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.