Atopic dermatitis (eczema)
Contact dermatitis (irritant and allergic)
Simple pruritus (cause not found)
Is the patient trying to tell me something?
Psychogenic including dermatitis artefacta.
Includes past history, especially chronic dermatoses (particularly atopic dermatitis and contact dermatitis), diabetes and psychological disorders. Enquire about exposure to infestations such as ‘backpacker’ lodgings, scabies and sexual contact. Drug history is important.
General and localised examination of the skin
Note any scratch marks
Look for evidence of insects such as scabies, lice and bed bugs, the violaceous rash of lichen planus and the vesicles of dermatitis herpetiformis
Pruritus is a feature of dry skin, common in the elderly.
An intense localised itch is suggestive of scabies or bed bugs.