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may be caused by - skin disease, systemic disease, nerve damage, psychiatric, drugs
usually - dry skin, contact dermatitis, atopic dermatitis
secondary lesions - excoriation, lichenification, prurigo nodules, hyperpigmentation (hypo in dark skin), bruising
Chronic itch >6/52
 
Clinically
Need good Hx - duration, localisation, intensity, sleep, exacerbate/relieve, atopy, travel, drugs
Good skin care impt
 
Systemic
CKD, Cholestasis, Hyperthyroid, ......
 
Ix
??Bx - if rash
FBC, LFT, U/E, TFT, Haematinics

Mx - best to treat cause
emollients / barriers
preventive measures - clothing, avoid soaps etc
steroids - topical or oral - relieve itch associated with inflammation
antihistamines - relieve itch caused by histamine, topical - limited use, sedating and non-sedating
SSRI, Gabapentin Pregabalin .....
 
Immunomodulators (Tacrolimus) - useful but also cause burning and systemic ones
Counterirritants - capsaicin
topical anaesthetics
topical salicylates - with lichen simplex
Opiates - Naltrexone
Phototherapy
CBT / CAM
 
Specific suggestions - looks useful
 
Complications
disturbs - sleep, concentration, libido
agitation / depression