Sauer note

When the presenting complaint is generalized itching of the skin, always stroke the skin on the forearm with your nail or a tongue depressor. After 5 minutes or so, if there is a wheal reaction at the stroking site, you have a diagnosis of dermographism. This is a common problem that is easily overlooked.

Senile Pruritis

Senile pruritus is a resistant form of generalized pruritus in the elderly patient. It can occur at any time of the year and may or may not be associated with dry skin. There is some evidence that these patients have a disorder of keratinization. This form of itch occurs most commonly on the scalp, the shoulders, the sacral areas, and the legs. Clinically, some patients have no cutaneous signs of the itch, but others may have linear excoriations. Scabies should be ruled out, as well as the diseases mentioned under the next form of pruritus to be considered, essential pruritus.

Treatment is usually not very satisfactory. In addition to the agents mentioned previously in connection with winter pruritus, the injection of 30 mg triamcinolone acetonide suspension (Kenalog-40) intramuscularly every 4 to 6 weeks for two or three injections is quite beneficial.

Essential Pruritus

Essential pruritus is the rarest form of the generalized itching diseases. No person of any age is exempt, but it occurs most frequently in the elderly patient. The itching is usually quite diffuse, with occasional "bites" in certain localized areas. All diffuse itching is worse at night, and no exception is made for this form of pruritus. Before a diagnosis of essential pruritus is made, the following diseases must be ruled out by appropriate studies: drug reaction, diabetes mellitus, uremia, lymphoma (mycosis fungoides, leukemia, or Hodgkin's disease), liver disease, bullous pemphigoid, AIDS, and intestinal parasites. Treatment is the same as for senile and winter pruritus.

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