-
American Journal of Nephrology 2001
-
Drugs Jun 2017Chronic pruritus remains a central societal issue because of its high occurrence and the substantial decrease in quality of life it may cause to affected individuals.... (Review)
Review
Chronic pruritus remains a central societal issue because of its high occurrence and the substantial decrease in quality of life it may cause to affected individuals. Not only dermatological conditions, but also systemic, neurological, or psychiatric diseases may lead to chronic pruritus. Additionally, various underlying conditions may coexist or the cause may be unknown. Due to its heterogeneity, the therapeutic approach is complex and remains a challenge for the clinician. Basic measures such as emollients to avoid xerosis and treatment of the underlying disease should be initiated regardless of the duration of the symptom. Depending on the indication, other topical (e.g., calcineurin inhibitors, topical corticosteroids, capsaicin) and systemic agents (immunosuppressive drugs, gabapentinoids, antidepressants, mu-opioid receptor antagonists) may provide further relief. Additionally, accompanying disorders such as sleep impairment, depression, or anxiety should also be treated. New insights into pathways involved in the development and maintenance of chronic pruritus have led in the past years to the development of a considerable number of novel antipruritic drugs. Several randomized controlled trials have been recently completed or are currently underway testing biological compounds with promising approaches. These include antagonists for nerve growth factor, neuropeptides, histamine 4 receptors, certain interleukin receptors, and opioid receptors.
Topics: Antipruritics; Chronic Disease; Double-Blind Method; Humans; Pruritus; Quality of Life; Randomized Controlled Trials as Topic
PubMed: 28466423
DOI: 10.1007/s40265-017-0746-9 -
American Family Physician Sep 2003Pruritus is a common manifestation of dermatologic diseases, including xerotic eczema, atopic dermatitis, and allergic contact dermatitis. Effective treatment of...
Pruritus is a common manifestation of dermatologic diseases, including xerotic eczema, atopic dermatitis, and allergic contact dermatitis. Effective treatment of pruritus can prevent scratch-induced complications such as lichen simplex chronicus and impetigo. Patients, particularly elderly adults, with severe pruritus that does not respond to conservative therapy should be evaluated for an underlying systemic disease. Causes of systemic pruritus include uremia, cholestasis, polycythemia vera, Hodgkin's lymphoma, hyperthyroidism, and human immunodeficiency virus (HIV) infection. Skin scraping, biopsy, or culture may be indicated if skin lesions are present. Diagnostic testing is directed by the clinical evaluation and may include a complete blood count and measurement of thyroid-stimulating hormone, serum bilirubin, alkaline phosphatase, serum creatinine, and blood urea nitrogen levels. Chest radiography and testing for HIV infection may be indicated in some patients. Management of nonspecific pruritus is directed mostly at preventing xerosis. Management of disease-specific pruritus has been established for certain systemic conditions, including uremia and cholestasis.
Topics: Cholestasis; Dermatitis; Female; Humans; Pregnancy; Pregnancy Complications; Pruritus
PubMed: 14524401
DOI: No ID Found -
Journal of Drugs in Dermatology : JDD Dec 2023
Topics: Humans; Pruritus; Lupus Erythematosus, Systemic
PubMed: 38051848
DOI: 10.36849/JDD.4770 -
Der Hautarzt; Zeitschrift Fur... Jul 2012
Topics: Humans; Ophthalmology; Pruritus
PubMed: 22751855
DOI: 10.1007/s00105-011-2317-4 -
Der Hautarzt; Zeitschrift Fur... Jul 2020Pruritus is a frequent symptom in the general population and in clinics. (Review)
Review
BACKGROUND
Pruritus is a frequent symptom in the general population and in clinics.
OBJECTIVE
This article gives an overview on psychological and psychosomatic aspects of chronic pruritus and tools for their diagnosis.
MATERIALS AND METHODS
This is a review.
RESULTS
Chronic pruritus can lead to psychological impairment and psychic diseases, e.g., adjustment disorder, depression. Psychological factors can also be important factors in the etiology and course of chronic pruritus, either in combination with somatic aspects or, in the absence of these, as somatoform pruritus or pruritus in coenasthetic schizophrenia. Self-induced scratch lesions with or without pruritus can be symptoms of impulse control disorders, obsessive-compulsive disease or artificial disorders. Furthermore, independent comorbidity with other psychic disorders can influence the management of chronic pruritus. We provide hints/tools for their diagnosis.
CONCLUSIONS
The diagnosis of psychological aspects in chronic pruritus is complex. The main diagnostic tool is the thorough taking of the patient history, including psychological aspects. It can be supplemented by standardized questionnaires, but these can not be substitutes.
