Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:19

Pruritus 1229

Imaging

■Chest x-ray, particularly in the absence of a primary cutaneous dis-

order

differential diagnosis

■Primary dermatologic diseases:

➣Eczema – including atopic and contact

➣Psoriasis

➣Scabies

➣Mycosis fungoides

➣Dermatitis herpetiformis

➣Lichen planus

➣Insect bites

➣Xerosis

➣Drug reactions

■Systemic diseases:

➣Renal disease – hemodialysis associated, uremic pruritus

➣Hepatic dysfunction – biliary obstruction, primary biliary cirrho-

sis, hepatitis C

➣Hyper- or hypothyroidism

➣Iron deficiency anemia

➣Diabetes mellitus

➣Polycythemia vera

➣Lymphoma – particularly Hodgkin’s disease

➣Parasitosis – intestinal

➣HIV infection

➣Pregnancy – might be due to cholestasis

■Localized pruritus:

➣Notalgia paresthetica – localized pruritus usually on the back of

middle-aged to elderly women – may reflect an underlying spinal

nerve impingement

➣Brachioradial pruritus – localized itching on the arm and fore-

arm. This condition might also reflect underlying nerve impinge-

ment.

➣Lichen amyloidosis

➣Lichen simplex chronicus

➣Pruritus ani or pruritus vulvae

management

What to Do First

■Assess severity of pruritus and possible causes