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ANNA Journal Apr 1994In end stage renal disease (ESRD) clients, pruritus can be so severe and intractable, despite scratching, that sleep deprivation and contemplation of suicide can result.... (Review)
Review
In end stage renal disease (ESRD) clients, pruritus can be so severe and intractable, despite scratching, that sleep deprivation and contemplation of suicide can result. The exact etiology of pruritus in ESRD is unknown, but several possible etiologies have been proposed. Assessment tools are available to nurses and clients to grade the severity, frequency, distribution, and sleep deprivation experienced with the itching. Various treatments have been used to manage pruritus in ESRD with limited success. This article reviews the anatomy and physiology of the skin, describes the pathophysiology of pruritus, discusses proposed etiologies, reviews an assessment for an ESRD client with pruritus, and discusses the collaborative management of pruritus in ESRD.
Topics: Humans; Kidney Failure, Chronic; Nursing Assessment; Pruritus
PubMed: 8080315
DOI: No ID Found -
JAMA Dermatology Sep 2023
Topics: Humans; Ketamine; Pruritus; Cervical Vertebrae
PubMed: 37531125
DOI: 10.1001/jamadermatol.2023.1772 -
Acta Dermato-venereologica Apr 2017Pruritus occurs frequently in the elderly population, but it has not been fully defined and its precise prevalence is unknown. Putative causes of pruritus are numerous... (Review)
Review
Pruritus occurs frequently in the elderly population, but it has not been fully defined and its precise prevalence is unknown. Putative causes of pruritus are numerous and patients' quality of life can be greatly reduced. In the absence of any specific cause, a diagnosis of senile pruritus is proposed, suggesting that itch is secondary to ageing. However, the relationship of pruritus with skin ageing and/or neuronal ageing and/or immune ageing is poorly understood. Many treatments have been reported, but are poorly effective. This paper reviews the literature on senile pruritus, in order to improve understanding of this condition and to enable improved diagnosis and treatment.
Topics: Age of Onset; Aged; Aging; Geriatric Assessment; Humans; Predictive Value of Tests; Prevalence; Pruritus; Quality of Life; Risk Factors; Treatment Outcome
PubMed: 27840888
DOI: 10.2340/00015555-2574 -
International Journal of Molecular... Mar 2016Chronic pruritus is a debilitating condition with numerous etiologies. Many patients suffer from nocturnal pruritus, which can decrease quality of life and affect... (Review)
Review
Chronic pruritus is a debilitating condition with numerous etiologies. Many patients suffer from nocturnal pruritus, which can decrease quality of life and affect mortality in hemodialysis patients. Nocturnal pruritus may occur in all sleep stages but is most prevalent in stages N1 and N2. Further research is needed to elucidate the pathophysiology of nocturnal itch, which will aid in the development of tailored management strategies.
Topics: Circadian Rhythm; Humans; Pruritus; Sleep Stages; Sleep Wake Disorders
PubMed: 27011178
DOI: 10.3390/ijms17030425 -
American Journal of Clinical Dermatology Aug 2016Chronic pruritus arises not only from dermatoses, but also, in up to half of cases, from extracutaneous origins. A multitude of systemic, neurological, psychiatric, and... (Review)
Review
Chronic pruritus arises not only from dermatoses, but also, in up to half of cases, from extracutaneous origins. A multitude of systemic, neurological, psychiatric, and somatoform conditions are associated with pruritus in the absence of skin disease. Moreover, pruritus is a frequently observed side effect of many drugs. It is therefore difficult for physicians to make a correct diagnosis. Chronic pruritus patients frequently present to the dermatologist with skin lesions secondary to a long-lasting scratching behavior, such as lichenification and prurigo nodularis. A structured clinical history and physical examination are essential in order to evaluate the pruritus, along with systematic, medical history-adapted laboratory and radiological tests carried out according to the differential diagnosis. For therapeutic reasons, a symptomatic therapy should be promptly initiated parallel to the diagnostic procedures. Once the underlying factor(s) leading to the pruritus are identified, a targeted therapy should be implemented. Importantly, the treatment of accompanying disorders such as sleep disturbances or mental symptoms should be taken into consideration. Even after successful treatment of the underlying cause, pruritus may persist, likely due to chronicity processes including peripheral and central sensitization or impaired inhibition at spinal level. A vast arsenal of topical and systemic agents targeting these pathophysiological mechanisms has been used to deter further chronicity. The therapeutic options currently available are, however, still insufficient for many patients. Thus, future studies aiming to unveil the complex mechanisms underlying chronic pruritus and develop new therapeutic agents are urgently needed.
