Pruritus as a sign of systemic disease

Pruritus, as one of the most common clinical manifestations in medicine, has been recognized for many centuries. Defined as an unpleasant sensation resulting in the need to scratch, it is divided into acute and chronic stages, based on the duration of the clinical manifestation. Classically, pruritus is associated with cutaneous disorders; however, it may also accompany various systemic disorders, including renal, hepatic, hematologic, or oncologic, and be the first or solitary manifestation of an underlying systemic disease. Additionally, the clinical manifestation may occur as an adverse reaction to drug administration. The pathogenesis of itch is multifactorial, involving various neuromediators and cytokines, with a prominent role of peripheral and central nervous system in its development. Based on an underlying disorder, the affected patients present different clinical patterns of pruritus. Diagnostic approach is based on detailed history taking and physical examination. Frequently, additional diagnostic measures, including laboratory or imaging tests, are performed, especially when the cause of pruritus is unknown. Pruritus remains a challenging clinical manifestation with a significant importance for physicians managing systemic disorders.