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ULY CLINIC

16 Septemba 2025, 03:22:50

Pruritus

Pruritus is an unpleasant itching sensation affecting the skin, certain mucous membranes, or the eyes, often provoking scratching for relief. It is commonly more severe at night and may be exacerbated by increased skin temperature, poor skin turgor, local vasodilation, dermatoses, and stress.

Pruritus may result from dermatologic disorders, systemic disease, drug reactions, physiologic conditions (e.g., pregnancy), or emotional stress.

History and Physical Examination

History

Determine onset, frequency, duration, and intensity of itching.
Assess pattern: localized vs generalized, and whether it occurs mainly at night.
Explore triggers: bathing, perfumes, physical exertion, hot water, contact with irritants, emotional stress, illness, travel, and pets.
Review personal hygiene and occupational exposures.
Obtain a complete drug history, including recent medications.

Physical Examination

Inspect for scratching marks: excoriation, purpura, scabs, scars, lichenification.
Identify primary skin lesions to help confirm dermatologic causes.
Check mucous membranes and eyes if relevant.

Medical causes

Cause	Key Features
Iron deficiency anemia	Pallor, fatigue, exertional dyspnea, koilonychia, cheilosis, smooth tongue, tachycardia
Cutaneous anthrax	Painless/pruritic papule → vesicle → black necrotic ulcer; lymphadenopathy, malaise, fever
Conjunctivitis	Eye itching, burning, photophobia, tearing; discharge varies by type (allergic, bacterial, viral, fungal)
Dermatitis	Atopic: erythematous rash at flexion points, edema, scaling, pustules; Contact: itchy vesicles, oozing; Dermatitis herpetiformis: symmetric bullous/papular lesions
Hepatobiliary disease	Generalized pruritus, jaundice, RUQ pain, clay-colored stools, mental changes, spider angiomas, palmar erythema
Herpes zoster	Pruritus, paresthesia, hyperesthesia, vesicular eruptions along dermatomes
Chronic lymphocytic leukemia	Fatigue, lymphadenopathy, fever, hepatosplenomegaly, pallor, bleeding
Lichen simplex chronicus	Localized, chronic pruritus with circumscribed scaling patch and thickened skin
Myringitis	Ear pruritus, purulent discharge, gradual hearing loss
Pediculosis	Intense itching at infestation site; scalp, body, or pubic lice; excoriations and secondary infections
Pityriasis rosea	Mild pruritus; herald patch followed by scaly patches on trunk/extremities
Psoriasis	Pruritus, erythematous plaques with silver scales, nail pitting
Scabies	Localized pruritus, worse at night; threadlike burrows, nodules, excoriation
Tinea pedis	Foot pruritus, pain, scaling, blistering, dry soles
Urticaria	Transient erythematous wheals, stinging/prickly sensation
Vaginitis	Localized pruritus, foul-smelling discharge, perineal pain, urinary dysfunction

Other Causes

Herbs: Ginkgo fruit pulp ingestion → vesicles, pruritus
Bedbug bites: Clusters of purpuric spots, ankle/lower leg itching
Drug hypersensitivity: Penicillin, sulfonamides → pruritus, erythema, urticaria; severe reactions → anaphylaxis

Special Considerations

Administer topical/oral corticosteroids, antihistamines, or tranquilizers as ordered.
If no primary skin lesions are found, suspect systemic disease and prepare for:
- CBC and differential
- ESR
- Protein electrophoresis
- Radiologic studies

Patient Counseling

Teach pruritus management strategies, including avoiding scratching.
Reinforce the importance of reporting worsening or persistent symptoms.

Pediatric Pointers

Many adult causes also affect children but may differ in distribution (e.g., scabies on the head in infants).
Childhood diseases such as measles and chickenpox can produce pruritus.
Adjust treatment for pediatric skin sensitivity and systemic conditions.

References

Buttaro, T. M., Tybulski, J., Bailey, P. P., Sandberg-Cook, J. Primary Care: A Collaborative Practice (pp. 444–447). St. Louis, MO: Mosby Elsevier; 2008.
Colyar, M. R. Well-Child Assessment for Primary Care Providers. Philadelphia, PA: F.A. Davis; 2003.
Lehne, R. A. Pharmacology for Nursing Care (7th ed.). St. Louis, MO: Saunders Elsevier; 2010.
McCance, K. L., Huether, S. E., Brashers, V. L., Rote, N. S. Pathophysiology: The Biologic Basis for Disease in Adults and Children. Maryland Heights, MO: Mosby Elsevier; 2010.
Schuiling, K. D. Women’s Gynecologic Health. Burlington, MA: Jones & Bartlett Learning; 2013.
Sommers, M. S., Brunner, L. S. Pocket Diseases. Philadelphia, PA: F.A. Davis; 2012.
Wolff, K., Johnson, R. A. Fitzpatrick’s Color Atlas & Synopsis of Clinical Dermatology (6th ed.). New York, NY: McGraw Hill Medical; 2009.