A rare case report: chronic generalized idiopathic pruritus

Generalized chronic pruritus (CP) can be associated with seborrheic dermatitis and psoriasis but often can present without any noticeable diagnosis or obvious skin lesion. When not related to a clear diagnosis, CP can be characterized as idiopathic pruritus. CP is both a diagnostically and therapeutically challenging presentation due to the variety of systemic, dermatological, neurological, and psychogenic diseases that must be ruled out before diagnosing idiopathic pruritus. This presentation is often overlooked but can lead to a greatly diminished quality of life for patients who present with idiopathic generalized pruritus. The course of treatment will vary between providers and specialties, however, most dermatologists will attempt control with antihistamines, topical steroids, or oral steroids. The use of gabapentinoids for the treatment of CP is understudied. Gabapentin was initially developed as an antiepileptic that has since been approved to treat neuropathic pain and has a common off-label use in dermatology and can be used to effectively treat CP.

Here we present a case of a 56-year-old Caucasian male who presented to the outpatient dermatology clinic with new-onset, diffuse, and intense pruritic symptoms that gradually progressed over a period of seven weeks. This case study details a patient with Idiopathic generalized pruritus previously uncontrolled that was well-controlled with the use of gabapentin after trials of other common treatments failed.

The understudied off-label use of gabapentin in the case of generalized chronic idiopathic pruritus should be explored and later implemented as a mainstay for patients suffering from uncontrolled CP as it was shown to completely eliminate pruritic symptoms and improve the quality of life for this patient.