Pruritus without rash in Child
Generalized itching without a rash can be an important symptom of "internal" conditions such as biliary obstruction, renal failure (acute, chronic), hyperthyroidism, Hodgkin disease, other lymphomas, and other myeloproliferative diseases. The connection, if any, between pruritus and solid malignancies is tenuous and exceedingly rare except when, for example, a tumor causes biliary obstruction. Medications can also cause generalized pruritus without a rash.
Diffuse itch with a prickling character that develops immediately after any water contact and lacks associated visible skin changes is called aquagenic pruritus and may be a sign of polycythemia vera. It has also been associated with myelodysplastic syndrome, hypereosinophilic syndrome, and juvenile xanthogranuloma. Rarely it has been reported as occurring with myelofibrosis. Some medications have been reported to induce the condition as well.
Localized itching, often with a burning or stinging character, can occur as a consequence of isolated peripheral sensory neuropathies. These abnormal sensations may be described as dysesthetic, paresthetic, or neuropathic. Itch localized to the forearms may represent brachioradial pruritus. Dysesthesia of the scalp can occur as a consequence of cervical spine disease. Intense itching of the scalp also occurs in dermatomyositis. On occasion, a localized neuropathic itch such as brachioradial pruritus may trigger generalized pruritus.
Generalized pruritus in the setting of immunocompromise can be a sign of lymphoma, drug reactions, and all of the other conditions associated with generalized itch.
Pediatric Patient Considerations:
In the pediatric age group, congenital disorders such as biliary atresia and Alagille syndrome can cause itching. The diagnosis of scabies can be easily missed in children, where locations such as the scalp and feet may have subtle diagnostic burrows.
Related topic: HIV/AIDS-related pruritus
L29.8 – Other pruritus
276444007 – Generalized pruritus
- Liver disease
- Renal failure / uremia (which may not respond to dialysis)
- Hodgkin disease and other lymphomas
- Iron deficiency
- Pruritus of pregnancy, cholestatic pruritus of pregnancy
- Zoonoses such as canine scabies or the Cheyletiella blakei mite (an ectoparasite of cats)
- Xerosis (dry skin, winter itch), "ashy skin" xerosis
- Atopic dermatitis
- Pre-bullous pemphigoid (see bullous pemphigoid)
- Dermatitis herpetiformis
- Mastocytosis (see urticaria pigmentosa)
- Drug reactions (see below)
- Fiberglass exposure
List of drugs commonly associated with generalized pruritus, without primary lesions:
- Narcotics, etc
- Opiate agonists, eg, morphine
- Oral contraceptives
- Para-aminosalicylic acid