Pruritus

Question 1

Pruritus is the most common complaint in dermatology. Is pruritus always associated with a primary skin pathology?

Answer 1

• no
• can be associated with pathology or not

Question 2

Pruritus is the most common complaint in dermatology. Is pruritus typically associated with one or multiple pathogenic mechanisms?

Answer 2

• multiple
• typically complex cause

Question 3

Which of the following is NOT a common mediator of pruritus?

1 - histamine
2 - gastrin-releasing peptide
3 - gliadin
4 - proteinases
5 - opioid peptides
6 - substance P

Answer 3

3 - gliadin
- fraction of gluten

Question 4

Is pruritus always associated with chronic pain?

Answer 4

• NOT always
• but can be linked to chronic pain

Question 5

Is pruritus always a physical symptom?

Answer 5

• no
• can be psychogenic
• BUT can be immune mediated

Question 6

When evaluating a patient with pruritus we must 1st rule out obvious dermatological condition-infestations, inflammatory skin disorders. Then we can assess which of the following systemic disorders that may be linked to pruritus?

1 - renal disease
2 - liver disease
3 - hematological causes
4 - lymphoma
5 - leukemia
6 - endocrine
7 - HIV
8 - all of the above

Answer 6

8 - all of the above

• drug causes must also be the cause

Question 7

In patients without a known cause of the pruritus should have all of the following:

1 - FBC, Liver and kidney function, ESR
2 - Thyroid function tests , parathyroid
3 - Serum iron and ferritin
4 - Stool for ova and parasites
5 - Chest Xray, skin biopsy
6 - Viral hepatitis and HIV screening
7 - Serum Ig E and skin prick test
8 - CT scan , serum elecrophoresis
9 - all of the above
Guided by history

Answer 7

9 - all of the above
- all should be guided by the patients history

Question 8

How can pruritus be treated?

1 - Topical –menthol, topical steroids , calcineurin inhibitors, capsaicin, local anesthetic creams
2 - Oral – amitriptyline, gabapentin, pregabalin
3 - phototherapy
4 - psychotherapy – CBT
5 - all of the above

Answer 8

5 - all of the above