Approach to the Patient with Chronic Pruritus

Zoe M Lipman; Giuseppe Ingrasci; Gil Yosipovitch

doi:10.1016/j.mcna.2021.04.007

Approach to the Patient with Chronic Pruritus

Med Clin North Am. 2021 Jul;105(4):699-721. doi: 10.1016/j.mcna.2021.04.007.

Authors

Zoe M Lipman¹, Giuseppe Ingrasci¹, Gil Yosipovitch²

Affiliations

¹ Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, University of Miami Hospital, 1600 Northwest 10th Avenue RMSB Building, 10th Street, 2067B Miami, FL, USA.
² Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, University of Miami Hospital, 1600 Northwest 10th Avenue RMSB Building, 10th Street, 2067B Miami, FL, USA. Electronic address: [email protected].

PMID: 34059246
DOI: 10.1016/j.mcna.2021.04.007

Abstract

Chronic pruritus (itch lasting ≥6 weeks) is a bothersome chief complaint that may present in a broad variety of diseases. Most itch-causing diagnoses fit into 1 of 5 categories (inflammatory, secondary to systemic disease, neuropathic, chronic pruritus of undetermined origin, and psychogenic itch) and this broad differential can be narrowed using key findings in the history and physical. In this article, we discuss which key findings are most pertinent for narrowing this differential and guiding further workup and treatment, as well as how to treat many itchy conditions.

Keywords: Chronic pruritus; Generalized pruritus; Inflammatory itch; Itch; Localized pruritus; Neuropathic itch.

Publication types

Review

MeSH terms

Administration, Topical
Adrenal Cortex Hormones / administration & dosage
Adrenal Cortex Hormones / therapeutic use
Algorithms
Analgesics, Opioid / administration & dosage
Analgesics, Opioid / therapeutic use
Antidepressive Agents / administration & dosage
Antidepressive Agents / therapeutic use
Calcineurin Inhibitors / administration & dosage
Calcineurin Inhibitors / therapeutic use
Chronic Disease
Counseling / methods
Detergents / administration & dosage
Detergents / therapeutic use
Diagnosis, Differential
Emollients / administration & dosage
Emollients / therapeutic use
Histamine Antagonists / administration & dosage
Histamine Antagonists / therapeutic use
Humans
Immunosuppressive Agents / administration & dosage
Immunosuppressive Agents / therapeutic use
Inflammation / complications*
Male
Neurotransmitter Agents / administration & dosage
Neurotransmitter Agents / therapeutic use
Nutritional Support / methods
Peripheral Nervous System Diseases / complications*
Pruritus / diagnosis*
Pruritus / drug therapy
Pruritus / etiology*
Relaxation Therapy / methods
Skin Diseases / pathology*

Substances

Adrenal Cortex Hormones
Analgesics, Opioid
Antidepressive Agents
Calcineurin Inhibitors
Detergents
Emollients
Histamine Antagonists
Immunosuppressive Agents
Neurotransmitter Agents