Pruritus Causes

Aka: Pruritus Causes, Dermatologic Causes of Pruritus, Systemic Causes of Pruritus, Localized Causes of Pruritus, Environmental Causes of Pruritus

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II. Causes: Dermatologic Conditions

  1. Dry Skin or Xerosis (most common cause)
  2. Atopic Dermatitis
  3. Allergic Contact Dermatitis
  4. Bullous Pemphigoid
  5. Dermatitis Herpetiformis
  6. Superficial Folliculitis
  7. Psoriasis
  8. Lichen Planus
  9. Chronic Urticaria
  10. Cutaneous T-Cell Lymphoma (Mycosis Fungoides)
    1. Pruritus suggests worse prognosis
  11. Sunburn
  12. Local Infection or bites
    1. Dermatophyte Infection (e.g. Tinea Corporis, Tinea Capitis, Tinea Pedis)
    2. Scabies
    3. Pediculosis corporis (lice)
    4. Bed Bugs
    5. Other Insect Bites (e.g. Mosquitoes, fire ants, gnats, fleas, Chiggers)
  13. Complications of excessive scratching
    1. Lichen Simplex Chronicus
    2. Prurigo Nodularis

III. Causes: Systemic

  1. Autoimmune Causes
    1. Dermatitis Herpetiformis
    2. Dermatomyostitis
    3. Linear Immunoglobulin A Disease
    4. Sjogren Syndrome
    5. Scleroderma
  2. Hematologic Causes
    1. Hemochromatosis
    2. Iron Deficiency Anemia
    3. Mastocytosis
    4. Monoclonal Gammopathy (Plasma Cell Disorder)
    5. Polycythemia Rubra Vera (Pruritus in 30-50% of cases)
      1. Provoked by hot shower or bath
      2. Pricking type itch may persist for hours
  3. Malignancy
    1. Leukemia
    2. Multiple Myeloma
    3. Hodgkin's Lymphoma
    4. Malignant Carcinoid
    5. Paraneoplastic Syndrome (solid malignancy)
  4. Hepatobiliary Disease
    1. Biliary Cirrhosis
    2. Cholestasis (bile salt protease release in skin)
      1. See Cholestasis associated Pruritus
    3. Hepatitis (esp. Hepatitis C)
    4. Sclerosing Cholangitis
    5. Biliary duct obstruction
  5. Endocrine Conditions
    1. Carcinoid Syndrome
    2. Hyperthyroidism (4-11% long-standing Grave's Disease)
    3. Hyperparathyroidism
    4. Diabetic Neuropathy
  6. Neurologic Causes
    1. Intracranial Mass
    2. Multiple Sclerosis
    3. Notalgia Paresthetica
    4. Peripheral Neuropathy
  7. Systemic infection
    1. HIV Infection (see Pruritus in HIV)
    2. Parvovirus B19
    3. Parasitic Infections
      1. Filariasis
      2. Schistosomiasis
      3. Onchocerciasis (River Blindness)
      4. Ascariasis
      5. Hookworm
      6. Trichinosis
  8. Miscellaneous Causes
    1. See Pruritus in Pregnancy
    2. See Exposures below (includes medications, pregnancy)
    3. Severe Chronic Renal Failure (Uremic Pruritus)
    4. Neurodermatitis or Delusions of Parasitosis
    5. Rapid weight loss (e.g. Anorexia Nervosa)
    6. Chronic Urticaria

IV. Causes: Localized

  1. Eye
    1. Allergic Blepharitis
    2. Allergic Conjunctivitis
    3. Atopic Dermatitis
    4. Contact Dermatitis
  2. Ear
    1. See Ear canal pruritus
  3. Scalp
    1. Pediculosis (Head Lice)
    2. Psoriasis
    3. Seborrheic Dermatitis
    4. Allergic Contact Dermatitis
    5. Pustule
  4. Back
    1. Notalgia Paresthetica
    2. Xerotic Eczema
    3. Psoriasis
    4. Folliculitis
    5. Cholestasis (Butterfly rash)
  5. Arm
    1. Brachioradial Pruritus
    2. Xerotic Eczema
    3. Eczematous Dermatitis (antecubital fossa)
  6. Hands
    1. Dyshidrotic Eczema
    2. Eczematous Dermatitis
    3. Contact Dermatitis
    4. Scabies (interdigital web space involvement)
  7. Groin or inguinal area
    1. See Pruritus Vulvae
    2. Candidiasis
    3. Tinea Cruris
    4. Erythrasma
    5. Contact Dermatitis
    6. Extramammary Paget's Disease
    7. Intertrigo
    8. Lichen Sclerosis et Atrophicus (LS&A)
    9. Pediculosis
    10. Scabies
  8. Rectum
    1. Pruritus Ani
    2. Anal Fissure
    3. Condylomata acuminata
    4. Pinworm
  9. Legs
    1. Xerotic Eczema (shin)
    2. Neurodermatitis
    3. Stasis Dermatitis
    4. Atopic Dermatitis (popliteal fossa)
    5. Lichen Simplex (lateral malleolus)
    6. Dermatitis Herpetiformis (knee)
    7. Cutaneous T-Cell Lymphoma (buttocks and thighs)
  10. Feet
    1. Tinea Pedis
    2. Eczematous Dermatitis
    3. Contact Dermatitis
    4. Scabies (interdigital web space involvement)

V. Causes: Exposure-Related Pruritus

  1. Water
    1. Aquagenic Pruritus
      1. Intense distressing itch after water contact
    2. CholinergicUrticaria
    3. Polycythemia Vera (follows warm bath)
    4. Swimmer's Itch
  2. Pregnancy (See Pruritus in Pregnancy)
    1. Pruritic Urticarial Papules and Plaques of Pregnancy
    2. Prurigo of Pregnancy
    3. Herpes Gestationis or Pemphigoid Gestationis
    4. Cholestasis associated Pruritus (Prurigo gravidarum)
    5. Pruritic Folliculitis of Pregnancy
    6. Atopic Dermatitis
    7. Contact Dermatitis
  3. Medications
    1. See Medication Causes of Pruritus
  4. Allergen or irritant exposure (e.g. Contact Dermatitis)
    1. See Allergic Contact Dermatitis
    2. See Occupational Contact Dermatitis
    3. See Irritant Contact Dermatitis
    4. Heat exposure: Miliaria Rubra (Prickly Heat)
    5. Cat exposure
    6. Fiberglass exposure (Fiberglass Dermatitis)

VI. Causes: Age-related Pruritus

  1. Children
    1. Atopic Dermatitis
    2. Contact Dermatitis
    3. Lice
    4. Scabies
    5. Parvovirus
    6. Pinworms
  2. Elderly
    1. Xerotic Eczema
    2. Contact Dermatitis
    3. Bullous Pemphigoid
    4. Herpes Zoster
    5. Mycosis Fungoides

VII. References

  1. Moses (2003) Am Fam Physician 68(6): 1135-42 [PubMed]
  2. Reamy (2011) Am Fam Physician 84(2): 195-202 [PubMed]
  3. Rupert (2022) Am Fam Physician 105(1): 55-64 [PubMed]

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