Psychogenic pruritis (PP) is a condition that has a psychological or psychiatric cause and manifests as an itch. It may also be referred to as functional itch, psychogenic itch, or functional itch disorder [1] [2]. It is one of the possible sources of chronic itch, which is defined as an itch that lasts for at least 6 weeks.

Pruritis occurs commonly among the general population, but only a minority of cases, about 10%, need treatment. Although itching may be caused by various etiologies, it may lead to significant psychological and psychiatric distress, including thoughts of suicide. It involves the skin and mucosa, and can be described as an uncomfortable sensation that may be relieved by scratching. There may be associated cutaneous sensations occurring simultaneously with the itch, such as burning, tingling or pain. Pruritis can also be caused by neurological problems stemming from nerve cell damage [3] [4]. This may have an atypical presentation, that is, accompanied by sensations such as paresthesia [3].

PP may prove a challenge to diagnose because it is often presumed to be dermatological in origin. Thus patients suffering from PP are more likely to present to dermatologists initially. Furthermore, misdiagnosis may be partly due to a poorly defined definition and criteria for the condition. Moreover, before PP may be proposed, there are systemic diseases that cause pruritis and that should be first considered and ruled out. It is further suggested that not only can psychological factors induce the occurrence of an itch, they can also exacerbate or prolong an already existing one. Although PP may be diagnosed by clinicians, patients are rarely referred for psychiatric evaluation and intervention.

In literature, the incidence of idiopathic itch in individuals with a psychiatric history is reportedly as high as 42% [5] [6]. Pruritis in the presence of psychiatric disease is more likely to involve the face and scalp than pruritis from other causes [7].

• Anemia

  […] counter drug use • medical allergies Systemic conditions associated with pruritus are: • Chronic Renal Disease • Diabetes • Cholestasis- liver diseases such as cirrhosis, obstructive gallstone disease • Polycythemia Vera – or bath itch • Iron deficiency anemia [pharmacy-and-drugs.com]

  Table TABLE 1 Medical Causes of Self-Inflicted Skin Lesions Hepatic disease Pregnancy Uremia Delirium Polycythemia vera Hypothyroidism Hyperthyroidism Urticaria Malignant lymphoma Other malignancies Carcinoid Myeloma Diabetes mellitus Iron deficiency anemia [aafp.org]

  a common anemia (low red blood cell or hemoglobin levels) Jaundice and cholestasis – bilirubin is a skin irritant at high concentrations Malignancy or internal cancer, such as lymphoma or Hodgkin's disease [12] Polycythemia, which can cause generalized [en.wikipedia.org]

  Other than a mild anemia and eosinophilia, all studies have been unremarkable. She has not worked for the past two years. The is an intelligent person. [vgrd.org]

  7 - 9 and the dominant pathologies were intestinal parasitoses. 3, 4 Other infrequent causes, which were also sources of pruritus, were drug‐induced allergies, 4 chronic kidney failure, and liver disorders. 3, 10 In elderly patients, iron‐deficiency anemia [onlinelibrary.wiley.com]

• Constitutional Symptom

  History should include any factors that make the itching better or worse Review of systems should seek symptoms of causative disorders, including Irritability, sweating, weight loss, and palpitations ( hyperthyroidism ) Constitutional symptoms of weight [merckmanuals.com]

  A thorough history can identify constitutional symptoms that may point towards an underlying systemic disease. Drug triggers such as opioids may be identified, especially if the commencement of the drug relates to the itch. [dermnetnz.org]

• Jaundice

  Some disorders that cause itching are readily apparent on evaluation (eg, chronic renal failure, cholestatic jaundice). Other systemic disorders that cause itching are suggested by findings (see Table: Some Causes of Itching ). [merckmanuals.com]

  Systemic diseases that may cause pruritus include diabetes mellitus (pruritus vulvae) and liver disorders with jaundice. Hemorrhoids are often accompanied by rectal pruritus. [medical-dictionary.thefreedictionary.com]

  In liver disease, pruritus is a symptom of biliary obstruction, and the association of jaundice and pruritus always signifies biliary obstruction. [consultant360.com]

  Generalized itching Itching that occurs all over the body may indicate a medical condition such as diabetes mellitus, liver disease, kidney failure, jaundice, thyroid disorders, or rarely, cancer. [healthofchildren.com]

• Pruritus

  […] eruption pruritic [pro͞orit′ik] adj … English World dictionary Pruritus — Klassifikation nach ICD 10 L29 Pruritus F45.8 Sonstige somatoforme Störungen Psychogener Pruritus … Deutsch Wikipedia Pruritus — Itching. [translate.academic.ru]

  pruritus pruritus 1650s, from L. pruritus, from prurire “to itch.” Related: Pruritic. Etymology dictionary. 2014. [etymology.enacademic.com]

