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Pruritus

  • Common ddx

    • dandruff, dry skin, bites, allergies, parasites
  • Serious ddx

    • biliary obstruction, malignancy
  • Labs

    • microscopy of burrows if scabies
    • wood's lamp if fungus
    • CBC
    • LFTs if suspect biliary
    • Cr if suspect renal failure
    • TSH if suspect thyroid
    • anti-mitochondrial ab if suspect PBC
  • Derm ddx

    • dandruff, dry skin, eczema, psoriasis
  • Bites ddx

    • mosquito bite, insect bite
  • Parasites/infections

    • scabies (crusty nodules under nails, in finger webs, sick contacts)
    • lice (nits, itch in hairy locations, sick contacts)
    • ringworm (ring rash, scalp)
    • athlete's foot
    • folliculitis (rash in hair follicles, pustules)
    • larva migrans (foreign travel, diarrhea)
    • pinworm (anal itch)
  • Allergies ddx (urticaria)

    • hypersensitivity (new meds, new foods)
    • contact dermatitis (hiking, new lotion, rash, blisters)
    • atopic dermatitis (rash, anterior elbow crease, hx of allergies)
  • Biliary ddx

    • biliary obstruction, cholestasis of pregnancy, PBC, PSC, hepatitis (RUQ pain)
  • Onc ddx

    • polycythemia vera (headache, dizziness)
    • biliary cancer
    • pancreatic cancer (nausea, vomiting, jaundice)
    • carcinoid syndrome (flushing, diarrhea)
    • lymphoma (lymphadenopathy), leukemia
  • Other ddx

    • hyperthyroidism, renal failure, uremia, diabetes
  • HPI

    • onset
    • triggering event
    • location
    • severity: mild vs keeps you awake at night
    • alleviates: meds tried
    • aggravates: winter/dry weather
  • ROS

    • fever, weight loss, nightsweats
    • skin: rash, dryness
    • head and body hair: lice, nits, patchy hair loss, ring rash
    • ENT: oral swelling
    • cardio: chest pain
    • pulm: cough
    • GI: nausea, vomiting, diarrhea, abdominal pain
    • neuro: headache, dizziness
    • endo: head/cold sensitivity
    • GU: polyuria, oliguria
  • PMH

    • derm conditions
    • allergies
    • cancer
    • biliary disease
    • renal failure
  • FH

  • SH

    • travel hx
    • sick contacts, contact with others with itch
    • new foods, lotions
  • Meds

    • new meds
  • Allergies

  • Px

    • vitals
    • gen impression
    • skin:
    • pruritus location, scratch marks
    • insect bite marks
    • rash, urticaria, folliculitis, location of rash
    • jaundice
    • lymphadenopathy
    • cardio
    • pulm
    • abd: organomegaly, mass, tenderness
    • ext: scabies burrows in fingers webs

  • Print | Citations

    Disclaimer: MDHero Workups is for educational use only, and is not meant to replace the clinical judgement of a professional. We do not guarantee the accuracy of any information on this website.