Pruritus without evidence of primary disease

Question 1

Prurigo Nodularis

Answer 1

• itch/scratch cycle
• multiple discreet, firm papulonodules with central scale/crust due to chronic scratching and picking
• butterfly sign = everwhere except where the pt cannot reach

Question 2

Lichen Simplex Chronicus

Answer 2

• plaques that are either skin colored, pink, or hyperpigmented with exaggerated skin lines and a leathery appearance due to habitual scratching/rubbing

Question 3

Aquagenic pruritus

Answer 3

• prickling, burning, stinging, and itching that may develop within 30 min of water exposure regardless of temperature or salinity
• →indicative of polycythemia vera
  
  • increased blood cell levels
    
    • due to overproduction by bone marrow

Question 4

Notalgia parasthetica

Answer 4

• neurological pruritus
• tends to be unilateral on the upper to mid back
• hyperpigmented patch may be present
• tx: capsaicin, ice packs, gabapentin

Question 5

bracioradial pruritus

Answer 5

• neuropathic pruritus
• tends to affect the arms and the neck bilaterally
• tx: capsaicin, ice packs, and gabapentin
• tends to affect women with light skin tones more than men
  
  • 35-45 yos

Question 6

Dysesthesia

Answer 6

• abnormal sensation that can be spontaneous or evoked
• may include pain, pruritys, tingling, burning, or ‘pins and needles’

****Cocnerning if symptoms are sudden, severe, or worsen significantly→ need to image the appropriate area of the spine***

Question 7

General Pruritus Treatment

Answer 7

1. apply cold, wet cloth or ice pack to skin that is itching
2. take an oatmeal bath
3. moisturize the skin
4. apply topical anesthetics that contain pramoxine
5. apply cooling agents, such as menthol or calamine

Answer 8

• Lichen Simplex Chronicus
• reduce/control itching
• **leathery patches**
• raw skin
• scales
• Lesions with SHARP borders

Answer 9

• Prurigo Nodularis
• butterfly sign
• dome-shaped, nodular lesions = usually symmetrical
• **chronic inflammatory skin disease
• tx:
  
  • topical corticosteroids creams
  • ointments with menthol or phenol to cool and soothe itchy skin

Answer 10

• Notalgia Parasthetica
• Dysthesia: abnormal/unpleasant sensation that is either spontaneous or evoked
• tx:
  
  • capsaicin, icepacks, gabapentin

Answer 11

• brachioradial pruritus often associated with sun exposure
• cervical nerve irritation
• Diagnosis: ice-pack sign
  
  • ​immediate relief of itching with application of icepack
• tx: Capsaicin, gabapentin, icepacks, antihistamines