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

Main Article Content

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.


1. Reich A, Stander S, Szepietowski JC. Pruritus in the elderly. Clinics in dermatology. 2011;29(1):15-23.

2. Patel T, Yosipovitch G. The management of chronic pruritus in the elderly. Skin therapy letter. 2010;15(8):5-9.

3. Stander S, Schafer I, Phan NQ, et al. Prevalence of chronic pruritus in Germany: results of a cross-sectional study in a sample working population of 11,730. Dermatology (Basel, Switzerland). 2010;221(3):229-235.

4. Berger TG, Shive M, Harper GM. Pruritus in the Older Patient: A Clinical ReviewPruritus in the Older PatientPruritus in the Older Patient. JAMA. 2013;310(22):2443-2450.

5. Yosipovitch G, Bernhard JD. Chronic Pruritus. New England Journal of Medicine. 2013;368(17):1625-1634.

6. Kini SP, DeLong LK, Veledar E, McKenzie-Brown AM, Schaufele M, Chen SC. The impact of pruritus on quality of life: the skin equivalent of pain. Archives of dermatology. 2011;147(10):1153-1156.

7. Pisoni RL, Wikstrom B, Elder SJ, et al. Pruritus in haemodialysis patients: International results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2006;21(12):3495-3505.

8. Yosipovitch G, Goon A, Wee J, Chan YH, Goh CL. The prevalence and clinical characteristics of pruritus among patients with extensive psoriasis. Br J Dermatol. 2000;143(5):969-973.

9. Millington GWM, Collins A, Lovell CR, et al. British Association of Dermatologists' guidelines for the investigation and management of generalized pruritus in adults without an underlying dermatosis, 2018. Br J Dermatol. 2018;178(1):34-60.

10. Kim BS, Berger TG, Yosipovitch G. Chronic pruritus of unknown origin (CPUO): Uniform nomenclature and diagnosis as a pathway to standardized understanding and treatment. Journal of the American Academy of Dermatology. 2019;81(5):1223-1224.

11. Ward JR, Bernhard JD. Willan's itch and other causes of pruritus in the elderly. International journal of dermatology. 2005;44(4):267-273.

12. Patel SP, Khanna R, Kwatra SG. Proposing a stratification scheme for Chronic Pruritus of Unknown Origin Nomenclature based on presence of eosinophilia: Implications for therapeutics and cohort homogeneity for clinical trials. Journal of the American Academy of Dermatology.

13. Yosipovitch G. Chronic pruritus: a paraneoplastic sign. Dermatologic therapy. 2010;23(6):590-596.

14. Berger TG, Steinhoff M. Pruritus in elderly patients--eruptions of senescence. Seminars in cutaneous medicine and surgery. 2011;30(2):113-117.

15. Mesa RA. Itchy mast cells in MPNs. Blood. 2009;113(23):5697-5698.

16. Wieland CN, Comfere NI, Gibson LE, Weaver AL, Krause PK, Murray JA. Anti-bullous pemphigoid 180 and 230 antibodies in a sample of unaffected subjects. Archives of dermatology. 2010;146(1):21-25.

17. Summers EM, Bingham CS, Dahle KW, Sweeney C, Ying J, Sontheimer RD. Chronic eczematous eruptions in the aging: further support for an association with exposure to calcium channel blockers. JAMA Dermatol. 2013;149(7):814-818.

Most read articles by the same author(s)

1 2 3 4 5 6 7 > >>