Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • underlying dermatosis
  • pruritus beginning during psychological stress
  • severe intractable itching
  • lichenification
  • erythematous to violaceous plaques
  • lesions on neck, ankles, scalp, vulva, scrotum, pubis, and extensor forearms

Other diagnostic factors

  • altered pigmentation
  • erosions
  • linear fissures
  • grouped hyperpigmented papules on the shins
  • hyperpigmented patch on the interscapular back
  • underlying psychiatric disorder
  • underlying systemic condition causing pruritus

Risk factors

  • atopic diathesis
  • environmental irritants
  • psychiatric disorder
  • dermatological disease
  • systemic conditions causing pruritus

Diagnostic investigations

Investigations to consider

  • skin biopsy
  • patch testing
  • potassium hydroxide preparation
  • fungal culture
  • skin scrapings
  • serum TSH and free T4
  • serum creatinine and urea and electrolytes
  • LFTs and gamma-GT
  • FBC
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Brian L. Swick

Clinical Associate Professor

University of Iowa Departments of Dermatology and Pathology

Iowa City Veterans Affairs Medical Center

Iowa City

IA

Disclosures

BLS declares that he has no competing interests.

Peer reviewers VIEW ALL

Dermatology Physician

Town Square Dermatology

Coralville

IA

Disclosures

HWW declares that he has no competing interests.

Consultant Paediatrician

Heartlands Hospital

Birmingham

UK

Disclosures

HG declares that she has no competing interests.

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