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Bolognia (Pocket) > Ch 4 Pruritus > Flashcards

Ch 4 Pruritus Flashcards

1
Q

Classic skin findings from chronic pruritus?

A
  1. Lichen simplex chronicus

2. Prurigo nodularis

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2
Q

What’s lichen simplex chronicus?

A
  • Skin colored, pink or hyperpigmented
  • plaques
  • exaggerated skin markings
  • leathery appearance
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3
Q

Distribution or lichen simplex chronicus?

A
  1. Posterior neck
  2. occipital scalp
  3. Anogenital region
  4. Ankles
  5. Extensor arms + legs
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4
Q

Rx of (LSC)?

A
  • Symptomatic = topical anesthetics (pramoxine)

* Topical CS under occlusion

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5
Q

Describe prurigo nodularis?

A

Discrete firm papulonodules with central scale-crust.

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6
Q

Distribution of prurigo nodularis?

A
  • Extensor extremities

- upper back + buttocks

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7
Q

Rx of prurigo nodularis?

A
  • CS
  • phototherapy
  • Thalidomide

Rx depends of # of lesions

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8
Q

Syndromes of neuropathic itch

A

Trigeminal trophies syndrome (TTS)

Radiculopathies

Notalgia paresthetica

Brachioradial pruritus

Meralgia paresthetica

Small fiber polyneuropathy

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9
Q

What’s neuropathic itch?

A

Itch syndrome due to CNS or PNS disorder

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10
Q

Distribution of neuropathic itch?

A

Head and neck > lower body

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11
Q

Quality of itch in neuropathic syndromes?

A

Affected Pt’s want to “dig at” or “gouge out” their skin

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12
Q

Rx of neuropathic itch syndrome?

A

Don’t respond to antihistamine

Ice packs offers relief

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13
Q

What’s trigeminal trophic itch?

A

Intractable facial itch characterized by painless scratching to the point of self harm + ulceration.

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14
Q

Distribution of trigeminal trophic syndrome?

A

Nasal ala

NB: Nasal tip is spared (?) nerve supply is derived from external branch of anterior ethmoidal nerve.

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15
Q

Clinical picture of trigeminal trophic syndrome?

A

Small crust develops into crescentic ulcer over nasal ala. extends to cheeks + upper lip.

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16
Q

Cause of trigeminal trophic itch?

A

Impingement of trigeminal nerve

Secondary to:
1- iatrogenic
2- infection = VZV, HSV
3- CNS tumor

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17
Q

Rx of trigeminal trophic syndrome?

A

Protective barrier
Surgical consult
Oral pimozide + carbamazepine

18
Q

What’s rediculopathy?

A

Focal neurological dysfunction caused by injury to single sensory nerve root, resulting in pruritus.

19
Q

Injuries to sensory nerve root causing pruritic radiculopathy?

A
  1. Impingement from spinal osteoarthritis
  2. Distal impingement by inflamed muscle
  3. Infection (VZV, leprosy, Lyme)
  4. Tumors (schwannoma, mets), vascular malformation, cysts.
20
Q

Clinical picture of pruritic radiculopathy?

A

Unilateral + on the side of damaged SNR.

21
Q

When to do MRI for pruritic radiculopathy?

A
  1. Sever, sudden pruritus

2. Worsening pruritus

22
Q

Rx of pruritic radiculopathies ?

A
  1. Symptomatic Rx:
    - Topical: anesthetics + capsaicin
  • Oral neuromedulators ( gabapentin, pregablin)
  • physical + acupuncture
  • Botox
23
Q

Classical radiculopathies in derm?

A
  1. Shingles - Post herpetic neuralgia | post herpetic itch.
  2. Notalgia paresthetica
  3. Brachioradial pruritus
  4. Meralgia parenthetic
24
Q

Clinical picture of notalgia paresthetica?

A

Focal intense pruritus of upper back, along the medial scapular boards (+/- pain or burning)

Hyper pigmented patch result of chronic rubbing.

25
Q

DDx of notalgia paresthetica?

A 
Macular amyloidosis
Sipple syndrome (esp in childhood)
26
Q

Rx of notalgia paresthetica?

A

Topical capsaicin 5x/day for 1 week then 3xday for 3-6 weeks

Anesthetics

Gabapentin

Acupuncture

27
Q

What’s brachioradial pruritus?

A

Chronic intermittent pruritus of dorsal forearm + elbows (+/- shoulder)

With excoriation / prurigo simplex lesions or scaring in affected area.

28
Q

Association with brachioradial pruritus?

A

Photo damaged skin + degenerative cervical spine

29
Q

Diagnostic sign of brachioradial pruritus?

A
  1. Patient can delineate affected area with pen.

2. Ice pack sign = only relief

30
Q

Rx of brachioradial pruritus?

A
  1. Sun protection
  2. Cold packs
  3. Topicals (pramoxine, capsaicin)
  4. Oral (gabapentin, amitriptyline)
31
Q

What’s meralgia paresthetica?

A

Pruritus of anterolateral thigh + numbness / burning pain

32
Q

Cause of meralgia paresthetica?

A

Impingement of lateral femoral cutaneous nerve as it passes through inguinal ligament

33
Q

Predisposing factors of meralgia paresthetica?

A

Obesity
Pregnancy
Tight cloths
Rarely: tumors or hemorrhage.

34
Q

Rx of meralgia paresthetica?

A

Removal of cause of compression

Focal nerve block

Surgical decompression

35
Q

Role of neuromedulator agents in meralgia paresthetica?

A

Not helpful

36
Q

What’s small fiber polyneuropathy?

A

Most common cause of pruritus with bilateral distribution.

37
Q

Distribution of small fiber polyneuropathy?

A

Stock-glove

38
Q

Dx of small fiber polyneuropathy?

A

Sensory sx
Intact muscle
R/o potential causes

Dx test:

  1. Immunohistochemical staining (anti-PGP9.5)
  2. Autoimmune function test
39
Q

Treatable causes of pruritus?

A
  1. DM = HA1c , FPG
  2. Anemia = B12, folate, copper, homocysteine
  3. Gammopathy = SPEP + UPEP, immunofixation, serum-free light chain analysis.
  4. Hematological Ca = CBC + PLT
40
Q

Dysesthesia syndromes?

A

Burning mouth syndrome (orodynia)

Burning scalp syndrome (scalp dysesthesia)

Dysesthetic anogenital syndrome

Bolognia (Pocket) (2 decks)

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