PRURITUS - ALSO A CHALLENGE IN INTERNAL-M EDICINE

Generalized or localized itch without primary skin manifestations may be the presenting symptom of serious internal diseases. Five character istic cases of pruritus are discussed: Hodgkin's disease, primary scle rosing cholangitis, polycythemia vera, iron deficiency (with pica), an d uremia. Other important causes must be considered; all forms of chol estasis, including primary biliary cirrhosis, drug-induced, pregnancy- related, and extrahepatic cholestasis; other hematologic and malignant disorders such as non-Hodgkin's lymphoma, leukemias, multiple myeloma , solid tumors, and myelodysplastic syndromes; metabolic and endocrine diseases, most notably diabetes mellitus, hyperthyroidism, hypothyroi dism, and carcinoid syndrome; focal neurologic diseases such as brain tumors, cerebral infarctions and multiple sclerosis; adverse drug reac tions without rash; infectious diseases, especially parasitic and HIV infections. A diagnostic laboratory screening for pruritus of undeterm ined origin is suggested.