Topics: Chronic Disease; Diagnosis, Differential; Humans; Pruritus; Risk Factors
PubMed: 27216284
DOI: 10.1007/s40257-016-0198-0 -
Clinical Medicine (London, England) Aug 2015Pruritus (itch) is a common complication of cholestatic liver diseases (CLD). It can be a distressing and debilitating symptom, causing significant impairment in quality... (Review)
Review
Pruritus (itch) is a common complication of cholestatic liver diseases (CLD). It can be a distressing and debilitating symptom, causing significant impairment in quality of life. Treatment of pruritus in liver diseases can be challenging and requires specific management with early initiation and a step-wise approach using specific drugs. Clinical trials are ongoing with novel agents that demonstrate potential efficacy. Patients with cholestatic pruritus are likely to present to a variety of clinicians who would benefit from medical awareness of available treatment options. In this review, we outline the pharmaceutical agents currently used to treat cholestatic pruritus and provide the evidence base for targeted symptom control of itch in liver diseases. We also highlight recent developments in the pathophysiology of cholestatic pruritus and the emerging novel therapies.
Topics: Anticholesteremic Agents; Cytochrome P-450 CYP2B6 Inducers; Humans; Liver Diseases; Pruritus; Quality of Life; Selective Serotonin Reuptake Inhibitors
PubMed: 26407384
DOI: 10.7861/clinmedicine.15-4-351 -
American Journal of Kidney Diseases :... Dec 2023
Topics: Humans; Pruritus; Renal Dialysis; Patients
PubMed: 37855785
DOI: 10.1053/j.ajkd.2023.08.004 -
Nephrology, Dialysis, Transplantation :... Apr 1999
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Expert Opinion on Emerging Drugs Sep 2015Chronic pruritus occurs in 13% of the general population without age limitation. There is a high unmet need here as effective treatment options are still missing. (Review)
Review
INTRODUCTION
Chronic pruritus occurs in 13% of the general population without age limitation. There is a high unmet need here as effective treatment options are still missing.
AREAS COVERED
Clinical and experimental research during the past decade identified new mechanisms in chronic pruritus allowing the definition of a broad range of specific treatment targets for the first time. This refers specifically to inflammatory pruritic dermatoses, uremic and cholestatic pruritus. Targets identified are, for example, receptors for substance P, IL-31 and nerve growth factor. Search was made for current studies addressing these diseases and targets in the available clinical registration databases.
EXPERT OPINION
The current pharmacological development is very promising especially for patients suffering from chronic pruritus in inflammatory dermatoses, chronic kidney diseases and hepatobiliary diseases. However, there are still several pruritic diseases in which neither mediators nor specific target populations (e.g., children) nor stages of diseases, have been identified; however, it can be assumed that within the next 10 years, major changes in the possibilities of antipruritic treatment will take place.
Topics: Animals; Antipruritics; Chronic Disease; Drug Design; Humans; Molecular Targeted Therapy; Pruritus
PubMed: 26027744
DOI: 10.1517/14728214.2015.1051964 -
Seminars in Cutaneous Medicine and... Jun 2011Patients with renal failure, usually end-stage renal disease (ESRD), commonly are afflicted by severe pruritus. The pathogenesis of ESRD pruritus is unknown, but... (Review)
Review
Patients with renal failure, usually end-stage renal disease (ESRD), commonly are afflicted by severe pruritus. The pathogenesis of ESRD pruritus is unknown, but improving the quality of dialysis can reduce the prevalence and severity of ESRD pruritus. Topical and systemic agents as well as broadband ultraviolet phototherapy can be extremely beneficial. Gabapentin has been recently discovered as an effective agent for the patient with ESRD pruritus. Kappa opiate agonists are promising new therapeutic options.
Topics: Humans; Kidney Failure, Chronic; Phototherapy; Pruritus; Renal Dialysis; Severity of Illness Index
PubMed: 21767770
DOI: 10.1016/j.sder.2011.04.005