PRURITUS, GENERALIZED

Ask the Following Questions:

1. Is the pruritus associated with a generalized rash? Almost every generalized rash may be associated with pruritus, but the most common ones are urticaria, dermatitis herpetiformis, eczema, scabies, and pemphigus.
2. Is there hepatomegaly or jaundice? The presence of hepatomegaly or jaundice should make one think of obstructive jaundice, hepatitis, metastatic carcinoma to the liver, and biliary cirrhosis. However, almost any form of liver disease may be associated with pruritus.
3. Is there polyuria, polydipsia, and polyphagia? These findings would suggest diabetes mellitus, hyperthyroidism, and pregnancy.
4. Is there an unusual odor? The presence of an unusual odor should bring to mind the possibility of uremia, liver failure, or diabetic acidosis.
5. Is there plethoric facies? The presence of plethoric facies suggests polycythemia vera.

DIAGNOSTIC WORKUP

If there is an associated skin rash, microscopic examination of a potassium hydroxide preparation of curetted burrows will be helpful. Additional examinations include Wood's lamp evaluation, a patch test, and skin biopsies. Therapeutic trials for scabies, fungal disease, or other disorders, however, are justified if testing is not economically feasible. Routine laboratory tests for the various systemic diseases that may cause pruritus include a CBC, sedimentation rate, urinalysis, chemistry panel, ANA assay, thyroid profile, and serum protein electrophoresis. A bone marrow examination and lymph node biopsy may be useful. A dermatologist, hematologist, or endocrinologist may help solve the diagnostic dilemma. Further workup may include plain films of the chest and abdomen and CT scans of the abdomen and pelvis. A bone scan may be useful in diagnosing metastatic carcinoma. HIV testing may be indicated if the patient has a history of high-risk sexual behavior.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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