How are dermatologic causes of pruritus differentiated from systematic causes in the physical exam?

Updated: Mar 03, 2020
  • Author: David F Butler, MD; Chief Editor: William D James, MD  more...
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Physical examination assists in differentiating between systemic causes of pruritus and primary dermatologic conditions. When systemic disease underlies pruritus, patients may have normal-appearing skin or secondary lesions, such as excoriations, prurigo nodules or papules, lichen simplex chronicus, or signs of a secondary bacterial infection. Patients may have the butterfly sign, which is an area of relative hypopigmentation or normal skin on the middle of the back in combination with areas of postinflammatory hyperpigmentation in locations accessible to the patient's hands.

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