Skip to Main Content

++

Probability diagnosis

++

Psychological/emotional

++

Old, dry skin (senile pruritus)

++

Atopic dermatitis (eczema)

++

Contact (allergic) dermatitis

++

Varicella (chicken pox)

++

Serious disorders not to be missed

++

Cancer:

++

  • lymphoma/Hodgkin

  • leukaemia: CLL

  • multiple myeloma

  • other cancer, e.g. mycosis fungoides

++

Scabies (severe infestation)

++

Chronic kidney failure

++

Primary biliary cirrhosis/other causes (e.g. jaundice)

++

Pitfalls (often missed)

++

Pregnancy

++

Tropical infection/infestation

++

Polycythaemia rubra vera

++

Polyarteritis nodosa

++

Lichen planus

++

Generalised sensitivity (e.g. fibreglass, bubble bath)

++

Masquerades checklist

++

Depression

++

Diabetes

++

Drugs (several types; see list)

++

Anaemia (iron deficiency)

++

Thyroid (hyper and hypo) disorders

++

Spinal dysfunction (nostalgia paraesthetica)

++

Is the patient trying to tell me something?

++

Quite likely: consider anxiety, parasitophobia.

++

Key history

++

Enquire about nature and distribution of itching. Consider pregnancy, liver disease and malignancy of the lymphatic system, particularly Hodgkin lymphoma. A careful review of any drug history is important. Note any associated general symptoms such as fever.

++

Key examination

++

  • General examination of the skin, abdomen and lymphopoietic systems

++

Key investigations

++

Consider:

++

  • FBE/ESR/CRP

  • urinalysis

  • pregnancy test

  • iron studies

  • kidney function tests

  • TFTs

  • blood sugar

  • chest X-ray

  • skin biopsy

  • stool examination (for ova and cysts)

  • lymph node biopsy (if present)

  • skin testing.

++

Diagnostic tips

++

  • The itching of polycythaemia may be triggered by a hot bath and lasts for at least 1 hour.

  • Pruritus can be the presenting symptom of primary biliary cirrhosis and may precede other symptoms by 1–2 years.

  • The itch of Hodgkin lymphoma (in 30%) may be unbearable.

  • Drugs that can cause pruritus: aspirin, barbiturates, morphine, cocaine, penicillin, other antibiotics, anticytotoxics.

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.