  Concerning the terminology “psychogenic pruritus”, the FPDG discussed other possibilities such as “non-organic pruritus”, “psychosomatic pruritus”, “somatoform pruritus”, “itch disorder associated with psychological factors” and “functional itch disorder [medicaljournals.se]

  Pruritus is an important factor in the development of epidermolysis bullosa pruriginosa and is the focus of management. [ncbi.nlm.nih.gov]

  Chapter: (p.132) 11 Psychogenic pruritus Source: Pruritus in Advanced Disease John Y. Koo Roger S. [oxfordscholarship.com]

• Fear

  […] stress-how they work together; Relationship between genetics and stress; Role of glia in stress; Sleep and stress; Diet and stress; Supplements and stress; Effect of severe stress on early brain development, attachment, and emotions; Role of stress and fear [books.google.com]

  Hyperhidrosis States of fear, rage, and tension can induce an increase of sweat secretion. Perspiration in the human has two distinct forms: thermal and emotional. [stmina-monastery.org]

  People often scratch their head when they are uncertain about something, it seems that when people tell a lie or fear that they might be unintentionally doing something incorrectly and feel a small amount of guilt, the rate of blood flow through certain [psychforums.com]

  (Psora/ Syphylis) Psychiatric Fears e.g. parasitophobia. (Psora) Itch originating from nerves in the skin. The only peripheral tissues from which it can be evoked are skin, mucous membranes, and cornea. [homeopathyworldcommunity.ning.com]

• Social Isolation

  Even the colour of a completely normal skin (e.g., negroes) may sometimes cause the person to be socially isolated from others with different skin colour (e.g., white men). [stmina-monastery.org]

  isolation and discrimination and, at times, have difficulty getting jobs. [84] Many patients are able to cope up with the disease while few develop secondary psychiatric morbidity. [ijdvl.com]

• Dysesthesia

  Scalp dysesthesia. Arch Dermatol 1998;134:327-330. Pour-Reza-Gholi F, Nasrollahi A, Firouzan A, Nasli Esfahani E, Farrokhi F: Low-dose doxepin for treatment of pruritus in patients on hemodialysis. Iran J Kidney Dis 2007;1:34-37. [doi.org]

  Pruritus and dysesthesia. In: Bolognia JL, Jorizzo JL, Schaffer JV: Dermatology. 3rd ed. [Philadelphia, Pa]: Elsevier Saunders, 2012, pp 111-25. [cancer.gov]

  Hypnotic trance can be defined as a heightened state of focus that can be helpful in reducing unpleasant sensations (i.e., pain, pruritus, dysesthesias), while simultaneously inducing favorable physiologic changes. [ijdvl.com]

• Insomnia

  Side effects (SE): nausea, Gastrointestinal cramping, fatigue, insomnia. [globale-dermatologie.com]

The diagnostic process for psychogenic pruritis entails the acquisition of a medical history, followed by a physical examination. Causes of pruritis related to medication use (delineated in the patient drug history) or systemic disease should be investigated, thus a systemic review is necessary [3] [8]. Dermatological conditions should also be excluded by thorough examination of the skin. PP may also be associated to other conditions, neuropathic in nature, that are not yet well-known or understood [9].

Investigative blood tests that may be requested include:

• Complete blood count (CBC)
• Liver, renal, thyroid function tests
• Inflammatory markers, such as erythrocyte sedimentation rate (ESR)
• Human immunodeficiency virus (HIV) test
• Chest X-ray

If a diagnosis is not found upon the first visit, patients should be reevaluated on subsequent visits.

An organized cognitive framework is presented to guide the clinician in the evaluation and treatment of these patients. Specific treatment options are offered and relevant psychopharmacologic agents are reviewed. [ncbi.nlm.nih.gov]

Lepping P, Freudenmann RW: Delusional parasitosis: a new pathway for diagnosis and treatment. Clin Exp Dermatol 2008;33:113-117. [doi.org]

Acupuncture Treatment for Itching Acupuncturists assess their patients’ symptoms to tailor treatments that address each individual’s specific needs. [livestrong.com]

However the limit is often 80mg before side effects stop the benefit of the treatment. [globale-dermatologie.com]

Prognosis Most cases of itching resolve successfully when the underlying cause is treated. Prevention There are certain things people can do to avoid itchy skin. [healthofchildren.com]

Management in these cases is directed by the age of the patient. [49], [50] Childhood cases have good prognosis. [ijdvl.com]

