Generalised Pruritus

What to consider in Primary Care before referring:

General Comments

• Dry skin, eczema and scabies are the commonest cause of generalised pruritus.

• If someone is itching all over, take a full history and examine the skin very carefully

• Check Lymph nodes and liver function

Treatment in primary care

• If NO RASH can be seen other than excoriations consider the following:
  Anaemia - Especially iron deficiency
  Uraemia
  Obstructive jaundice
  Thyroid disease both hypo and hyperthyroidism
  Lymphoma, especially in young adults
  Carcinoma, especially in middle age and elderly
  Psychological

• A full general examination may be helpful.

• Organise the following investigations:
  FBC and differential
  ESR
  Urea and electrolytes
  LFT’s
  Thyroid function tests
  Iron Studies
  Abdominal USS (Consider if clinically indicated)
  Chest X-ray (Consider if clinically indicated)
  Protein Electropherisis

NB. Pruritus may occasionally predate a lymphoma by several years. Close supervision is advised in such patients

Referral Threshold

Refer to Dermatology if treatment fails.