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Chronic pruritus, which is associated with a wide variety of underlying diseases, represents a challenge in diagnostics and treatment in dermatology and general medicine. The cause of pruritus remains unknown in up to 45% of patients. In this study, 718 patients with chronic pruritus were analysed concerning lactase deficiency, demographic data, aetiology, duration and intensity of pruritus. A total of 154 patients were tested positive for lactase deficiency and 38.3% showed a significant anti-pruritic response to a lactose-free diet (minimum 4 weeks). The best results were observed in patients with pruritus of mixed or unknown origin (n = 91; 64% response). Age, sex, localization or duration had no significant influence on the anti-pruritic effect of a lactose-free diet. Lactase deficiency might be an independent causal factor in the elicitation of chronic pruritus. Thus, screening for lactase deficiency represents a rational step in the diagnostic work-up of chronic pruritus. In case of a positive test result, a lactose-free diet offers a low-cost, efficient and specific therapy in patients with chronic pruritus. [ABSTRACT FROM AUTHOR]

Chronic pruritus is a frequent symptom, which also presents in fields other than dermatology. A number of internal diseases can be accompanied by severe chronic pruritus (CP). A new classification for CP was developed in 2007, suggesting three categories according to the clinical presentation of CP and six categories according its aetiology (1). Prurigo nodularis (PN) is a chronic inflammatory skin alteration that is usually caused by severe CP, with secondary development of excoriated and ulcerated papules and nodules being the result of frequent scratching (2). According to the clinical classification described above, PN corresponds to group III (Pruritus with chronic secondary scratch lesions) and, due to its aetiology, PN can be caused by dermatological, systemic, neurological or psychosomatic/somatoform diseases, or may have mixed causes (1). [ABSTRACT FROM AUTHOR]