about half of affected individuals become agitated or depressed. Uraemic pruritus in haemodialysis patients is associated with a 17% increase in mortality. How is uraemic pruritus diagnosed? Tetracyclic antidepressants such as mirtazepine and selective serotonin reuptake inhibitors (paroxetine, sertraline, fluoxetine) may also help some patients with severe itch including when it is caused by cholestasis, T-cell lymphoma, malignancy or a neuropathic cutaneous dysaesthesia. Your doctor or pharmacist will talk to you about which type of emollient will work best for your skin condition.