Topics: Depression; Humans; Mental Disorders; Pruritus
PubMed: 32347353
DOI: 10.1007/s00105-020-04596-1 -
QJM : Monthly Journal of the... Sep 1995Pruritus is a challenging clinical problem which often complicates chronic cholestatic liver disease. For practical purposes, cholestasis may be defined as impaired... (Review)
Review
Pruritus is a challenging clinical problem which often complicates chronic cholestatic liver disease. For practical purposes, cholestasis may be defined as impaired hepatocellular secretion of bile and is a feature of a wide variety of liver diseases. Cholestasis is usually suspected clinically when a patient presenting with jaundice or pruritus is found to have an elevation in serum alkaline phosphatase activity disproportionate to increases in serum aminotransferase levels. Early imaging by ultrasonography, computerized tomography, or cholangiography is important to address the possibility of remediable biliary tract obstruction. The majority of patients who develop problematic pruritus due to chronic cholestasis will have one of several diseases: primary biliary cirrhosis, primary sclerosing cholangitis, drug-induced cholestasis, autoimmune chronic active hepatitis, or alcoholic liver disease. Specific aetiological diagnosis is usually possible when history and physical examination are complemented, as appropriate, by serological testing, hepatobiliary imaging, and liver biopsy. This review does not address issues in diagnosis, but concentrates upon the management of pruritus, a potentially disabling complication of prolonged cholestasis.
Topics: Cholestasis; Chronic Disease; Humans; Pruritus
PubMed: 7583073
DOI: No ID Found -
Journal of General Internal Medicine 1992Pruritus is usually caused by a primary disorder of the skin, but can also be caused by a systemic disease (Table 1). Some dermatologic conditions that cause pruritus... (Review)
Review
Pruritus is usually caused by a primary disorder of the skin, but can also be caused by a systemic disease (Table 1). Some dermatologic conditions that cause pruritus can be inconspicuous or nonspecific (Table 2), while others are usually apparent on physical examination (Table 3). Classification of pruritus as localized (Fig. 1) vs. generalized (Fig. 3) can be helpful in arriving at a correct diagnosis. The history and physical examination are the most important diagnostic tools, though laboratory testing for systemic disease may be necessary. In refractory cases, one should consider occult systemic disease (such as malignancy), psychiatric disease (especially depression), and HIV infection. Subsequent referral to a dermatologist may be indicted. When treatment of the underlying cause of pruritus is not possible, antihistamines and topical agents (menthol, phenol, and/or pramoxine) can be helpful.
Topics: Anal Canal; Clinical Protocols; Follow-Up Studies; Groin; Histamine H1 Antagonists; Humans; Leg; Menthol; Morpholines; Phenol; Phenols; Physical Examination; Pruritus
PubMed: 1351941
DOI: 10.1007/BF02598094 -
Journal of Burn Care & Research :... Sep 2022Postburn pruritus is a significant issue that can have a devastating impact on patient quality of life. Despite its known negative impact, few studies have focused on...
Postburn pruritus is a significant issue that can have a devastating impact on patient quality of life. Despite its known negative impact, few studies have focused on the pediatric population. Thus, the aim of this study was to determine the incidence of pruritus among pediatric burn patients as well as identify its predictive factors and commonly used treatments, including the novel use of laser therapy. A retrospective analysis of all burn patients treated at our pediatric burn center from 2009 to 2017 was conducted. The primary outcome measure was the presence or absence of pruritus at any point following the burn. One thousand seven hundred and eighty-three patients met the inclusion criteria for this study. The mean age at injury was 3.67 years (SD = 4.02) and the mean burn TBSA was 3.48% (SD = 4.81) with most burns resulting from scalds (66%). In total, 665 patients (37.3%) experienced pruritus. Following multivariable logistic regression, TBSA, age >5 years, burns secondary to fire/flame, and burn depth, were identified as significant predictors of pruritus (P < .05). Pruritus was treated with diphenhydramine (85.0%), hydroxyzine (37.3%), and gabapentin (4.2%) as well as massage (45.7%), pressure garments (20.0%), and laser therapy (8.6%). This study addresses the knowledge gap in the literature related to postburn pruritus among pediatric patients and includes one of the largest patient cohorts published to date. Moreover, the results further contribute to our understanding of postburn pruritus in children and may help us to predict which patients are most likely to be affected, so that treatment can be initiated as soon as possible.
Topics: Burns; Child; Child, Preschool; Humans; Incidence; Pruritus; Quality of Life; Retrospective Studies
PubMed: 35079812
DOI: 10.1093/jbcr/irac006 -
Rehabilitation Nursing : the Official... 2018Postburn pruritus is a syndrome of stressful symptoms that is pervasive and occurs in over 90% of burn patients and continues for years after the burn has healed.... (Review)
Review
BACKGROUND
Postburn pruritus is a syndrome of stressful symptoms that is pervasive and occurs in over 90% of burn patients and continues for years after the burn has healed. Postburn pruritus is experienced by burn survivors that may require medical management and effective interventions.
PURPOSE
This article shows how to effectively relieve postburn pruritus by developing a postburn pruritus relief protocol.
DESIGN
A descriptive literature review was conducted, and relevant empirical articles written during the years 2000-2014 were appraised to create a postburn pruritus relief protocol. Twenty-six of 79 articles were selected using preestablished inclusion criteria: any age group experiencing burn-related pruritus after second- or third-degree burns. Databases were Cochrane Central Register of Controlled Trials, CINAHL, EBSCO, PubMed, the National Guideline Clearinghouse, Google Scholar, and the American Burn Association website.
CONCLUSIONS
This protocol included both nonpharmacological and pharmacological interventions that have been delineated for use and was developed to apply based on the healing stage: prehealing, healing, and posthealing.
Topics: Burns; Guidelines as Topic; Humans; Pruritus; Wound Healing
PubMed: 30395557
DOI: 10.1097/rnj.0000000000000095