{"id":4343,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/pruritus\/"},"modified":"2023-08-29T15:26:21","modified_gmt":"2023-08-29T14:26:21","slug":"pruritus","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/dermatology\/pruritus\/","title":{"rendered":"Pruritus"},"content":{"rendered":"\n<title>Pruritus<\/title>\n\n\n\n<h3 class=\"wp-block-heading\">Generalised pruritus<\/h3>\n\n\n\n<p>May occur with or without an underlying skin disease.&nbsp; <\/p>\n\n\n\n<p><strong>Xerosis\/dry skin is one of the commonest causes of itch especially in elderly patients.<\/strong><\/p>\n\n\n\n<p><strong>In the absence of overt skin disease consider the following : <\/strong><\/p>\n\n\n\n<p><span style=\"text-decoration:underline\">Itch associated with underlying medical conditions:<\/span><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Diabetes mellitus<\/li>\n\n\n\n<li>Anaemia \/ Iron deficiency<\/li>\n\n\n\n<li>Thyroid dysfunction<\/li>\n\n\n\n<li>Liver disease<\/li>\n\n\n\n<li>Haematological conditions eg Lymphoma, Polycythaemia Vera<\/li>\n\n\n\n<li>Other malignancies<\/li>\n\n\n\n<li>HIV<\/li>\n<\/ul>\n\n\n\n<p><span style=\"text-decoration:underline\">Medication related itch:<\/span><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>In particular morphine and other opioids, statins, ACEI, NSAIDs, digoxin, antimalarials and sulphonamides<\/li>\n<\/ul>\n\n\n\n<p><span style=\"text-decoration:underline\">Neurological itch:<\/span><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Brachioradial pruritus \u2013 itch localised to dorsi-lateral forearm (sometimes shoulder).<\/li>\n\n\n\n<li>Notalgia paraesthetica \u2013 itch localised to between or below the scapulae.<\/li>\n<\/ul>\n\n\n\n<p><span style=\"text-decoration:underline\">Psychogenic itch:<\/span><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Anxiety and depression can be associated with itch and can be made worse by it.<\/li>\n\n\n\n<li>Delusional parasitosis<\/li>\n\n\n\n<li>Morgellon&#8217;s Syndrome (where patients report fibres coming out of their skin)<\/li>\n<\/ul>\n\n\n\n<p><span style=\"text-decoration:underline\">Infections\/infestations (skin changes not always obvious)<\/span><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Scabies<\/li>\n\n\n\n<li>Bed bugs<\/li>\n\n\n\n<li>Fleas<\/li>\n<\/ul>\n\n\n\n<p><span style=\"text-decoration:underline\">Idiopathic itch:<\/span><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Up to 50% of patients with itch will have no clear cause for this.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Vulval and perianal pruritus<\/h3>\n\n\n\n<p><strong>Consider the following diagnoses:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Candidiasis<\/li>\n\n\n\n<li>Dermatophyte infection<\/li>\n\n\n\n<li>Irritant dermatitis or allergic contact dermatitis<\/li>\n\n\n\n<li>Lichen simplex<\/li>\n\n\n\n<li>Lichen sclerosus<\/li>\n\n\n\n<li>Infestation with thread worms<\/li>\n\n\n\n<li>Intra-epithelial neoplasia \u2014 ask about previous history of anogenital warts or cervical intra-epithelial neoplasm<\/li>\n<\/ul>\n\n\n\n<p><a rel=\"noreferrer noopener\" href=\"\/refhelp\/guidelines\/Genital%20ItchSexualHealth\" target=\"_blank\">See also Sexual Health &#8211; Genital itch<\/a><\/p>\n\n\n\n<p><strong>R.C 18-05-23<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h3 class=\"wp-block-heading\">Generalised pruritus<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Unresponsive to management<\/li>\n\n\n\n<li>Diagnostic uncertainty<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Vulval and perianal pruritus<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Diagnosis uncertainty<\/li>\n\n\n\n<li>Uncontrolled symptoms<\/li>\n\n\n\n<li>If contact allergy suspected,&nbsp;patch testing may be appropriate.<\/li>\n\n\n\n<li><\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h3 class=\"wp-block-heading\">Generalised pruritus<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Treat any underlying disease<\/li>\n\n\n\n<li>&nbsp;Frequent &amp; plentiful use of emollient and soap substitutes (see Eczema pages for more details). Consider if relatives\/carers needed to apply in elderly patients.<\/li>\n\n\n\n<li>Crotamiton cream can be helpful in soothing itch after scabies and calamine after chicken pox.