How do you manage generalized pruritus in a patient with no cutaneous signs on exam?
If a patient with HIV has generalized pruritus with no obvious cutaneous diagnosis, acute drug reactions such as Stevens-Johnson syndrome, which can be life-threatening, and coexisting systemic illness such as hepatic dysfunction must be ruled out (see Table 8-4 and earlier section on medication-related issues). Order a complete blood count, liver function tests, and blood chemistries. Occasionally, scabies can present with minimal to no cutaneous signs. Pruritus due solely to HIV infection is a diagnosis of exclusion; it can respond to ART. (Symptomatic treatments for generalized pruritus are listed in Table 8-5.) In general, if a clear cause is not identified, xerosis, a common condition in patients with HIV disease, will be the most likely diagnosis. In this case, decreasing the amount of bathing, avoiding dry soaps, using emollient creams, and ceasing scratching are the basis of symptomatic treatment. In addition, general agents such as H-1 antagonists can be used. The best studied
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- How do you manage generalized pruritus in a patient with no cutaneous signs on exam?
