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Generalised pruritus | Granuloma annulare | Gianotti Crosti syndrome


This term refers to generalised itching that is not associated with any definite skin disease.

  • Obstructive liver disease.
  • Kidney failure.
  • Underlying cancers.
    • Lymphoma.
    • Leukaemia
    • Internal cancers.
  • Blood disorders.
    • Polycythaemia rubra vera.
    • Iron deficiency anaemia.
  • Hormonal disorders
    • Diabetes.
    • Over or under active thyroid.
  • Pregnancy (pruritus gravidarum).
  • Parasitic infestations
    • Pediculosis (before other signs appear).
    • Scabies (before other signs appear).
    • Intestinal worm infestations.
  • Drugs allergies.
  • Psychological causes.
  • Xerosis (dry skin).
  • Senile pruritus.
  • Idiopathic (unknown).
  • Generalised itching which may be worse at night.
  • No signs of skin disease other scratch marks.
    What you can do
  • You should consult a doctor to exclude underlying diseases.
    What the doctor may do
  • Determine the cause and treat accordingly.
  • If no cause is found, the diagnosis of senile pruritus (if the person is over 79 years) or idiopathic pruritus is made and antihistamines and moisturisers are usually prescribed.


Granuloma annulare is characterised by skin-coloured or pink bumps arranged in a circle or semi-circle It usually affects children and young adults. In rare cases, granuloma annulare can be very widespread and is called generalised granuloma annulare.


  • Unknown.
  • Generalised granuloma annulare may be due to underlying diabetes.


  • Skin coloured or pink bumps arranged in rings or semi-circles around a slightly depressed flat centre.
  • Usually occur on the knuckles, fingers, elbows, ankles, tops of the feet and on the ears.
  • Usually few in number but on rare occasions may be generalised (generalised granuloma annulare).
  • Seventy five per cent of granuloma annulare resolve within 2 years.
      Granuloma annulare.
    Click on image for larger view
    What you can do
  • You should consult a doctor.
    What the doctor may do
  • Perform a skin biopsy to confirm the diagnosis.
  • Exclude diabetes.
  • Prescribe topical steroids or inject intralesional steroids or use PUVA for very persistent cases.
  • Leave to heal on their own accord.


Gianotti Crosti syndrome is also known as papular acrodermatitis. It usually affects children under the age of 12 years.

    Gianotti Crosti syndrome is believed to be a reaction to a virus infection. The viruses implicated include:-
  • Hepatitis B.
  • Epstein Barr virus (the cause of infectious mononucleosis or glandular fever),
  • Coxsackie viruses.
  • Echo viruses.
  • Respiratory syncytial viruses.
  • Polio vaccine enterovirus.
  • Multiple pink or dull red bumps on the face, arm, legs and buttocks.
  • Itching may occur but is uncommon.
  • The lymph glands in the neck, armpits and groins may be slightly enlarged.
  • The child usually feels well although there may be a mild fever.
  • Jaundice may occasionally occur.

    What you can do
  • You should consult the doctor.

    What the doctor may do
  • Prescribe antihistamines if itchy.
  • Prescribe a mild topical steroid cream.
  • The rash usually clears after 1 - 2 months with slight peeling.