Generalized Pruritus: An Etiological Breakup of 700 patients presenting to dermatology opd of a local hospital.

Background: Pruritus is an itching sensation or a constant urge to itch over skin that may be localized in response to a local stimulus or generalized due to an underlying condition  with or without presence of causative agent.  It can be caused by dermatological or systemic conditions, iatrogenic or as a response to external substances such as parasites. Generalized pruritus may not be necessarily due to dermatological causes and systemic, neurologic, endocrinologic, and psychogenic conditions may have pruritus as a primary cutaneous manifestation. Skin conditions like Scabies, eczema and airborne dermatitis are commonly incriminated as reason for intense itching and so lab workup or clinical examination and history taking is often omitted, in our busy outdoors. Therefore, the purpose of this study is to rule out underlying common systemic diseases like hypothyroidism, diabetes mellitus and chronic renal and liver disease as cause of severe generalized pruritus. Objective: To identify the underlying cause of generalized pruritus in patients presenting to dermatology outdoor excluding pruritic dermatological diseases. Methodology: This is a cross-sectional observational study conducted on 700 patients from January 2018 to October 2021, in Fauji Foundation hospital Rawalpindi. Patients between the ages of 15 to 69 years visiting dermatology OPD of the department with complaints of generalized pruritus, who were recruited for the study after filling the consent form. Clinical investigations (Blood Cp, LFTS, RFTs, TFTs) and past medical history were taken to identify the underlying cause of pruritus was conducted and diagnoses were documented Only the patients who were having non dermatological causes were included in the study and the diagnoses were further categorized as idiopathic, systemic, endocrinological, neurogenic, psychogenic and drug induced. Results were compiled and analyzed using SPSS version 22. Results: The results of this study show that 700 participants with mean age of 47.39, out of which 110 were males and 590 were females had generalized pruritus. Out of them, 126 (19%) had pruritus due to chronic renal disease, 119(17%) had chronic liver disease, 63 (9%) had diabetes mellitus, 42 (6%) had paraneoplastic, 126(18%) senile pruritis, 35(5%) had cholinergic pruritus,21 (3%) iron deficiency anemia. 14(2%) had atopic dermatitis of elderly. Drug induced pruritus 56(8%). Conclusion: Pruritus without known pruritic dermatoses is a common presenting complaint in patients presenting to outdoors having one of the underlying systemic disease. Further work is needed to evaluate impact of pruritus on quality of life in these already diseased patients.