Doctor attributes decades-long genital itching to psychogenic pruritus, recommends CBT and medication
GP advises referral to clinical psychologist and consideration of low‑dose antidepressants or gabapentin; separate guidance on unexplained weight loss and rare statin side‑effect
A UK physician advising a national newspaper said a 78‑year‑old man's 55‑year history of severe genital itching may be explained by psychogenic pruritus and could respond to psychological therapy and medication.
The patient reported intense, painful itching at the tip of the penis after sex at age 23 and said repeated specialist tests had never identified a sexually transmitted infection or other physical cause. In a column responding to readers, Dr. Martin Scurr said the absence of infection and the long duration of symptoms pointed away from ongoing disease and toward a disorder in which psychological factors alter the brain’s processing of itch.
Psychogenic pruritus is a diagnosis used when persistent itching appears to be triggered or maintained by psychological factors rather than an identifiable primary skin disease or infection, specialists say. Research using magnetic resonance imaging has shown altered activity in areas of the brain involved in the perception and modulation of itch in people with this condition, suggesting that central nervous system mechanisms can amplify or perpetuate the sensation.
Dr. Scurr said the patient may initially have had a minor skin condition, such as thrush, and that a distressing clinical encounter coupled with repeated negative test results could have acted as a psychological trigger. He recommended the patient raise this possibility with his general practitioner and seek referral to a clinical psychologist for cognitive behavioural therapy (CBT). He added that some patients benefit from low‑dose antidepressants or gabapentin, drugs that can dampen abnormal nerve signalling and reduce the intensity of chronic itch.
"If the patient accepts this change of direction and is given the appropriate referral, he could be cured within months," Dr. Scurr wrote. He counselled open discussion with the GP so care can be coordinated between psychology and primary care, and stressed that such symptoms are common and treatable.
In the same column Dr. Scurr addressed a separate reader query about unexplained weight loss in a partner whose only abnormal test was a raised lactate dehydrogenase (LDH) level. LDH is an enzyme present in many tissues and rises in the blood when cells are damaged or destroyed. The doctor said isolated elevation of LDH can have many causes, including tissue ischaemia, some infections, liver conditions and, less commonly, cancer, but that it usually accompanies other abnormalities or clinical signs.
He advised the reader to ask their GP to refer the partner to a Rapid Diagnosis Team for further assessment, including repeated weighing over a period of weeks, additional imaging and more specialised blood tests that can look for occult infection or other hidden causes. He suggested home weight checks once a week at the same time of day and keeping a careful record, and recommended that the patient be re‑reviewed within three months of the last CT scan if no cause is found sooner.
Dr. Scurr also highlighted a rarely reported side effect of statin therapy: male breast enlargement. He said enlargement of male breast tissue is typically due to hormonal changes related to ageing or, in younger men, anabolic steroid use, but that clinicians have noted breast enlargement linked to statins in some cases. The enlargement often reduces after stopping the statin, he said, but patients and doctors then need to consider alternative lipid‑lowering strategies, such as ezetimibe combined with dietary measures.
Clinicians emphasise that chronic genital itching has many potential causes and that a careful history, examination and targeted tests are important to rule out infections, dermatologic conditions and systemic illness before concluding symptoms are psychogenic. When no physical cause is found, a multidisciplinary approach that includes primary care, dermatology, psychology and sometimes neurology or pain specialists can help identify effective treatments.
Patients experiencing persistent or distressing symptoms are advised to consult their GP for assessment and to discuss the range of diagnostic and therapeutic options, including referral pathways and medication risks and benefits.