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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

• Folliculitis – Lesions are always follicular and often concentrated around the trunk; pustules are often present.
• Eosinophilic folliculitis – Lesions favor the scalp, face, and neck.
• Prurigo nodularis – Thickened hyperpigmented nodules, few in number and sparing areas where patients can't scratch, like the mid-back.
• Atopic dermatitis – Dry, scaly, sometimes fissured patches with weeping may be present in those without eczema history.
• Porphyria cutanea tarda – Itchy, painful blisters that heal with scarring are present in sun-exposed areas.
• Contact dermatitis – Nonspecific, eczematous patches, and potential triggering exposures are identified.
• Psoriasis – May be more pruritic in patients with HIV; can be extensive in total body surface area nearing erythroderma.
• Scabies – Burrows in web spaces, intertriginous areas.
• Polycythemia vera – Laboratory abnormalities and itching that is exacerbated by warmth exposure.
• Pruritus secondary to liver disease (see pruritus without rash)
• Pruritus secondary to renal disease (see pruritus without rash)
• Pruritus secondary to xerosis 
• Pruritus secondary to thyroid disease
• Medication-induced pruritus
• Pruritus associated with iron deficiency anemia
• Delusions of parasitosis – Diagnosis of exclusion.

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