Pruritus under treatment with an estrogen-gestagen-combination

History and clinical findings: A 51 year old female patient complained abou t marked pruritus of the whole integument. Since seven years she had been t aking a two phase combination of estragens and gestagen because of climacte rical symptoms. 24 years ago severe pruritus occured especially at the hand s during the last trimenon of her first pregnancy whereas 7 years later dur ing the subsequent pregnancy pruritus was absent. Physical examination reve aled multiple excoriations over the whole body. No other relevant pathologi cal findings were noted. Investigations: Laboratory findings, chest X-ray and abdominal sonography w ere normal. Treatment and course: Neither oral administration of an antihistaminic drug nor topical application of betamethason improved the situation to a releva nt extent. For 12 months the occurrence of pruritus had not been referred t o hormonal treatment by the physicians in charge. Complete cessation of pru ritus was seen within a few days after the patient had stopped hormonal med ication on her own Conclusion: Patients should be asked for pregnancy associated pruritus or j aundice before receiving drug combinations with estrogens and gestagens. In case of a positive history, the physician should inform them about possibl e side effects such as pruritus and icterus.