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Pruritus (itch) can be defined as an unpleasant sensory and emotional experience that provokes a desire to scratch. In the approach to the management of a pruritic skin condition, identification of an underlying cause is important. The first step is to determine the presence of an underlying dermatological disease. If no primary dermatosis is identified and only secondary excoriations from chronic scratching are present, the patient should be evaluated for an underlying systemic and/or neurological cause for the pruritis. Psychogenic causes are considered only after the exclusion of organic causes.


There are four major categories of conditions causing chronic pruritus—dermatological, systemic, neurological, and psychogenic (Table 18.1). In some patients, more than one factor contributes to the occurrence and such cases are classified as “mixed.” Dermatological diseases are the most common cause, being present in 60% to 95% of patients consulting the dermatological clinic for chronic itch. Systemic disease accounts for 15% to 40% of patients presenting with generalized pruritus.

Table 18.1Etiological Classification of Chronic Pruritus


In a patient presenting with chronic pruritus, the history is directed at elucidating the cause and to provide insight into the disease process. In the physical examination, an attempt is made to identify the presence of primary skin pathology or features of an underlying systemic disease that may account for the itch. It is essential ...

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