Diagnosis and treatment of pruritus.

OBJECTIVE: To describe an approach that allows for a streamlined assessment and accurate differentiation of most patients with itch in primary care and to provide an update on the available nonpharmacologic, topical, and systemic therapies.

SOURCES OF INFORMATION: MEDLINE (Ovid) and PubMed were searched for the key words itch or pruritus. Searches were refined for each cause and treatment by adding appropriate key words, and subsequent hand searches of the references of retrieved literature were performed.

MAIN MESSAGE: A good body of evidence from high-quality trials does not exist for treatment of pruritus, and the treatments that do exist are inconsistent in their success. The dominant causes of generalized itch are xerosis and eczema. Most patients will improve with nonpharmacologic therapy including frequent moisturization. If this avenue fails, further investigations are warranted to help guide subsequent treatment with any of the many cause-specific topical and systemic approaches available.

CONCLUSION: Chronic itch can be debilitating for patients. The approach described allows for a streamlined assessment and accurate differentiation of most patients with itch in primary care.