Pruritus and Dysesthesia

Pruritus is defined as an unpleasant sensation of the skin that elicits a desire to scratch. It is the most common skin-related symptom. In primary skin diseases, pruritus often accompanies the distinct skin lesions. For pruritus due to underlying systemic diseases (e.g. renal, hepatic, neoplastic, psychiatric) or drug intake, there may be no cutaneous findings or only secondary skin lesions due to scratching (e.g. prurigo nodularis, lichen simplex chronicus). This chapter provides an approach to the evaluation and treatment of patients with pruritus as a chief complaint. Regional forms of pruritus and dysesthesia are also reviewed, including those with neurologic etiologies. Although our incomplete understanding of the pathogenesis of pruritus has hampered therapeutic advances, recent discoveries provide hope for more effective treatments in the future.