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Approaching the Pruritic Patient

»	What is the most common symptom of dermatologic disease?
»	What is an “itch”?
»	Is an itch a separate modality of pain or a submodality of pain?
»	What causes an itch?
»	Describe the difference between localized and generalized pruritus.
»	What is the best approach to evaluation of a patient with localized pruritus?
»	What are the common causes of localized pruritus?
»	What is notalgia paresthetica?
»	What is the physician’s best approach when seeing a patient with generalized pruritus?
»	After obtaining a complete history and physical examination, what clinically oriented classification scheme should be followed?
»	What are common causes of generalized pruritus?
»	How prevalent is an underlying systemic disease in a patient who seeks medical attention for pruritus?
»	What is “winter itch”? In which patient population is it common?
»	The patient complains that “wool makes me itch” or “I am allergic to wool.” What disease does this patient probably have?
»	What treatment should the physician consider if a patient presents with pruritus and “hives”?
»	What disease should the physician consider if the patient volunteers that his spouse also suffers from itching?
»	Is pruritus in HIV-infected patients common? What are the common causes of pruritus in these patients?
»	Which psychiatric disorder often presents with intractable pruritus?
»	Which patients with renal failure experience “renal itch”?
»	Which patients with liver disease are most likely to experience pruritus? What is the best screening laboratory test?
»	What are the common causes of cholestic pruritus?
»	Which hematologic disorders are known to present with pruritus?
»	Is generalized pruritus a common symptom of endocrine disorders?
»	Can itching cause skin disease?
»	What is the best symptomatic treatment for a patient with pruritus?

Is pruritus in HIV-infected patients common? What are the common causes of pruritus in these patients?

Pruritus is common in HIV-infected patients and is experienced with increasing frequency as the disease progresses. Occult HIV infection can present with generalized pruritus. Causes of pruritus secondary to skin disease in HIVinfected patients include

xerosis;
infectious etiologies, such as scabies; and
noninfectious etiologies,

S uch as photoeruptions, eosinophilic pustular folliculitis, or pruritic papular eruption. Pruritus unassociated with skin disease is probably secondary to immune dysregulation of HIV disease. The physical exam will help identify specific causes of skin disease, but a significant number of HIV-infected patients have no demonstrable skin lesions. Singh F, Rudikoff D: HIV-associated pruritus: etiology and management, Am J Clin Dermatol 4:177–188, 2003.