Most skin eruptions and rashes are more or less pruritic, but there are states where there is severe pruritus in the absence of skin lesions, except for scratch marks (Fig. 35-1). This is called pruritus sine materia (from Latin, “itch without physical substrate”).

The diagnostic approach to the patient with generalized pruritus without identifiable skin lesions is a diagnosis of exclusion.

Pruritus is a symptom of skin disease that at the time of examination does not manifest with specific lesions.

It may be due to an internal organ disease, metabolic and endocrine conditions, or hematologic disease.

It may be a manifestation of malignant tumors, psychogenic states, or HIV infection; or it may be related to injected or ingested drugs.

The various causes of pruritus sine materia are listed in Table 35-1, and an algorithm of how to approach a patient with pruritus sine materia is shown in Table 35-2.

Skin signs may be clinically inapparent, perhaps confined to only circumscribed areas, and this is particularly important with regard to the exclusion of scabies, pediculosis, or conditions such as urticaria factitia.

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