Psychogenic pruritis (PP) is a condition that has a psychological or psychiatric cause and manifests as an itch. It may also be referred to as functional itch, psychogenic itch, or functional itch disorder [1] [2]. It is one of the possible sources of chronic itch, which is defined as an itch that lasts for at least 6 weeks.

Pruritis occurs commonly among the general population, but only a minority of cases, about 10%, need treatment. Although itching may be caused by various etiologies, it may lead to significant psychological and psychiatric distress, including thoughts of suicide. It involves the skin and mucosa, and can be described as an uncomfortable sensation that may be relieved by scratching. There may be associated cutaneous sensations occurring simultaneously with the itch, such as burning, tingling or pain. Pruritis can also be caused by neurological problems stemming from nerve cell damage [3] [4]. This may have an atypical presentation, that is, accompanied by sensations such as paresthesia [3].

PP may prove a challenge to diagnose because it is often presumed to be dermatological in origin. Thus patients suffering from PP are more likely to present to dermatologists initially. Furthermore, misdiagnosis may be partly due to a poorly defined definition and criteria for the condition. Moreover, before PP may be proposed, there are systemic diseases that cause pruritis and that should be first considered and ruled out. It is further suggested that not only can psychological factors induce the occurrence of an itch, they can also exacerbate or prolong an already existing one. Although PP may be diagnosed by clinicians, patients are rarely referred for psychiatric evaluation and intervention.

In literature, the incidence of idiopathic itch in individuals with a psychiatric history is reportedly as high as 42% [5] [6]. Pruritis in the presence of psychiatric disease is more likely to involve the face and scalp than pruritis from other causes [7].

The diagnostic process for psychogenic pruritis entails the acquisition of a medical history, followed by a physical examination. Causes of pruritis related to medication use (delineated in the patient drug history) or systemic disease should be investigated, thus a systemic review is necessary [3] [8]. Dermatological conditions should also be excluded by thorough examination of the skin. PP may also be associated to other conditions, neuropathic in nature, that are not yet well-known or understood [9].

Investigative blood tests that may be requested include:

• Complete blood count (CBC)
• Liver, renal, thyroid function tests
• Inflammatory markers, such as erythrocyte sedimentation rate (ESR)
• Human immunodeficiency virus (HIV) test
• Chest X-ray

If a diagnosis is not found upon the first visit, patients should be reevaluated on subsequent visits.

Treatment for psychogenic pruritus focuses on addressing the underlying psychological factors. This may involve psychotherapy, such as cognitive-behavioral therapy (CBT), which helps patients manage stress and anxiety. Medications like antidepressants or anxiolytics may be prescribed to alleviate symptoms. In some cases, topical treatments or antihistamines can provide temporary relief from itching, but they do not address the root cause.

The prognosis for psychogenic pruritus varies depending on the individual's response to treatment and their ability to manage psychological stressors. With appropriate therapy and support, many patients experience significant improvement in symptoms. However, if underlying psychological issues are not addressed, the condition may persist or recur.

The exact cause of psychogenic pruritus is not fully understood, but it is believed to be linked to psychological factors such as stress, anxiety, depression, or other emotional disturbances. These factors can trigger or exacerbate the sensation of itching, even in the absence of a physical cause. The mind-body connection plays a significant role in the development of this condition.

Psychogenic pruritus is relatively common, though its exact prevalence is difficult to determine due to underreporting and misdiagnosis. It can affect individuals of any age, but it is more frequently observed in adults. Women may be more susceptible than men, possibly due to differences in how psychological stress is experienced and expressed.

The pathophysiology of psychogenic pruritus involves complex interactions between the nervous system and psychological factors. Stress and emotional disturbances can alter the perception of itch through the central nervous system. Neurotransmitters and stress hormones may play a role in amplifying the sensation of itching, even in the absence of a physical trigger.

Preventing psychogenic pruritus involves managing stress and maintaining good mental health. Techniques such as mindfulness, relaxation exercises, and regular physical activity can help reduce stress levels. Seeking support from mental health professionals when experiencing emotional difficulties can also be beneficial in preventing the onset or worsening of symptoms.

Psychogenic pruritus is an itching condition primarily driven by psychological factors. It presents as persistent itching without a clear physical cause and is often linked to stress or emotional disturbances. Diagnosis involves ruling out other causes, and treatment focuses on addressing psychological issues. With appropriate management, many patients experience relief from symptoms.

If you experience persistent itching without a clear cause, it may be related to stress or emotional factors. This condition, known as psychogenic pruritus, can be managed with the help of mental health professionals. Techniques like therapy and stress management can significantly improve symptoms. It's important to discuss your symptoms with a healthcare provider to explore potential causes and treatment options.

1. Harth W, Hermes B, Niemeier V, Gieler U. Clinical pictures and classification of somatoform disorders in dermatology. Eur J Dermatol. 2006;16(6):607-614.
2. Misery L, Alexandre S, Dutray S. Functional itch disorder or psychogenic pruritus: suggested diagnosis criteria from the French psychodermatology group. Acta Derm Venereol. 2007;87(4):341-344.
3. Misery L, Brenaut E, Le Garrec R, et al. Neuropathic pruritus. Nat Rev Neurol. 2014;10(7):408-416.
4. Stander S, Weisshaar E, Mettang T. Clinical classification of itch: a position paper of the International Forum for the Study of Itch. Acta Derm Venereol. 2007;87(4):291-294.
5. Kretzmer GE, Gelkopf M, Kretzmer G, Melamed Y. Idiopathic pruritus in psychiatric inpatients: an explorative study. Gen Hosp Psychiatry. 2008;30(4):344-348.
6. Mazeh D, Melamed Y, Cholostoy A, Aharonovitzch V, Weizman A, Yosipovitch G. Itching in the psychiatric ward. Acta Derm Venereol. 2008;88(2):128–131.
7. Ferm I, Sterner M, Wallengren J. Somatic and psychiatric comorbidity in patients with chronic pruritus. Acta Derm Venereol. 2010;90(4):395-400.
8. Yosipovitch G. Chronic pruritus: a paraneoplastic sign. Dermatol Ther. 2010;23(6):590–596.
9. Misery L, Bodéré C, Genestet S, Zagnoli F, Marcorelles P. Small-fiber neuropathies and skin: news and perspectives for dermatologists. Eur J Dermatol. 2014;24(2):147-153.