Psychogenic pruritus, also known as psychogenic itch or functional itch disorder, is

pruritus An itch (also known as pruritus) is a sensation that causes a strong desire or reflex to scratch. Itches have resisted many attempts to be classified as any one type of sensory experience. Itches have many similarities to pain, and while both ...

not associated with a dermatologic or systemic cause. More often than not, it is attributed to a psychiatric cause. Psychogenic pruritus is not the same as

neuropathic Peripheral neuropathy, often shortened to neuropathy, refers to damage or disease affecting the nerves. Damage to nerves may impair sensation, movement, gland function, and/or organ function depending on which nerve fibers are affected. Neuropa ...

itch though both are conditions which require more research. This condition is not explained well in

DSM-5 The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the '' Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiat ...

and is typically considered a diagnosis of exclusion. This condition is not well-studied and is difficult to ascertain as it is seen by both dermatologists and psychiatrists. In order to provide some consensus to this condition, the French Psychodermatology Group have created diagnostic criteria for this condition.

Signs and symptoms

Psychogenic pruritus typically appears as itching on the face and on the extensor surfaces of the body. This includes the back side of the arms, the abdomen, the side of the legs and the upper back and shoulders. These areas are more frequent because they are within hand's reach.

Diagnosis

When considering the diagnosis of psychogenic pruritus, it is important to rule out medical, dermatologic and neuropathic causes. A strong history should be obtained and appropriate labwork should be drawn. One should consider drawing for a

CBC CBC may refer to: Media * Cadena Baja California or Grupo Cadena, a radio and television broadcaster in Mexico * Canadian Broadcasting Corporation, Canada's radio and television public broadcaster ** CBC Television ** CBC Radio One ** CBC Music ** ...

(complete blood count), ESR (erythrocyte sedimentation rate), liver, renal and thyroid panel as abnormalities with any can contribute to pruritus. Pruritus can be seen with hepatic and renal disease such as

cholestasis Cholestasis is a condition where the flow of bile from the liver to the duodenum is impaired. The two basic distinctions are: * obstructive type of cholestasis, where there is a mechanical blockage in the duct system that can occur from a gallston ...

alcoholic liver disease Alcoholic liver disease (ALD), also called alcohol-related liver disease (ARLD), is a term that encompasses the liver manifestations of alcohol overconsumption, including fatty liver, alcoholic hepatitis, and chronic hepatitis with liver fibrosi ...

primary biliary cholangitis Primary biliary cholangitis (PBC), previously known as primary biliary cirrhosis, is an autoimmune disease of the liver. It results from a slow, progressive destruction of the small bile ducts of the liver, causing bile and other toxins to buil ...

hepatitis B Hepatitis B is an infectious disease caused by the '' hepatitis B virus'' (HBV) that affects the liver; it is a type of viral hepatitis. It can cause both acute and chronic infection. Many people have no symptoms during an initial infection. ...

and C, and chronic kidney disease. Drug and alcohol use can contribute to pruritus as well so it is worthwhile to gather a social history. Those who use

cocaine Cocaine is a tropane alkaloid and central nervous system stimulant, derived primarily from the leaves of two South American coca plants, ''Erythroxylum coca'' and ''Erythroxylum novogranatense, E. novogranatense'', which are cultivated a ...

and

amphetamines Substituted amphetamines, or simply amphetamines, are a chemical class, class of compounds based upon the amphetamine structure; it includes all derivative (chemistry), derivative compounds which are formed by replacing, or substitution reacti ...

may experience pruritus due to feelings of abnormal cutaneous sensations called 'delusions of parasitosis', also known as "meth mites".

Opioid Opioids are a class of Drug, drugs that derive from, or mimic, natural substances found in the Papaver somniferum, opium poppy plant. Opioids work on opioid receptors in the brain and other organs to produce a variety of morphine-like effects, ...

users can also experience pruritus so examining a patient's medication list can be beneficial.

