STUDY - Technical - New Dacian's Medicine
Pruritus
(Classical / Allopathic Medicine)
Commonly
provoking scratching as an attempt to gain relief,
pruritus is an unpleasant itching sensation that affects
the skin, specific mucous membranes, and the eyes. Most
severe at night, pruritus may be exacerbated by increased
skin temperature, poor skin turgor, local vasodilation,
dermatoses, and stress.
The
most common symptom of a dermatologic disorder, pruritus
may also result from a local or systemic disorder or from
drug use. Physiologic pruritus (such as pruritic
urticarial papules and plaques of pregnancy) may occur in
primigravidas late in the third trimester. Pruritus can
also stem from emotional upset or contact with skin
irritants.
HISTORY:
Have the patient describe the pruritus, its onset, frequency, and intensity. If the pruritus occurs at night, ask him whether it prevents him from falling asleep or awakens him after he falls asleep. Locate the pruritic area.
Ask the patient if the itching is localized or generalized. When is it most severe? How long does it last?
Ask the patient if the pruritus occurs after activities, such as physical exertion, bathing, makeup, or perfume application. Has the patient recently changed medications or brands of soap or laundry detergent?
Ask the patient how he cleans his skin. In particular, look for excessive bathing, harsh soaps, contact allergy, and boiling water.
Ask the patient about occupational exposure to known skin irritants, such as fiberglass insulation or chemicals.
Ask the patient if he has recently traveled abroad.
Ask the patient if anyone else in his house has reported itching. Does he have pets?
Ask the patient if stress, fear, depression, or illness seems to aggravate the itching.
Ask the patient about his general health. Does he have related symptoms?
Review the patient's medical history for skin disorders.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Have the patient describe the pruritus, its onset, frequency, and intensity. If the pruritus occurs at night, ask him whether it prevents him from falling asleep or awakens him after he falls asleep. Locate the pruritic area.
Ask the patient if the itching is localized or generalized. When is it most severe? How long does it last?
Ask the patient if the pruritus occurs after activities, such as physical exertion, bathing, makeup, or perfume application. Has the patient recently changed medications or brands of soap or laundry detergent?
Ask the patient how he cleans his skin. In particular, look for excessive bathing, harsh soaps, contact allergy, and boiling water.
Ask the patient about occupational exposure to known skin irritants, such as fiberglass insulation or chemicals.
Ask the patient if he has recently traveled abroad.
Ask the patient if anyone else in his house has reported itching. Does he have pets?
Ask the patient if stress, fear, depression, or illness seems to aggravate the itching.
Ask the patient about his general health. Does he have related symptoms?
Review the patient's medical history for skin disorders.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
PHYSICAL
ASSESSMENT:
Note the color of the patient's skin. Check sclerae for jaundice.
Examine the patient for signs of scratching, such as excoriation, purpura, scabs, scars, or lichenification.
Look for primary lesions to help confirm dermatoses.
Palpate the abdomen for tenderness.
Note the color of the patient's skin. Check sclerae for jaundice.
Examine the patient for signs of scratching, such as excoriation, purpura, scabs, scars, or lichenification.
Look for primary lesions to help confirm dermatoses.
Palpate the abdomen for tenderness.
SPECIAL
CONSIDERATIONS:
Administer a topical corticosteroid, an antihistamine, or a tranquilizer, as ordered. If the patient doesn't have a localized infection or skin lesions, suspect a systemic disease.
Administer a topical corticosteroid, an antihistamine, or a tranquilizer, as ordered. If the patient doesn't have a localized infection or skin lesions, suspect a systemic disease.
PEDIATRIC
POINTERS:
Many adult disorders also cause pruritus in children, but they may affect different parts of the body. For example, scabies may affect an infant's head but not an adult's.
Pityriasis rosea may affect the face, hands, and feet of adolescents.
Some childhood diseases, such as measles and chickenpox, can cause pruritus.
Hepatic diseases can produce pruritus in children as bile salts accumulate on the skin.
Many adult disorders also cause pruritus in children, but they may affect different parts of the body. For example, scabies may affect an infant's head but not an adult's.
Pityriasis rosea may affect the face, hands, and feet of adolescents.
Some childhood diseases, such as measles and chickenpox, can cause pruritus.
Hepatic diseases can produce pruritus in children as bile salts accumulate on the skin.
PATIENT
COUNSELING:
Advise the patient to avoid scratching or rubbing the itchy areas. To ease itching, tell the patient to take tepid baths, using little soap and rinsing thoroughly. Recommend soothing oatmeal or cornstarch bath. Tell the patient to apply an emollient lotion after bathing to soften and cool the skin.
Advise the patient to avoid scratching or rubbing the itchy areas. To ease itching, tell the patient to take tepid baths, using little soap and rinsing thoroughly. Recommend soothing oatmeal or cornstarch bath. Tell the patient to apply an emollient lotion after bathing to soften and cool the skin.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common symptoms,
Edition V, McGraw - Hill, 2002.