Generalised pruritus without a rash

Tip: Look for sparing at sites that are hard to reach e.g. central back. Skin will appear normal in the absence of skin pathology.

 

Useful links: http://www.pcds.org.uk/clinical-guidance/pruritus-without-a-rash

 

What is the role of phototherapy?

Patients will need to attend either WCH, Bodmin Hospital or RCHT twice weekly for 6-12 weeks and be able to stand independently for several minutes during treatments.

 

Primary care management prior to referral for phototherapy:

 

1. Investigations have been carried out to look for an underlying cause

FBC, UE, LFT, bone, TFT, HBA1C, ferritin, CRP, antimitochondrial antibody, urinalysis, Ig + PE (in older patients) and CXR.

 

2. Trial of topical treatments

• 1 or 2% menthol in aqueous cream
• Balneum Plus cream
• 5% doxepin hydrochloride can be useful for localized areas of itch

3.  Sedative antihistamines

• Hydroxyzine 25-50mg on.

Such treatments should be used periodically, long term use should be avoided if possible. Please see cautions in the BNF.

 

What to include in the referral letter:

 

What treatments have been trialled in primary care and for how long.

 

The Advice and Guidance service can be useful in challenging cases.