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Dermatology
Pruritus and Dysesthesia
Built from Dermatology, 5th Edition
What’s inside
11 sections · 127 slides
Overview
- What this topic covers
Epidemiology and Classification
How common itch is, and how doctors group its many causes
- What is pruritus
- A clinical classification of chronic pruritus
- Why this classification matters
- How common is pruritus
- Insect bite reaction
- Pruritus is common in many diseases
- Prevalence of pruritus in selected conditions
- Prevalence of pruritus in selected conditions (continued)
Evaluation of the Patient
A structured history and exam narrows down the cause
- Why evaluation is structured
- A simplified approach to the patient with pruritus
- Taking the history
- Descriptive features of pruritus and patient history
- Skin examination
- Dermographism
- Lymph nodes and general exam
- When to order tests
- Laboratory and radiographic evaluation of unexplained pruritus
Pruritus in Dermatologic Disease
Itch as a leading symptom of specific skin conditions
- Urticaria (hives)
- Atopic dermatitis (eczema)
- Atopic dermatitis
- Psoriasis
- Infestations: scabies and lice
- Cutaneous T cell lymphoma (CTCL)
- Skin diseases that commonly itch
- Primary dermatologic conditions associated with pruritus
- Primary dermatologic conditions associated with pruritus (continued)
Dermatoses from Scratching
When the scratching itself becomes the disease
- The itch-scratch cycle
- Prurigo nodularis: what it is
- Prurigo nodularis: appearance
- Prurigo nodularis: clinical appearance
- Prurigo nodularis: additional examples
- Prurigo nodularis: what causes the itch
- Prurigo nodularis and excoriations in atopic dermatitis
- Bullous pemphigoid can mimic prurigo
- Pemphigoid nodularis
- Prurigo nodularis: nerve changes
- Prurigo nodularis: treatment principles
- Prurigo nodularis: further options
- Lichen simplex chronicus (LSC)
- Lichen simplex chronicus
- Lichen simplex chronicus: further sites
- Lichen simplex chronicus: treatment
Pruritus in Specific Locations
Itch confined to the scalp or the anogenital region
- Scalp pruritus
- Pruritus ani (anal itch)
- Pruritus ani: evaluation and care
- Pruritus vulvae and scroti
Pruritus Variants
Distinct itch patterns tied to water, scars, burns, and fibers
- Aquagenic pruritus
- Differential diagnosis of pruritus provoked by water contact
- Aquagenic pruritus: treatment
- Pruritus in scars, and after burns
- Fiberglass dermatitis
Pruritus in Systemic Disease
When the skin itches because another organ is failing
- Causes of unexplained generalized itch
- Chronic kidney disease-associated pruritus (CKD-aP)
- CKD-aP: proposed mechanisms
- Dry skin in chronic kidney disease
- Xerosis in kidney disease and HIV infection
- Treating CKD-associated pruritus
- Therapeutic ladder for renal pruritus
- Therapeutic ladder for renal pruritus (continued)
- Cholestatic pruritus (liver-related itch)
- Cholestatic pruritus: treatment
- Treatment options for hepatic or cholestatic pruritus
- Treatment options for hepatic or cholestatic pruritus (continued)
- Treatment options for hepatic or cholestatic pruritus (continued)
- Hematologic causes: iron and polycythemia
- Pruritus and malignancy (paraneoplastic itch)
- Hodgkin and non-Hodgkin lymphoma
- Endocrine causes: thyroid and diabetes
- HIV infection and pregnancy
- Drug-induced pruritus
- Common pharmacologic etiologies of pruritus
- Common pharmacologic etiologies of pruritus (continued)
- Psychogenic pruritus
Neuropathic Pruritus and Dysesthesia
When damaged or irritated nerves themselves cause the sensation
- What is dysesthesia
- Neuropathic pruritus: the mechanism
- Distribution of the sensory mononeuropathies
- Sensory mononeuropathies: overview
- Notalgia paresthetica
- Notalgia paresthetica: findings and treatment
- Brachioradial pruritus
- Notalgia paresthetica and brachioradial pruritus
- Meralgia, cheiralgia, and digitalgia paresthetica
- Burning mouth syndrome
- Burning mouth syndrome: treatment
- Burning scalp syndrome and red ear syndrome
- Dysesthetic anogenital pain syndromes
- Dysesthetic anogenital pain syndromes
- Trigeminal neuralgia
- Trigeminal trophic syndrome
- Trigeminal trophic syndrome
- Trigeminal trophic syndrome: treatment
- Complex regional pain syndrome (CRPS)
- Complex regional pain syndrome
- Congenital insensitivity to pain
- Congenital insensitivity to pain: features
- Congenital insensitivity to pain and related HSANs
- Congenital insensitivity to pain and related HSANs (continued)
Treatment
General measures, and topical, systemic, and physical options
- No single itch drug works for everyone
- General measures
- Topical treatment
- Systemic treatment
- Physical and psychological treatment
- General measures for the treatment of pruritus and dysesthesia
- General measures for the treatment of pruritus and dysesthesia (continued)
- General measures for the treatment of pruritus and dysesthesia (continued)
- Key takeaways
- What to remember about neuropathic causes
References
Sources cited in this chapter
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- References (continued)
- Dermatology, 5th Edition (2-Volume Set)