PRURITIS
Pruritis (itching) is one of the most common dermatologic complaints. Scratching the itchy area causes the inflamed cells and nerve endings to release histamine, which produces more pruritis and, in turn, a vicious itchscratch cycle. Scratching can result in altered skin integrity with excoriation, redness, raised areas (wheals), infection, or changes in pigmentation. Although pruritis usually is due to primary skin disease, it may also reflect systemic disease, such as diabetes mellitus; renal, hepatic, thyroid, or blood disorders; or cancer. Pruritis may be caused by certain oral medications (aspirin, antibiotics, hormones, opioids), contact with irritating agents (soaps, chemicals), or prickly health (miliaria). It may also be a side effect of radiation therapy, a reaction to chemotherapy, or a symptom of infection. It may occur in elderly patients as a result of dry skin. It may also be caused by psychological factors (emotional stress).

CLINICAL MANIFESTATIONS
·    Itching and scratching, often more severe at night (itch-scratch-itch cycle)
·    Excoriations, redness, raised areas on the skin (wheals), as a result of scratching.
·    Infections or changes in pigmentation
·    Debilitating itching, in severe cases.

MEDICAL MANAGEMENT
The cause of pruritis needs to be identified and treated. The patient is advised to avoid washing with soap and hot water. Cold compresses, ice cubes, or cool agents that contain soothing menthol and camphor may be applied.
·    Bath oils (Lubriderm or Alpha Keri) are prescribed, except for elderly patients or those with impaired balance, who should not add oil to the bath because of the danger of slipping.
·    Topical steroids are prescribed to decrease itching.
·    Oral antihistamines (diphenhydramine [Benadryl] ) are sometimes used.
·    Tricyclic antidepressants (doxepin [Sinequan]) may be prescribed when pruritis is of neuropsychogenic origin.

NURSING MANAGEMENT
·    Reinforce reasons for the prescribed therapeutic regimen.
·    Remind patient to use tepid (not hot) water and to shake off excess water and blot between intertriginous areas (body folds) with a towel.
·    Advise patient to avoid rubbing vigorously with towel, which overstimulates skin, causing more itching.
·    Instruct patient to avoid scratching and to trim nails short to prevent skin damage and infection.
·    Advise patient to avoid situations that cause vasodilation (warm environment, ingestion of alcohol or hot foods and liquids).
·    Lubricate skin with an emollient that traps moisture (specifically after bathing).
·    Keep room cool and humidified.
·    Advise patient to wear soft cotton clothing next to skin and avoid activities that result in perspiration.
·    When the underlying cause of pruritis is unknown and further testing is required, explain each test and the expected outcome.