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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].

Cough
  • Are pruritus and scratching the cough of the skin? Dermatology. 2008;216:3-5. Google Scholar 9. Barnig C, Kopferschmitt MC, de Blay F. Syndrome d’hypersensibilité chimique multiple: phsyiopathologie et clinique.[link.springer.com]
  • These disorders may be similar to other disorders that are not in the muco-cutaneous field, including psychogenic pain, psychogenic cough and irritable bowel syndrome. Table II.[medicaljournals.se]
Dyspnea
  • Palliative patients might be using opioids for the management of pain or dyspnea, and opioid antagonists could reverse analgesia or lead to withdrawal symptoms.[ncbi.nlm.nih.gov]
Dysphagia
  • […] classifications of psychiatric diseases, psychogenic pruritus is not cited in the (Inter-national Classification of Diseases-version 10) ICD-10 but pruritus is reported in the diagnosis termed “other somatoform disorders” (F45.8) along with dysmenorrhea, dysphagia[link.springer.com]
  • […] excoriation Type 1 Excludes Excoriation (skin-picking) disorder ( F42.4 ) L98.1 ) psychogenic pruritus ( ICD-10-CM Diagnosis Code F45.8 Other somatoform disorders 2016 2017 2018 2019 Billable/Specific Code Applicable To Psychogenic dysmenorrhea Psychogenic dysphagia[icd10data.com]
  • In the ICD-10, psychogenic pruritus is not clearly defined, but pruritus is reported in the diagnosis “other somatoform disorders” (F45.8), along with dysmenorrhoeal, dysphagia, psychogenic stiff neck and bruxism.[medicaljournals.se]
Abdominal Pain
  • The book then examines clinical diagnosis and use of instruments, including pain, swelling, prolapse, discharge, irritation, abdominal pain, palpation, and biopsy.[books.google.com]
  • The following findings are of particular concern: Constitutional symptoms of weight loss, fatigue, and night sweats Extremity weakness, numbness, or tingling Abdominal pain and jaundice Urinary frequency, excessive thirst, and weight loss Generalized[merckmanuals.com]
Bruxism
  • […] psychogenic pruritus is not cited in the (Inter-national Classification of Diseases-version 10) ICD-10 but pruritus is reported in the diagnosis termed “other somatoform disorders” (F45.8) along with dysmenorrhea, dysphagia, psychogenic stiff neck and bruxism[link.springer.com]
  • In the ICD-10, psychogenic pruritus is not clearly defined, but pruritus is reported in the diagnosis “other somatoform disorders” (F45.8), along with dysmenorrhoeal, dysphagia, psychogenic stiff neck and bruxism.[medicaljournals.se]
Hypotension
Photophobia
Pruritus
  • Pruritus is an important factor in the development of epidermolysis bullosa pruriginosa and is the focus of management.[ncbi.nlm.nih.gov]
  • 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]
  • 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]
Chronic Anxiety
  • 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]
  • Psychogenic pruritus is a common manifestation of chronic anxiety, usually a localized itch, especially in the anogenital area. [1] : 393,401 [2] The condition is often managed with drugs including H1- antihistamines, tricyclic antidepressants, tetracyclic[wikiwand.com]
  • Psychogenic pruritus is a form of pruritus, it is a skin disorder that is a common manifestation of chronic anxiety, usually a localized itch, especially in the anogenital area. [1] :393,401 [2] See also Edit List of cutaneous conditions References Edit[psychology.wikia.com]
  • Mez. nat-sil. olnd. op. sul-ac. sulph. urt-u. ) Psychiatric disease Localized pruritus is often a common manifestation of chronic anxiety, and persistent rubbing of the localized area will result in lichenification.[homeopathyworldcommunity.ning.com]
  • anxiety. (15) Psychogenic pruritus vs. non-psychogenic pruritus Radmanesh & Shafiei revealed the features that differentiate the psycho-pruritic disorders from the pruritic ones: the episodes are chronic and recurrent with short, intense and uncontrollable[go.galegroup.com]
Dysmenorrhea
  • […] international classifications of psychiatric diseases, psychogenic pruritus is not cited in the (Inter-national Classification of Diseases-version 10) ICD-10 but pruritus is reported in the diagnosis termed “other somatoform disorders” (F45.8) along with dysmenorrhea[link.springer.com]
  • Applicable To Neurotic excoriation Type 1 Excludes Excoriation (skin-picking) disorder ( F42.4 ) L98.1 ) psychogenic pruritus ( ICD-10-CM Diagnosis Code F45.8 Other somatoform disorders 2016 2017 2018 2019 Billable/Specific Code Applicable To Psychogenic dysmenorrhea[icd10data.com]
Headache