The prognosis seems to be best in young patients who use the artefact to draw attention to a particular problem and who recover when this is solved. Often, however, the artefact is but one incident in a long history of psychiatric illness. [stmina-monastery.org]

It can be severe, which may imply a worse prognosis. Excoriations, papules and prurigo nodules from continuous scratching may also be present. [podiatrytoday.com]

Etiological aspects Dermatological causes represented 95% of the etiologies (220 of 232). Eczema represented 36.8% (81 of 220), urticaria 14% (31 cases), mycoses 9.5% (21), pruritus 5.9% (13), and scabies 5% (11). [onlinelibrary.wiley.com]

Although itching may be caused by various etiologies, it may lead to significant psychological and psychiatric distress, including thoughts of suicide. [symptoma.com]

Based on etiology, chronic pruritus may be classified as being of dermatologic, systemic, neurologic, psychogenic/psychosomatic, mixed, or unknown etiology. Chronic pruritus can be very distressing and refractory to treatment. [online.epocrates.com]

After you have ruled out other causes of pruritus and made a diagnosis of psychogenic itch, educate your patient about the multifactorial etiology. [mdedge.com]

The etiology of itch is poorly defined. [the-rheumatologist.org]

Epidemiology Itching is a common ailment. [online.epocrates.com]

Psoriasis of early and late onset: a clinical and epidemiologic study from Spain. J Am Acad Dermatol 2002 ; 46 : 867 –73. 26 van Voorhees, A, Vittorio, CC, Werth, VP. Papulosquamous disorders of the elderly. [cambridge.org]

[…] excoriations: diagnostic criteria, semiological analysis and psychiatric profiles L.Misery, M.Chastaing, S.Touboul, V.Callot, M.Schollhammer, P.Young, N.Feton-Danou, S.Dutray and the French Psychodermatology Group Acta Derm Venereol, 2012, 92, 416-418 Epidemiology [univ-brest.fr]

It explains the pathophysiology of itch, describes all causes, and provides guidelines for management and treatment. [books.google.de]

[…] tool=bestpractice.com Pathophysiology This depends on the underlying disease. [bestpractice.bmj.com]

Pathophysiology of Itch Classically, itch was viewed as a mild form of pain. As a result, the prevailing wisdom was that the same neurologic pathways mediated both pain and itch. [the-rheumatologist.org]

The best way to prevent pruritus is to take care of your skin. To protect skin: Use skin creams and lotions that moisturize your skin and prevent dryness. Use sunscreens regularly to prevent sunburns and skin damage. [webmd.com]

Having a healthy diet with Vit B, D, and zinc prevents dryness of scalp and itchiness. 4 Related Clinical Trials [findatopdoc.com]

Initially, general measures have to be taken, including avoiding irritating factors, preventing skin dryness, and frequent application of emollients. [ncbi.nlm.nih.gov]

They work by killing bacteria or by preventing their growth. Be sure to tell your doctor of any allergies you have whether it is to medication or more... [pharmacy-and-drugs.com]

Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets [books.google.com]

1. Harth W, Hermes B, Niemeier V, Gieler U. Clinical pictures and classification of somatoform disorders in dermatology. Eur J Dermatol. 2006;16(6):607-614.
2. Misery L, Alexandre S, Dutray S. Functional itch disorder or psychogenic pruritus: suggested diagnosis criteria from the French psychodermatology group. Acta Derm Venereol. 2007;87(4):341-344.
3. Misery L, Brenaut E, Le Garrec R, et al. Neuropathic pruritus. Nat Rev Neurol. 2014;10(7):408-416.
4. Stander S, Weisshaar E, Mettang T. Clinical classification of itch: a position paper of the International Forum for the Study of Itch. Acta Derm Venereol. 2007;87(4):291-294.
5. Kretzmer GE, Gelkopf M, Kretzmer G, Melamed Y. Idiopathic pruritus in psychiatric inpatients: an explorative study. Gen Hosp Psychiatry. 2008;30(4):344-348.
6. Mazeh D, Melamed Y, Cholostoy A, Aharonovitzch V, Weizman A, Yosipovitch G. Itching in the psychiatric ward. Acta Derm Venereol. 2008;88(2):128–131.
7. Ferm I, Sterner M, Wallengren J. Somatic and psychiatric comorbidity in patients with chronic pruritus. Acta Derm Venereol. 2010;90(4):395-400.
8. Yosipovitch G. Chronic pruritus: a paraneoplastic sign. Dermatol Ther. 2010;23(6):590–596.
9. Misery L, Bodéré C, Genestet S, Zagnoli F, Marcorelles P. Small-fiber neuropathies and skin: news and perspectives for dermatologists. Eur J Dermatol. 2014;24(2):147-153.