Date:
Patient:
Reason for Visit:
Follow-up for pruritus (itching)
Evaluation of severity and impact on quality of life
Management plan discussion
History:
Present Illness:
Onset, duration, and location of pruritus
Severity (describe using a scale or patient’s own words)
Character of itch (burning, stinging, etc.)
Frequency and triggers (e.g., seasonal changes, nighttime, after showering)
Impact on sleep, daily activities, and emotional well-being
Past Medical History (PMH):
Skin conditions (eczema, psoriasis, atopic dermatitis)
Liver disease (hepatitis, cirrhosis)
Kidney disease (chronic kidney disease)
Thyroid disease
Neurological conditions (diabetes with neuropathy)
Psychiatric conditions (anxiety, depression)
Medications (opioids, some antidepressants)
Social History:
Alcohol or illicit drug use (can worsen itch)
Occupational exposures (irritants, chemicals)
Travel history (potential exposure to parasites)
Pet ownership (fleas, mites)
Physical Exam:
General: Assess for signs of systemic illness (fever, jaundice) or malnutrition (scratch marks may suggest chronic severe itch).
Skin:
Inspect for signs of underlying skin conditions (eczema, psoriasis, scabies)
Evaluate for excoriations (scratched areas) and lichenification (thickened, leathery skin) due to chronic scratching.
Diagnostic Tests (may be ordered depending on clinical presentation):
Complete Blood Count (CBC) and Liver Function Tests (LFTs) – to rule out underlying medical conditions.
Thyroid Stimulating Hormone (TSH) – to assess thyroid function.
Skin scraping or biopsy – to diagnose scabies or other skin conditions.
Serum bile acids – to evaluate for liver disease.
Assessment:
Possible cause(s) of pruritus: Consider underlying medical conditions, medications, environmental factors, or idiopathic (unknown cause).
Severity of pruritus: Impacts treatment decisions and quality of life.
Impact on sleep and daily activities: Helps assess the burden of pruritus.
Plan:
Treatment based on identified cause:
Addressing underlying medical conditions (e.g., eczema treatment, liver disease management)
Discontinuing or switching medications if possible (consult prescribing physician)
Avoiding triggers (harsh soaps, wool clothing)
Skin care measures:
Moisturizers to improve skin barrier function
Cooling baths or lotions (calamine lotion)
Short, cool showers with gentle cleansers
Medications (may be used in combination):
Antihistamines (for allergic pruritus)
Corticosteroid creams or ointments (for inflammatory skin conditions)
Calcineurin inhibitors (tacrolimus, pimecrolimus) – for severe atopic dermatitis
Selective serotonin reuptake inhibitors (SSRIs) – may help with itch and associated anxiety/depression
Gabapentin or pregabalin – for neuropathic itch
Referral to a dermatologist: For complex cases or if underlying skin condition is unclear.
Patient education: Provide information about the cause of pruritus (if identified), management strategies, importance of good skin care, and potential side effects of medications.
Follow-up:
Schedule for follow-up appointments to monitor response to treatment and adjust the plan as needed.
Discuss coping mechanisms for managing itch and improving quality of life.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of pruritus.