Pruritus is a key symptom in clinical dermatology, being a manifestation of primary skin disease, but also for the diagnosis and follow-up of diseases with systemic involvement. Prolonged, intensive and/or recurrent pruritus may result in secondary dermatological changes such as abrasion, excoriation, Hyde’s nodular prurigo, lichinefication and scar lesions. Consequently, the approach to the patient with pruritus most be holistic, since in up to 50% of the cases this may be the only symptom of a systemic and potentially severe disease. Primary Biliary Cirrhosis is an autoimmune gastrointestinal disease, with a low incidence and prevalence, and pruritus is the initial manifestation in around 60-80% of the cases, and may be one of the earliest symptoms. For this reason, the dermatologist must be aware of Primary Biliary Cirrhosis’s clinical manifestations for a diagnostic and therapeutic approach. This is a case of a 58-year old female patient with chronic pruritus and secondary Hyde’s nodular prurigo, who had previously received several treatments (including cyclosporine), with no improvement. The patient underwent several studies and the Primary Biliary Cirrhosis diagnosis was confirmed. After treatment pruritus and secondary skin manifestations improved.