<\/li>\n\n\n\n<li>Oral antihistamines (sedating type may be more helpful in itch especially at night, though non-sedating may be safer in the elderly)<\/li>\n\n\n\n<li>Consider menthol in aqueous cream (0.5%- 2%). Dermacool (1% menthol in aqueous cream) is listed on the Lothian Joint Formulary. It is not licensed as a medicine, but it is reimbursable on GP prescriptions as it is listed in part 7U of the drug tariff<\/li>\n\n\n\n<li>5% doxepin hydrochloride cream can be helpful for localised areas of itch though is non-formulary.<\/li>\n\n\n\n<li>If medication is suspected, discontinue for a few weeks (if possible) and see if symptoms improve.<\/li>\n<\/ul>\n\n\n\n<p><strong>Investigations<\/strong>&nbsp;as appropriate<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Glucose<\/li>\n\n\n\n<li>Renal Function<\/li>\n\n\n\n<li>Full blood count<\/li>\n\n\n\n<li>Ferritin<\/li>\n\n\n\n<li>Liver Function test<\/li>\n\n\n\n<li>Thyroid Function tests<\/li>\n\n\n\n<li>Urinalysis<\/li>\n<\/ul>\n\n\n\n<p><strong>If indicated by history or clinical suspicion:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Chest x-ray<\/li>\n\n\n\n<li>Abdominal ultrasound<\/li>\n\n\n\n<li>HIV test<\/li>\n\n\n\n<li>Anti-mitochondrial antibody<\/li>\n\n\n\n<li>Myeloma screen<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Vulval and perianal pruritus<\/h3>\n\n\n\n<p><strong>Investigations&nbsp;<\/strong>as appropriate<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Urinalysis for glycosuria or near-patient BG test<\/li>\n\n\n\n<li>Swab for yeasts<\/li>\n\n\n\n<li>Stool sample for ova and parasites<\/li>\n<\/ul>\n\n\n\n<p><strong>Management<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Emollients, soap substitutes and avoidance of irritants<\/li>\n\n\n\n<li>Good hygiene regime (not over or under cleaning)<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">For Patients<\/h4>\n\n\n\n<p>PIL re Pruritis<\/p>\n\n\n\n<p><a href=\"http:\/\/www.bad.org.uk\/shared\/get-file.ashx?id=121&amp;itemtype=document\" target=\"_blank\" rel=\"noreferrer noopener\">http:\/\/www.bad.org.uk\/shared\/get-file.ashx?id=121&amp;itemtype=document<\/a><\/p>\n\n\n\n<p>PIL re Pruritis ani<\/p>\n\n\n\n<p><a href=\"http:\/\/www.bad.org.uk\/shared\/get-file.ashx?id=120&amp;itemtype=document\" target=\"_blank\" rel=\"noreferrer noopener\">http:\/\/www.bad.org.uk\/shared\/get-file.ashx?id=120&amp;itemtype=document<\/a><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">For Health Professionals<\/h4>\n\n\n\n<p>&nbsp;<a rel=\"noreferrer noopener\" href=\"http:\/\/www.pcds.org.uk\/clinical-guidance\/pruritus-without-a-rash\" target=\"_blank\">http:\/\/www.pcds.org.uk\/clinical-guidance\/pruritus-without-a-rash<\/a><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Pruritus Generalised pruritus May occur with or without an underlying skin disease.&nbsp; Xerosis\/dry skin is one of the commonest causes of itch especially in elderly patients. In the absence of overt skin disease consider the following : Itch associated with underlying medical conditions: Medication related itch: Neurological itch: Psychogenic itch: Infections\/infestations (skin changes not always<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3853,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[107],"class_list":["post-4343","page","type-page","status-publish","hentry","category-pruritis"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/dermatology\/pruritis\/\" rel=\"tag\">Pruritus<\/a>","rttpg_excerpt":"Pruritus Generalised pruritus May occur with or without an underlying skin disease.&nbsp; Xerosis\/dry skin is one of the commonest causes of itch especially in elderly patients. In the absence of overt skin disease consider the following : Itch associated with underlying medical conditions: Medication related itch: Neurological itch: Psychogenic itch: Infections\/infestations (skin changes not always","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4343","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=4343"}],"version-history":[{"count":7,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4343\/revisions"}],"predecessor-version":[{"id":15438,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4343\/revisions\/15438"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3853"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=4343"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=4343"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}