Diagnostic criteria

The French Psychodermatology Group is a subgroup of the French Society of Dermatology made up on psychiatrists, dermatologists and psychologists. They met in 2007 to propose diagnostic criteria for this disease in hope of preventing further misdiagnosis of this condition. They believed the term "functional itch disorder" was the best phrase to describe this condition, avoiding the use of the word "psychogenic". To diagnose a patient with functional itch disorder, the patient should meet three required criteria and three of seven optional criteria. Diagnostic Criteria: * 3 Required criteria ** Localized or generalized pruritus without a primary skin lesion ** Chronic pruritus, characterized as being greater than 6 weeks ** There is no somatic cause present * 7 Optional criteria (need 3 to diagnose) ** A chronological relationship of pruritus with one or several life events that can have psychological consequences ** Changes during the nighttime ** More present during rest or inaction ** There is a coupled psychological disorder ** Pruritus that could be improved with psychotropic drugs ** Pruritus that could be improved by psychotherapies

Treatment

The treatment for this condition has not been well studied but the most common options are

psychotherapy Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of Psychology, psychological methods, particularly when based on regular Conversation, personal interaction, to help a person change behavior, increase hap ...

and medicines geared toward psychiatric conditions. Stress reduction and relaxation techniques have also been shown to be helpful for alleviating this condition. Having a strong physician-patient alliance can also lead to the improvement of symptoms. The condition is often managed with drugs including H₁-

antihistamine Antihistamines are drugs which treat allergic rhinitis, common cold, influenza, and other allergies. Typically, people take antihistamines as an inexpensive, generic (not patented) drug that can be bought without a prescription and provides ...

tricyclic antidepressant Tricyclic antidepressants (TCAs) are a class of medications that are used primarily as antidepressants. TCAs were discovered in the early 1950s and were marketed later in the decade. They are named after their chemical structure, which contains ...

tetracyclic antidepressant Tetracyclic antidepressants (TeCAs) are a class of antidepressants that were first introduced in the 1970s. They are named after their tetracyclic chemical structure, containing four cyclic compound, rings of atoms, and are closely related to th ...

selective serotonin reuptake inhibitor Selective serotonin reuptake inhibitors (SSRIs) are a class of drugs that are typically used as antidepressants in the treatment of major depressive disorder, anxiety disorders, and other psychological conditions. SSRIs primarily work by blo ...

antipsychotic Antipsychotics, previously known as neuroleptics and major tranquilizers, are a class of Psychiatric medication, psychotropic medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), p ...

s, or

benzodiazepine Benzodiazepines (BZD, BDZ, BZs), colloquially known as "benzos", are a class of central nervous system (CNS) depressant, depressant drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. They are prescribed t ...

s. If the cause is found to be dermatologic in nature, dermatologists can offer solutions such as intralesional injections, wet wraps and other occlusive options. Menthol and cool compresses can also relieve the patient of their itch. It is also common for psychologic conditions such as

obsessive–compulsive disorder Obsessive–compulsive disorder (OCD) is a mental disorder in which an individual has intrusive thoughts (an ''obsession'') and feels the need to perform certain routines (''Compulsive behavior, compulsions'') repeatedly to relieve the dis ...

, depression,

anxiety Anxiety is an emotion characterised by an unpleasant state of inner wikt:turmoil, turmoil and includes feelings of dread over Anticipation, anticipated events. Anxiety is different from fear in that fear is defined as the emotional response ...

bipolar disorder Bipolar disorder (BD), previously known as manic depression, is a mental disorder characterized by periods of Depression (mood), depression and periods of abnormally elevated Mood (psychology), mood that each last from days to weeks, and in ...

, and

psychosis In psychopathology, psychosis is a condition in which a person is unable to distinguish, in their experience of life, between what is and is not real. Examples of psychotic symptoms are delusions, hallucinations, and disorganized or inco ...

to present with pruritus.

Epidemiology

The incidence is not known. However, it is more common in females of the age range of 30–45 years.

References

External links

{{Medical resources , DiseasesDB = , ICD10 = F45.8 (

ILDS The International League of Dermatological Societies (ILDS) is a non-governmental organization that works closely with the World Health Organization. It was founded in 1935, but because of World War II no congresses were held until 1952. It is gov ...

F45.800) , ICD9 = {{ICD9, 306.3 , ICDO = , OMIM = , MedlinePlus = , eMedicineSubj = , eMedicineTopic = , MeshID = Neurocutaneous conditions