Psychogenic pruritis is a psychological condition that causes the manifestation of an itch as the main symptom or the worsening of an existing itch.
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  . 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  . This may have an atypical presentation, that is, accompanied by sensations such as paresthesia .
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%  . Pruritis in the presence of psychiatric disease is more likely to involve the face and scalp than pruritis from other causes .
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]
pruritus pruritus 1650s, from L. pruritus, from prurire вЂњto itch.вЂќ Related: Pruritic. Etymology dictionary. 2014. [etymology.enacademic.com]
[…] 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]
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  . 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 .
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.
Lepping P, Freudenmann RW: Delusional parasitosis: a new pathway for diagnosis and treatment. Clin Exp Dermatol 2008;33:113-117. [doi.org]
Treatment options are summarized in Table 1. 2, 5 – 11, 14, 16 – 18, 20 – 22 Table 1. [ncbi.nlm.nih.gov]
If the patient cannot manage 0.075% try 0.025% cream An alternative topical treatment is 5% doxepin hydrochloride cream For patients failing to respond to, or tolerate topical treatments consider systemic treatment with gabapentin or low dose amitriptyline [pcds.org.uk]
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. ,  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]
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]
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]
The etiology of itch is poorly defined. [the-rheumatologist.org]
Epidemiology Itching is a common ailment. [online.epocrates.com]
[…] 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]
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]
It explains the pathophysiology of itch, describes all causes, and provides guidelines for management and treatment. [books.google.com]
[…] 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]
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]
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]
- 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.
- 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.
- Misery L, Brenaut E, Le Garrec R, et al. Neuropathic pruritus. Nat Rev Neurol. 2014;10(7):408-416.
- 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.
- Kretzmer GE, Gelkopf M, Kretzmer G, Melamed Y. Idiopathic pruritus in psychiatric inpatients: an explorative study. Gen Hosp Psychiatry. 2008;30(4):344-348.
- 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.
- Ferm I, Sterner M, Wallengren J. Somatic and psychiatric comorbidity in patients with chronic pruritus. Acta Derm Venereol. 2010;90(4):395-400.
- Yosipovitch G. Chronic pruritus: a paraneoplastic sign. Dermatol Ther. 2010;23(6):590–596.
- 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.