Itchy Skin with Lesions but Without Hives

CLINICAL DIAGNOSTIC MANUAL

Itchy skin with lesions but without hives is a dermatological condition that may be associated with various inflammatory, infectious, and autoimmune diseases. Unlike pruritus accompanied by hives (such as in urticaria), these lesions can present as papules, plaques, vesicles, or scales. Identifying the underlying cause is crucial for effective treatment.

Pathology	Suspected Diagnosis	Confirmatory Diagnosis
Allergic contact dermatitis	Redness and vesicles in areas exposed to allergens, intense itching.	Patch testing, physical examination.
Candidiasis	White, moist plaques in warm, moist areas, itching, and redness.	Skin culture, KOH examination.
Discoid eczema	Round, itchy plaques, dry and scaly skin.	Skin biopsy, physical examination.
Drug-induced eczema	Skin rashes, itching, history of drug exposure.	Medical history, physical examination, allergy tests.
Varicose eczema	Redness and itching in areas of venous insufficiency, varicose ulcers.	Venous Doppler ultrasound, physical examination.
Scabies	Papules and vesicles, intense itching, especially at night.	Skin scraping, identification of mites.
Seborrheic dermatitis	Greasy, yellowish plaques, itching, scaling in sebaceous areas.	Physical examination, skin biopsy.
Asteatotic eczema	Dry, cracked skin, itching, more common in elderly individuals.	Physical examination, medical history.
Dermatitis herpetiformis	Itchy vesicles, association with gluten enteropathy.	Skin biopsy, direct immunofluorescence.
Lichen planus	Purple papules, intense itching, mucosal involvement.	Skin biopsy, physical examination.
Psoriasis	Red plaques with silvery scales, itching, thickened skin.	Skin biopsy, physical examination.
Eczema herpetiformis	Itchy vesicular lesions, history of atopic dermatitis.	Skin biopsy, physical examination.
Lichen sclerosus	White, atrophic papules, intense itching.	Skin biopsy, physical examination.
Lichen simplex chronicus	Thickened skin, intense itching, purple papules.	Skin biopsy, physical examination.
Pellagra	Photosensitive dermatitis, diarrhea, dementia, associated with niacin deficiency.	Medical history, niacin level analysis.
Polymorphous light eruption	Itchy lesions after sun exposure, vesicles, and papules.	Medical history, photoprovocation test.
Pompholyx eczema	Itchy vesicles on hands and feet, exacerbated by stress.	Skin biopsy, physical examination.