Prurigo (overview) L28.2

Etiologically and morphologically heterogeneous group of intensely itchy, papular skin diseases with acute, sub-acute or chronic course. Primary lesions are papules with or without vesicles or intensively itchy, urticarial lesions.

The prurigo diseases can be subdivided as follows:

• Primary prurigo:
  • Strophulus infantum (prurigo simplex acuta)
  • Prurigo simplex subacuta
  • Prurigo , chronic (prurigo nodularis).
• Secondary prurigo in internal diseases, especially due to:
  • Diabetes mellitus ( Prurigo diabetica)
  • Chronic terminal renal failure (prurigo uraemica)
  • Chronic liver disease ( prurigo hepatica)
  • Gout disease (prurigo uratica)
  • Myeloproliferative diseases (e.g. prurigo lymphogranulomatotica in Hodgkin's disease)
  • Prurigo paraneoplastica.
• Other prurigo diseases (diseases that can be assigned to other entities):
  • Prurigo, actinic (Hutchinson`s summer prurigo)
  • Prurigo form of atopic eczema
  • Prurigo pigmentosa.

Prurigo test program (varies according to stand)

General laboratory values

• BSG/CRP
• CBC with differential blood count
• iron, ferritin, transferrin
• calcium, phosphate, creatinine, urea
• Transaminases (GOP, GPT, GGT) LDH, alkaline phosphatase, bilirubin, hepatitis serology
• Protein, glucose (Hb A1C)
• TSH
• Urine status, possibly creatinine clearance
• Stool test for occult blood
• only with anal pruritus: worm eggs, parasites (e.g. Giardia lamblia)

instrumental diagnostics

• X-ray thorax, X-ray spine (in case of localized itching)
• Sonography abdomen and lymph nodes

Further examinations depending on the anamnesis and previous findings

• Protein electrophoresis, possibly immune electrophoresis to exclude paraproteins(MGUS)
• Antinuclear antibodies (ANA), anti-mitochondrial antibodies (AMA), anti-gliadin antibodies, anti-transglutaminase antibodies (see below dermatitis herpetiformis)
• Electrolytes, parathormone, porphyrins (see porphyrinemias), iron levels
• vitamin B12, folic acid, zinc
• HIV status
• If necessary, tryptase determination (see mastocytosis)
• Bacteriological and mycological smears

In American literature the term "prurigo" is not a common term, except for the prurigo nodularis and the actinic prurigo (Ständer S 2018).

1. Stand S (2018) Pruritus, Prurigo. In: Braun-Falco`s Dermatology, Venerology Allergology G. Plewig et al (Hrsg) Springer Verlag S 587
2. Topal SG et al (2017) The Value of Etiological Tests and Skin Biopsy in the Management of Prurigo Simplex Subacuta. Acta Dermatovenerol Croat 25:276-278.