A practical review and update on the management of pruritus sine materia

Pruritus can be divided into several categories: pruritoceptive, neurogenic, neuropathic, and psychogenic. Neuropathic itch is caused by lesions of afferent neural pathways. Psychogenic itch is secondary to primary psychiatric disorders. Both of these types of pruritus present with no evidence of primary cutaneous lesions. The presentation of both conditions can be confusing and patients with no primary cutaneous lesions can be prematurely diagnosed as having a psychiatric disorder. Treatment of neuropathic and psychogenic pruritus can be divided into pharmacologic and nonpharmacologic therapies. Medications used include topical capsaicin and anesthetic agents, antiepileptic agents, tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), and atypical antipsychotic agents. Nonpharmacologic therapies such as psychotherapy and hypnosis have been beneficial. Further studies are needed, as most reports of efficacy are not evidence based.