Itching (Pruritus): Medical History

Medical history (history of illness) represents an important component in the diagnosis of pruritus (itching). Family history

Social history

• What is your occupation?
• Are you exposed to harmful working substances in your profession?
• Is there any evidence of psychosocial stress or strain due to your family situation?

Current medical history/systemic history (somatic and psychological complaints).

• How long has the itching existed?
• Where does it itch?
  • In one place? If so, in which part of the body does the itching occur?
  • Entire body?
• At what time of day does the itching occur?
• Is the itching stronger at night than during the day?
• Do you have prickly itching after contact with water (aquagenic pruritus)?
• Are there any skin lesions?
  • Pustules (pustules)?
  • Vesicles?
  • Redness of the skin?
  • Jaundice?
• Do you have a fever?
• Do you suffer from dry skin?
• Is the itching reduced or increased by daily skin care?
• Does the itching occur more after taking medication?

Vegetative anamnesis incl. nutritional anamnesis.

• Have you lost body weight?
• Has your appetite changed?
• Have your bowel movements and/or urination changed? In quantity, consistency, admixtures?
• Do you use any drugs? If yes, what drugs and how often per day or per week?

Self history incl. medication history.

• Pre-existing conditions (infections, metabolic diseases, liver disease, kidney disease).
• Operations
• Allergies
• Pregnancies

Medication history

• Α4β7-integrin antagonist (vedolizumab).
• ACE inhibitors (benazepril, captopril, cilazapril, enalapril, fosinopril, lisinopril, moexipril, peridopril, quinapril, ramipril, spirapril).
• Allopurinol
• Analgesics
  • NSAID (nonsteroidal anti-inflammatory drug (NSAID); also nonsteroidal anti-inflammatory drug (NSAP) or NSAID, non steroidal anti- inflammatory drugs) – acetylsalicylic acid (ASA; 1-5% of those exposed).
  • Paracetamol
• Angiogenesis inhibitors (sorafenib, sunitinib).
• Antiarrhythmics (amiodarone, quinidine).
• Antibiotics
  • Aminopenicillins (amoxicillin); esp. as amoxicillin/clavulanic acid combination (frequency: very low).
  • Β-Lactam antibiotics (aminopenicillins) – ampicillin.
  • Beomycin (> 5% of those exposed).
  • Macrolide antibiotics (erythromycin).
  • Nitroimidazoles (metronidazole)
  • Sulfonamides
  • Tetracyclines (minocycline)
  • Trimethoprim and sulfamethoxazole
• Antidepressants
• Antiepileptic drugs
  • Aromatic anticonvulsants (carbamazepine, lamotrigine, phenobarbital).
  • Functionalized amino acid (lacosamide).
  • Phenytoin
  • Selective dopamine and norepinephrine (marginally also serotonin) reuptake inhibitor (NDRI) – bupropion [aquagenic pruritus].
  • Valproic acid/valproate
• Antihypotensives: α-adrenoceptor agonist (midodrine).
• Antimalarials (artesunate, chloroquine, primaquine) [aquagenic pruritus].
• Antifungal agents, local
  • Imidazole derivatives (clotrimazole, econazole, ketoconazole, miconazole).
  • Morpholine (amorolfine)
• Antipsychotics (neuroleptics) – chlorpromazine, phenothiazines.
• Antirheumatic drugs
  • NSAID (nonsteroidal anti-inflammatory drug (NSAID); also nonsteroidal anti-inflammatory drug (NSAP) or NSAID, non steroidal anti- inflammatory drugs) – acetylsalicylic acid (ASA; 1-5% of those exposed).
• Antisympathotonic drug (clonidine).
• Arsenic trioxide
• Α2-agonists (apraclonidine, brimonidine, clonidine).
• Beta-blockers
  • Non-selective beta-blockers (e.g., carvedilol, propranolol, soltalol).
  • Selective beta-blockers (e.g., atenolol, bisoprolol, metoprolol).
• Biologicals (etanercept, infliximab, secukinumab, ustekinumab).
• Intestinal therapeutics, anti-inflammatory (mesalazine).
• Dicarboxylic acid
• Direct Factor Xa inhibitor (rivaroxaban).
• Fibrate (Clofibrate)
• Gold preparations (gold salts)
• Glutamate modulator (acamprosate)
• Hormones
  • Anabolic steroids
  • Glucocorticoids (betamethasone dipropionate, mometasone furoate, clobetasol).
  • Estrogens (ethinyl estradiol, estradiol)
  • Prostaglandin (alprostadil)
  • Selective estrogen receptor modulator (SERM) – tamoxifen
  • Testosterone
• Hydroxyethyl starch (pruritus often persists for months after infusion) [median latency between hydroxyethyl starch administration and onset of pruritus is 3 weeks].
• Hypnotics/sedatives (clomethiazole).
• Intestinal anti-inflammatory (sulfasalcin).
• Insecticides and acaricides
  • Pyrethroids (allethrin, permethrin)
  • Pyrethrins (pyrethrum)
• Colloids (colloidal solution)
• Lithium
• Monoclonal antibodies
  • Anti-CD25 antibody daclizumab (DAC).
  • IgG1 antibody pertuzumab
  • PD-1 immune checkpoint inhibitors: Nivolumab
  • Trastuzumab
• Mucolytics (acetylcysteine (ACC); N-acetylcysteine (NAC); N-acetyl-L-cysteine).
• Narcotics (halothane)
• Nicotinic acid derivatives (nicotinic acid)
• Norepinephrine reuptake inhibitor (atomoxetine).
• Opiates or opioids (alfentanil, apomorphine, buprenorphine, codeine, dihydrocodeine, fentanyl, hydromorphone, loperamide, morphine, methadone, nalbuphine, naloxone, naltrexone, oxycodone, pentazocine, pethidine, piritramide, remifentanil, sufentanil, tapentadol, tilidine, tramadol).
• Peroxides (benzoyl peroxide).
• Phytotherapeutics (horse chestnut (triterpene glycoside).
• Proton pump inhibitors (proton pump inhibitors, PPI; acid blockers) – esomeprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole.
• Quaternary amonium compounds (dequalinium.
• Retinoids (alitretinoin, tazarotene)
• X-ray contrast media (as an immediate reaction).
• Statins – lovastatin, simvastatin
• Sulfasalazine (INN), also salazosulfapyridine.
• Topical calcineurin inhibitors (pimecrolimus, tacrolimus).
• Tuberculostat (isoniazid).
• Vasodilators (diazoxide)
• Antivirals (aciclovir, brivudine, famciclovir, simeprevir, valaciclovir).
  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs) – efavirenz, nevirapine, rilpivirine.
  • NS5A inhibitors (daclatasvir, ledipasvir, ombitasvir).
  • Protease inhibitors (PI; protease inhibitors) – boceprevir, paritaprevir, telaprevir (anal pruritus).
• Cytostatic drugs (busulfan, ingenol mebutate, methotrexate (MTX), sunitinib, temodal).
• See also under “Photosensitizing drugs“.

Environmental history

• Irritants (chemicals, solvents)
• Air conditioning (dry air)
• Overheated rooms
• Dry room climate
• Sun (frequent sunbathing)
• Winter (cold) → reduction of sebaceous gland secretion.