https://mauiderm.com/wp-content/uploads/2013/10/Zirwas-HeadShot-for-Maui-Derm.jpg 589 492 Maui Derm News https://mauiderm.com/wp-content/uploads/2013/04/MD-WebLogo.jpg Maui Derm News2015-01-29 07:44:482015-01-29 07:44:48Pruritis: 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.