OBJECTIVE: Pruritus (itching) is a disturbing symptom that occurs on the superficial layers of the skin with a high prevalence among public. Pathological pruritus has many causes. Not only in primary skin diseases but also in hematologic, metabolic, neoplastic and psychiatric diseases, clinical picture may appear as pruritus. If the pruritus is of organic etiology, history of the patient, generally observed concurrent symptoms and referring the patient to the proper department upon determination of the underlying disorder via lab technology is possible while with psychiatric pruritus, it is not easy to draw the diagnostic lines. The distinction of such pruritus from other pruritus and referral of the patient to the psychiatric department with diagnosis of psychogenic pruritus may be difficult for dermatologists. In most cases where the patient is distressed and anxious, and the physician cannot find any reason to cause pruritus, the psychogenic pruritus (PP) term is replaced with the term "idiopathic pruritus”. In this case we presented the difficulties with PP and delayed treatment.
CASE: A 43-year-old high school graduate, working, married with a child, with a pruritus complaint that started after a dispute between mother and father when she was 10 years old has been referred to psychiatry unit after consultation by dermatologists and used various medication with no improvement. In the history of the patient, it was determined that pruritus complaints were increasing with stress and were affecting the functioning of the patient; it has been decreased from time to time but never stopped and that sometimes depressive complaints (unhappiness, anhedonia, social withdrawal, etc.) were added. In the routine physical examinations of the patient, no pathology was found. The patient started to use moclobemide 300 mg/g. A month later, a marked reduction in both depressive and pruritus complaints was noted.
DISCUSSION: PP, which is not yet clearly classified in both the dermatologic and psychiatric classification, is discussed under the title of Physical Symptomatic Disorders in DSM-5. However, the diagnosis and treatment are difficult for both dermatologists and psychiatrists. PP may be perceived as a skin disease and unnecessary examination and treatment costs may be caused, and secondary pruritus with skin or systemic diseases may be perceived as PP and this may lead to inadequate and wrong treatment. With our case, we aim to provide a detailed assessment for patients coming with pruritus complaints in terms of PP.