By:Dr Neda adibi
Researcher and dermatologist in IUMS
The pruritus is an unpleasant sensation which may lead to scratch
The most common complaint in dermatology
With or without skin lesion Can be a manifestation of systemic
disease(10-50%)
Systemic etiology like: Metabolic disorder,hematologic
disease,malignancy ,HIV,complication of pharmacologic agents,neuropsychiatry disease
1. Psoriasis <85%2. ESRD 60-80%3. CTCL 70-80%4. Hodgkin 10-30%5. Pregnanacy 20%6. Herpes zooster 60%
Localized or generalized lesion is not predictive or systemic disease
Acute onset ,without skin lesion less likely to be systemic
Butterfly sign:sparing of the upper mid back may rule out skin problems (it may be psychogenic or systemic)
Most non dermatologic pruritic patients show only excoriation but not primary lesion
Urticaria and mastocytosis have rubbing and pressing not scratching
Involvement of several family members may be due to scabies
Exacerbation after bath may be due to polycytemia or aquagenic pruritus
Nocturnal generalized pruritus,chill and fever may detect hodgkin (pruritus may be up to 5 year before lymphoma)
Most pruritus interferes with sleep except psychogenic
Carefull examination of nail,scalp,hair and lymph node ,liver and spleen
No geneneral need for LAB Generalized pruritus of unknown
etiology ESR,CBCdiff ,LFT,FBS,TFT,fe and ferritin Stool for parasite CXR
Scabies:local or general with a burning component,starts 3-6 week after first infestation
Pediculosis Atopic disease :attacks-
heat,perspiration,wool,stress,contact with air may provoke
Summer type and winter type
Patients with psoriasis y for rarely respond to antihistamines
Prurigo nodularis:more in middle aged women
Atopy,psychological stress , may be underlying
Most effective treatment is thalidomide 200 mg/d for at least 6 months
• It is independent of water temperature or its salinity
• It starts 30 minute following water contact and lasts for 2 hours
• Begin in lower extremity and then generalized with sparing of head ,palm,sole and mucosa
• Treatment cimetidine,colestiramin cyproheptadin,PUVA,UVB,topical capcaiecin two times per week for 4 week
Folliculitis and impetigo may cause pruritus
HSV,varicella,HIV and viral exanthems
DM,hepatic dysfunction,renal dysfunction and tyroid problem
Polypharmacy Lice and scabies Most common cause is xerosis
Decrease the frequency of cold and hot bath and alkaline soap
Decrease the frequency of bath Moisturizers Post CVA using amitriptelyne and
carbamazepin
1-5 % of people more in men 25-90 % are primary Cause:dietary like excessive coffee
intake,poor heigiene,psychogenic Rule out of anxiety and
depression,patch test,colonoscopy in refractive cases
pinworm in children
Treat with cool compress,sitz bath,fragrance free soap,mild corticosteroid cream
Topical capcaiecin
Acute:infection and ACD and ICD Chronic:dermatosis like
psoriasis ,LSA,malignancy
Scalp folliculitis seborhoeic dermatitis,psoriasis and folliculitis
Wound healing may cause pruritus Post burn pruritus Renal failure:gabapentine ,ranal
transplant Hepatic diseas
Myelodysplasia Iron defficiency Polycythemia Lymphoma and lukemia
Thyroid disease Diabetes:genital and perianal pruritus is
common in women with uncontrolled diabetes
HIV
Drug related:estrogen,captopril,co amoxiclav,phenytoin,beta blockers,retinoid.,lithium
Topical like corticosteroid,menthol,coal tar and anasthetics ,urea.
Topical doxepin Capcaiecin Tacrolimus and pimecrolimus PUVA and UVB