Itchy Skin Without Skin Lesions

CLINICAL DIAGNOSTIC MANUAL

Itchy skin without visible lesions is a condition that can be very uncomfortable and frustrating for patients, as it is not accompanied by rashes, hives, or other obvious skin manifestations.

This type of pruritus can be a symptom of various underlying systemic conditions, including liver, kidney, hematological, and endocrine diseases. A thorough evaluation is important to identify the cause and provide appropriate treatment.

Pathology	Suspected Diagnosis	Confirmatory Diagnosis
Chronic liver disease	Jaundice, fatigue, history of liver disease.	Liver function tests, abdominal ultrasound, liver biopsy.
Chronic kidney failure	Edema, fatigue, hypertension, history of kidney disease.	Kidney function tests, renal ultrasound.
Iron deficiency	Fatigue, pallor, brittle nails, pica.	Ferritin and iron levels, complete blood count.
Hyperhidrosis	Excessive sweating, especially on palms, soles, and armpits.	Physical examination, sweat tests.
Primary hypothyroidism	Fatigue, weight gain, dry skin, cold intolerance.	Thyroid profile (TSH, free T4), thyroid ultrasound.
Lymphoma (Hodgkin or Non-Hodgkin)	Unexplained weight loss, fever, night sweats, lymphadenopathy.	Lymph node biopsy, CT scan, PET-CT.
Neoplasia	Specific symptoms depending on affected organ, weight loss, fatigue.	Imaging tests, biopsy.
Primary biliary cirrhosis	Generalized pruritus, fatigue, xanthomas, family history.	Liver function tests, antimitochondrial antibodies (AMA), liver biopsy.