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Feature Article

Pruritus: an approach to diagnosis and management

Ian D Hamann

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Abstract

Pruritus is a common presenting symptom in primary care medicine that can prove distressing to the patient and frustrating for the treating doctor. Here is a practical approach to the diagnosis of its causes and its management, including a discussion of some less familiar conditions in which pruritus is a feature.

Key Points

  • It is important to distinguish pruritus with a rash from that without; pruritus without a rash suggests a systemic cause for the itch.
  • If a systemic cause for pruritus is suspected, limited investigations are warranted.
  • Attention to general skin care principles is essential for patients with pruritus.
  • If possible, provide patients with written instructions of skin care and keep regimens reasonably simple.
  • Topical corticosteroids are only helpful in treating the underlying disease in patients with inflammatory dermatoses.
  • Oral treatments for pruritus, including antihistamines, tricyclic antidepressants, benzodiazepines and opioid receptor antagonists, may offer relief in specific circumstances.
  • Pruritus is a feature of the following less familiar conditions: lichen simplex chronicus, prurigo nodularis, Grover’s disease, brachioradial pruritus, notalgia paraesthetica and urticarial dermatosis.

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