Pruritis: Clinical Pearls

Matthew J. Zirwas, MD

What are the key issues we should remember when managing an itchy patient? Dr Zirwas provides his clinical pearls…

• Don’t go crazy with labs – they very rarely give an answer.

• In itch with an underlying systemic cause, the underlying systemic is usually either obvious or is diagnosed prior to itch onset.

• If you don’t have a definite diagnosis, address each entity in your differential one at a time.

• Every adult with new onset severe itch and a non-specific rash should be treated for scabies, regardless of results of scabies prep.

• Peppermint extract is cheap, available at most grocery stores, and can be mixed into any moisturizer or topical steroid to give immediate, short term itch relief.

• Gabapentin is pretty reliably effective, but often need 600 mg tid to 900 mg tid.

• Mirtazapine is very good for night-time itch but can cause significant weight gain.

• Butorphanol nasal spray is VERY effective, but is a controlled substance because it has opioid effects.