Diagnostic Approach to Patients with Chronic Pruritus of Unknown Origin: A Single-Site Retrospective Chart Review

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Roselyn Stanger
Kathryn Tan
Mark Lebwohl


pruritus, idiopathic pruritus, scabies, bullous pemphigoid


Background: Patients with generalized pruritus lacking primary skin lesions are typically subjected to extensive laboratory tests. For many, the results fail to reveal any clinically significant findings; the British Association of Dermatologists published detailed guidelines for the work-up and management of these patients. Our objectives were twofold: to evaluate the clinical utility of the diagnostic approach used in our practice, and to ascertain how closely we adhered to the suggested guidelines.

Method: We conducted a retrospective chart review of 106 adult patients who presented with generalized pruritus without primary skin lesions.  

Results: While 82.1% of patients received at least a complete blood count, far fewer received serum ferritin (23.6%) or chest imaging (36.8%). Almost 11% of patients responded to empiric anti-scabetic treatment. Approximately 9% of the skin biopsies were consistent with bullous pemphigoid. One patient had resolution of their pruritus after discontinuing an angiotensin-converting-enzyme inhibitor.

Conclusion: In conclusion, dermatologists should consider empiric anti-scabetic treatment, skin biopsies for patients over the age of 65, and discontinuation of an angiotensin-converting-enzyme inhibitor enzyme to better conform to existing guidelines.


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