Pruritus is a symptom, not a diagnosis or disease. Generalized pruritus is a “cardinal symptom of medical significance”[1] and should be taken seriously.

Assessment of pruritus must incorporate an accurate and thorough history and physical examination. The history includes the following data:[2,3]

• Location, onset, duration, and intensity of itching.
• Previous history of pruritus.
• Previous history of malignant disease.
• Current malignant disease and treatment.
• Nonmalignant systemic diseases.
• Use of analgesics.
• Use of antibiotics.
• Use of other prescription and nonprescription drugs.
• Presence of infection.
• Nutritional and fluid level status.
• Current skin care practices.
• Existence of other pruritic risk factors.
• Review of relevant laboratory values (complete blood cell chemistry).
• Factors that relieve and aggravate itching.
• Patient's emotional state.

Physical examination will provide data from assessment of the following:

• All skin surfaces for signs of infection.
• All skin surfaces for signs of drug reaction.
• Environmental factors (temperature, humidity).
• Physical factors (tight, constrictive clothing).
• Evidence of scratching (erythema, dryness, excoriation).
• Skin turgor, texture, color, temperature, and lesions.

References

1. Bernhard JD: Clinical aspects of pruritus. In: Fitzpatrick TB, Eisen AZ, Wolff K, et al., eds.: Dermatology in General Medicine. 3rd ed. New York, NY: McGraw-Hill, 1987, Chapter 7, pp 78-90. 
   
   
2. Lydon J, Purl S, Goodman M: Integumentary and mucous membrane alterations. In: Groenwald SL, Frogge MH, Goodman M, et al., eds.: Cancer Nursing: Principles and Practice. 2nd ed. Boston, Mass: Jones and Bartlett, 1990, pp 594-635. 
   
   
3. Pace KB, Bord MA, McCray N, et al.: Pruritus. In: McNally JC, Stair JC, Somerville ET, eds.: Guidelines for Cancer Nursing Practice. Orlando, Fla: Grune and Stratton, Inc., 1985, pp 85-88. 
   
   

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