Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ INTRODUCTION ++ Most skin eruptions and rashes are more or less pruritic, but there are states where there is severe pruritus in the absence of skin lesions, except for scratch marks (Fig. 35-1). The diagnostic approach to the patient with generalized pruritus without identifiable skin lesions is a diagnosis of exclusion. Pruritus is a symptom of skin disease that at the time of examination does not manifest with specific lesions. It may be cause by an internal organ disease, metabolic and endocrine conditions, or hematologic disease. It may be a manifestation of malignant tumors, psychogenic states, or HIV infection; or it may be related to injected or ingested drugs. The various causes of pruritus sine materia are listed in Table 35-1, and an algorithm of how to approach a patient with pruritus sine materia is shown in Table 35-2. Skin signs may be clinically inapparent, perhaps confined to only circumscribed areas. This is particularly important with regard to the exclusion of scabies, pediculosis, or conditions such as urticaria factitia. ++ FIGURE 35-1 Pruritus without diagnostic skin lesions This patient had multiple scratch marks resulting from compulsive scratching because of severe pruritus. There were no other diagnostic lesions. Workup revealed biliary cirrhosis without jaundice. Graphic Jump LocationView Full Size||Download Slide (.ppt) ++Table Graphic Jump LocationTABLE 35-1Causes of Pruritus Sine MateriaView Table||Download (.pdf) TABLE 35-1 Causes of Pruritus Sine Materia Metabolic, endocrine conditions Hyperthyroidism: probably due to increased blood flow Hypothyroidism: probably due to excessive dryness Pregnancy related Diabetes: pruritus is rarely associated, but can be a symptom of diabetic neuropathy Malignant neoplasms: can be the presenting feature Lymphoma, myeloid, and lymphatic leukemia, myelodysplasia Multiple myeloma Hodgkin disease Other cancer (rare) Drug ingestion Subclinical drug sensitivities Aspirin, alcohol, dextran, polymyxin B, morphine Codeine, scopolamine, D-tubocurarine Hydroxyethyl starch Infestations/Infections Scabiesa Pediculosis corporis, capitis, pubis Hookworm (ancylostomiasis) Onchocerciasis Ascariasis HIV: can be a primary symptom of infection or a chronic comorbidity Renal disease Renal failure: may develop prurigo nodularis, lichenification, or nummular eczema as a result of scratching Hematologic disease Polycythemia vera: seen in up to 50% of patients upon contact with water Paraproteinemia, iron deficiency Hepatic disease Obstructive biliary disease: pruritus starts acrally and then disseminates Pregnancy (intrahepatic cholestasis) (see Section 15) Neurologic disease Peripheral nerve damage: lumbosacral radiculopathy or entrapment neuropathy (anogenital pruritus, meralgia paresthetica) Peripheral nerve damage: lumbosacral radiculopathy (brachioradial pruritus, notalgia paresthetica [Fig. 35-2]) Spinal nerve damage (notalgia paresthetica) Psychogenic states Transitory: Periods of emotional stress Persistent Delusions of parasitosis Psychogenic pruritus Neurotic excoriations Anorexia nervosa Latent dermatoses and miscellaneous conditions Xerosis (dry skin, “winter itch”) Senile pruritus: very common in people >70 years Bullous pemphigoid (without skin lesions) Dermatitis herpetiformis (without skin lesions) Atopic dermatitis (without skin lesions) Factitious urticaria (dermographism) Fiber glass exposure Aquagenic pruritus: usually in middle aged and elderly; provoked by contact with water of any ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.