Transcript pruritus

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.
2.
3.
4.
5.
6.
Psoriasis <85%
ESRD
60-80%
CTCL 70-80%
Hodgkin 10-30%
Pregnanacy 20%
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 :attacksheat,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
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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