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Psychogenic Pruritus

Psychogenic Pruritis

Psychogenic pruritis is a psychological condition that causes the manifestation of an itch as the main symptom or the worsening of an existing itch.


Presentation

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].

Hypotension
Pruritus
  • CONCLUSIONS: Pruritus is an important factor in the development of epidermolysis bullosa pruriginosa and is the focus of management.[ncbi.nlm.nih.gov]
  • This article examines the organic and psychologic causes and concomitants of dermatologic conditions associated with pruritus and self-excoriation.[ncbi.nlm.nih.gov]
  • From Wikidata Jump to navigation Jump to search No description defined edit Language Label Description Also known as English Psychogenic pruritus No description defined Statements subclass of itch 0 references somatoform disorder 0 references health specialty[wikidata.org]
  • Psychogenic pruritus is a common manifestation of chronic anxiety, usually a localized itch, especially in the anogenital area.The condition is often managed with drugs including H1-antihistamines, tricyclic antidepressants, tetracyclic antidepressants[en.wikipedia.org]
  • There are three compulsory criteria: localized or generalized pruritus sine materia, chronic pruritus ( 6 weeks) and the absence of a somatic cause.[medicaljournals.se]
Excitement
  • Characteristically, itching can be provoked by emotional triggers, most notably during stages of excitement, and also by mechanical or chemical stimuli.[mdedge.com]

Workup

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.

Polyps
  • The text then ponders on irritable colon syndrome, polyps and polyposis, cancer of the colon and rectum, colostomy, and ileostomy.[books.google.com]

Treatment

  • 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]
  • Stay at the forefront of your field with updated treatment methods throughout, as well as an increased focus on patients with skin of color.[books.google.com]
  • Pruritis occurs commonly among the general population, but only a minority of cases, about 10%, need treatment.[symptoma.com]
  • It explains the pathophysiology of itch, describes all causes, and provides guidelines for management and treatment.[books.google.com]

Prognosis

  • 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]
  • 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]

Etiology

  • 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]
  • However, when itching is accompanied by discrete skin lesions of uncertain etiology, biopsy can be appropriate.[merckmanuals.com]
  • […] also occur without any skin signs - Patients suffer from low self image and have difficulties coping with aggression; also experience shame or embarrassment about behavior and often do not disclose habit to doctors or relatives - Clues for psychogenic etiology[vgrd.org]

Epidemiology

  • Clinical features, proposed diagnostic criteria, epidemiology and approaches to treatment. CNS Drugs . 2001;15:351-359. PubMed CrossRef Google Scholar 26. Ikoma A, Steinhoff M, Stander S, Yosipovitch G, Schmelz M. The neurobiology of itch.[link.springer.com]
  • Clinical features, proposed diagnostic criteria, epidemiology and approaches to treatment. CNS Drugs. 2001;15:351–9. CrossRef PubMed Google Scholar 29. Ikoma A, Steinhoff M, Stander S, Yosipovitch G, Schmelz M. The neurobiology of itch.[link.springer.com]
  • 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]
Sex distribution
Age distribution

Pathophysiology

  • It explains the pathophysiology of itch, describes all causes, and provides guidelines for management and treatment.[books.google.com]
  • Pathophysiology This depends on the underlying disease.[bestpractice.bmj.com]
  • For instance, the frequency of chronic pruritus in hemodialysis patients has been estimated to be between 25% and 35%. [11] [12] Pathophysiology This depends on the underlying disease.[online.epocrates.com]

Prevention

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

References

Article

  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.

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Last updated: 2018-07-08 08:58