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  • Most skin eruptions and rashes are more or less pruritic, but there are states where there is severe pruritus in the absence of skin lesions, except for scratch marks (Fig. 35-1).

  • The diagnostic approach to the patient with generalized pruritus without identifiable skin lesions is a diagnosis of exclusion.

  • Pruritus is a symptom of skin disease that at the time of examination does not manifest with specific lesions.

  • It may be cause by an internal organ disease, metabolic and endocrine conditions, or hematologic disease.

  • It may be a manifestation of malignant tumors, psychogenic states, or HIV infection; or it may be related to injected or ingested drugs.

  • The various causes of pruritus sine materia are listed in Table 35-1, and an algorithm of how to approach a patient with pruritus sine materia is shown in Table 35-2.

  • Skin signs may be clinically inapparent, perhaps confined to only circumscribed areas. This is particularly important with regard to the exclusion of scabies, pediculosis, or conditions such as urticaria factitia.


Pruritus without diagnostic skin lesions This patient had multiple scratch marks resulting from compulsive scratching because of severe pruritus. There were no other diagnostic lesions. Workup revealed biliary cirrhosis without jaundice.

TABLE 35-1Causes of Pruritus Sine Materia

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