  • However, some research studies estimate up to two thirds of illnesses seen by general practitioners are ‘stress related’–GI problems, sleep disturbance, mental concentration, headaches, fatigue, shortness of breath, high blood pressure, dermatitis, illnesses[books.google.com]
  • They can provide some level of sedation, which may assist sleep, but may also carry with it the adverse effects of unwanted sedation and other anticholinergic properties such as dry mouth, gastrointestinal upset, stomach pain, nausea, and headache.[skintherapyletter.com]
  • Curr Pain Headache Reports 2002; 6: 23–29. 26. Aronoff GM, Tota-Faucette M, Phillips L, Lawrence CN. Are pain disorder and somatization disorder valid diagnostic entities? Curr Rev Pain 2000; 4: 309–312. 27. Mayou R, Levenson J, Sharpe M.[medicaljournals.se]
  • Diphenhydramine † 25–50 mg po q 4–6 hours (no more than 6 doses in 24 hours) Sedating, also helpful when given before bedtime Doxepin 25 mg po once/day Helpful in severe and chronic itching Very sedating so taken at bedtime Fexofenadine * 60 mg po bid Headache[merckmanuals.com]
  • Concurrent symptoms of headache or menstrual disorders are common in these patients. Usually the history, presentation and physical examination will quickly narrow the diagnostic choices.[aafp.org]
Tingling
  • In some cases, a patient uses a tool or instrument to autoaggressively manipulate his (her) skin in response to tingling or stabbing sensations. Artificial lesions or eczemas brought on by self- manipulation can occur.[mdedge.com]
  • 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.[symptoma.com]
  • The tingling skin and urge to scratch known as itching are a protective response triggered in the brain. While most itching is harmless, the uncomfortable sensation may lead to excessive scratching, damaging the skin.[livestrong.com]
  • Itching is skin tingling or irritation that makes you want to scratch the itchy area. It's a symptom of many health conditions.[icd10data.com]
  • The following findings are of particular concern: Constitutional symptoms of weight loss, fatigue, and night sweats Extremity weakness, numbness, or tingling Abdominal pain and jaundice Urinary frequency, excessive thirst, and weight loss Generalized[merckmanuals.com]
Paresthesia
  • 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.[symptoma.com]
  • The sensations are itch with paresthesia. It is probably a neuropathic itch due to the entrapment of spinal nerves as they come out through the muscle fascias of the back.[homeopathyworldcommunity.ning.com]
  • Somatoform itching is part of a family of functional mucocutaneous skin disorders with psychogenic pain, paresthesia, vulvodynia, stomatodynia, glossodynia. (1) In women, the vulva and the perianal itching are recognized as manifestations of psychogenic[go.galegroup.com]
Excitement
  • Characteristically, itching can be provoked by emotional triggers, most notably during stages of excitement, and also by mechanical or chemical stimuli.[mdedge.com]
  • […] synapse, cross the midline, ascend in the anterolateral spinothalamic tract to the thalamus, and then pass through the internal capsule to the sensory cortex. 5 The perception of itch can be modified by psychological factors such as stress, anxiety, excitation[consultant360.com]
Meningism
  • Ferri’s popular "5 books in 1" format provides quick guidance on short QT syndrome, microscopic polyangiitis, fungal meningitis, and much more. This medical reference makes the answers you need even easier to find - anytime, anywhere.[books.google.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:

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]
  • At any time, persons may use antihistamine treatments orally, to control the itching. [ citation needed ] In case of long-lasting symptoms, above all in patients over 50 years of age, a colonoscopy is useful to rule out a colonic polyp or tumor, that[en.wikipedia.org]

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]
  • Evaluation and treatment of “psychogenic” pruritus and self-excoriation. J Am Acad Dermatol. 1994;30:993–9. CrossRef PubMed Google Scholar 3. Misery L, Alexandre S, Dutray S, Chastaing M, Consoli SG, Audra H, et al.[link.springer.com]

Prognosis

  • Awareness and pertinent treatment of psychodermatological disorders among dermatologists will lead to a more holistic treatment approach and better prognosis in this unique group of patients.[ijdvl.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]
  • 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]
  • 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]
  • 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

  • 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]
  • 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: 2019-07-11 21:05