Examination of patients

Abstract

Precise history, clinical examination and laboratory as well as radiological diagnostics are of high importance in diagnosing pruritus. The intensity of pruritus, onset, time course, quality (burning, painful, stinging, prickling), localization and trigger factors (e.g., physical activity, contact with water, own observation) should be assessed. The patient's own theory should be enquired into because this enables determination of important differential diagnoses. Special attention should also be paid to the time relationship of events or preceding events (e.g., prodromal pruritus especially on the neck minutes before an asthma attack; pruritus following bathing). It is important to ask the patient for his/her own initiative to combat or relieve pruritus such as showering, or use of brushes and other objects. This may explain clinically striking findings such as the absence of secondary skin lesions in the mid-back area known as the butterfly sign. This shows that the patient cannot reach and scratch this region by hand. © 2010 Springer-Verlag London.