From the Guidelines
Psychogenic pruritus should be treated with a combination of psychosocial and behavioural interventions, including education on trigger factors, lifestyle interventions, relaxation techniques, and cognitive restructuring, as these approaches have been shown to improve itch-related coping and reduce symptom severity 1.
Diagnosis
The diagnosis of psychogenic pruritus, also referred to as functional itch disorder, involves identifying chronic pruritus without a somatic cause, with variations in intensity associated with stress, and a predominance of symptoms during rest or inaction 1.
- The proposed diagnostic criteria include:
- Three compulsory criteria: generalized pruritus, chronic pruritus (> 6 weeks), and no somatic cause
- Three out of seven optional criteria, such as chronological relationship of pruritus with life events, pruritus worse at night, and associated psychological disorder
Treatment
Treatment of psychogenic pruritus focuses on addressing the psychological factors contributing to the condition, as well as providing symptomatic relief.
- Psychological interventions, such as cognitive behavioral therapy (CBT), habit reversal training, and relaxation techniques, are recommended to address underlying anxiety, stress, or depression 1.
- Patient support groups and referral to social workers, liaison psychiatry, and psychologists may also be beneficial in individual cases 1.
- Symptomatic relief can be achieved through topical treatments, such as menthol or pramoxine, and oral antihistamines like hydroxyzine or doxepin.
- Lifestyle modifications, including avoiding hot showers, using mild soaps, applying moisturizers, and wearing loose cotton clothing, can help prevent symptom exacerbation.
- Stress reduction techniques, such as mindfulness meditation, deep breathing exercises, and regular physical activity, are important complementary approaches to manage psychological stress and reduce itching.
From the Research
Diagnosis of Psychogenic Pruritus
- Psychogenic pruritus, also referred to as functional itch disorder, is a distinct clinical entity characterized by pruritus as the chief complaint and psychologic factors that contribute to eliciting, worsening, and sustaining the symptoms 2
- The French Psychodermatology Group (FPDG) proposed specific diagnostic criteria, including 3 compulsory and 7 optional criteria, of which 3 have to be met in order to establish the diagnosis 2
- Psychogenic pruritus may require cooperation between dermatologists, psychiatrists, and psychologists for accurate diagnosis 2
Treatment of Psychogenic Pruritus
- General measures include avoiding irritating factors, preventing skin dryness, and frequent application of emollients 2
- Psychotherapy and psychopharmacotherapy are mainstays of managing the disease 2
- Medications used to treat psychogenic pruritus include:
- H1-antihistamines (hydroxyzine, chlorpheniramine, cyproheptadine, diphenhydramine, promethazine) 2, 3
- Tricyclic antidepressants (doxepin) 2, 4
- Selective serotonin reuptake inhibitors (citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline) 2, 4
- Antipsychotic drugs (pimozide) 2
- Anticonvulsants (topiramate) 2
- Benzodiazepines (alprazolam) 2
- Nonpharmacologic therapies such as psychotherapy and hypnosis have also been beneficial 4
Interdisciplinary Approach
- Medical care of patients with chronic pruritus, including psychogenic pruritus, should include interdisciplinary diagnosis and therapy of the triggering underlying disease, therapy of secondary symptoms, and symptomatic antipruritic therapy 5
- An organized cognitive framework is presented to guide the clinician in the evaluation and treatment of patients with psychogenic pruritus and self-excoriation 6