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Deutsche Medizinische Wochenschrift... Nov 2016Pruritus (itch) is the most frequent skin symptom. It can be attributed to a skin disease in many cases. Furthermore pruritus may also be a precursing symptom or... (Review)
Review
Pruritus (itch) is the most frequent skin symptom. It can be attributed to a skin disease in many cases. Furthermore pruritus may also be a precursing symptom or principal complaint of an internal, neurological or psychiatric disease. It has been observed that elderly patients are increasingly affected. In many cases pruritus has multifactorial causes. This requires careful diagnostics, including a detailed medical history and medical examination of the patient. Previous diseases and comorbidities need to be considered as possible causes, as well as current and previous drug intake. By this important information can be obtained at an early time, which may lead to further investigation. Aim of rational diagnostics is to evaluate especially internal diseases which need to be assessed by laboratory testing and more specific diagnostics. Due to the multitude of possible causing diseases, diagnosis and therapy of chronic itch need an interdisciplinary approach.
Topics: Humans; Medical History Taking; Physical Examination; Pruritus
PubMed: 27855461
DOI: 10.1055/s-0042-114092 -
The Ulster Medical Journal Sep 2016Pruritus is a common complaint associated with many conditions. It negatively impacts sleep, quality of life, and mortality. Itch is transmitted along both histaminergic... (Review)
Review
Pruritus is a common complaint associated with many conditions. It negatively impacts sleep, quality of life, and mortality. Itch is transmitted along both histaminergic and non-histaminergic pathways with a complex interplay between keratinocytes, immune cells and cutaneous neurons. Individuals who present with pruritus should undergo a thorough assessment, especially those over 65 years old, to exclude underlying malignancy. Treatment no longer consists of antihistamines alone. Physicians now have an array of therapies in their armamentarium, to help alleviate this distressing symptom.
Topics: Diagnosis, Differential; Female; Humans; Immunity, Cellular; Middle Aged; Pruritus; Quality of Life
PubMed: 27698518
DOI: No ID Found -
Der Hautarzt; Zeitschrift Fur... Aug 2016Chronic pruritus is a highly prevalent, multifactorial symptom requiring extensive diagnostics, treatment and consideration of accompanying symptoms (reduced quality of... (Review)
Review
Chronic pruritus is a highly prevalent, multifactorial symptom requiring extensive diagnostics, treatment and consideration of accompanying symptoms (reduced quality of life, sleep disorders, psychic factors). Patient care is thus complex and requires consideration of individual treatment goals. Patients indicate their wish for a symptom-free life an explanation of the causes and a trustful physician-patient relationship. The targeted use of questionnaires is thus advisable in order to structurally survey the history, pruritus intensity, quality of life and treatment progression. Nevertheless, there are many administrative and economical hurdles in the health care system to overcome in order to provide patients with chronic pruritus the best possible care, also per the recommended guidelines. The development of specialized centers and training courses for medical practitioners is thus urgently needed.
Topics: Chronic Disease; Critical Pathways; Diagnosis, Differential; Evidence-Based Medicine; Humans; Medical History Taking; Patient Care Planning; Pruritus; Treatment Outcome
PubMed: 27316924
DOI: 10.1007/s00105-016-3829-8 -
Deutsche Medizinische Wochenschrift... Jul 2014
Review
Topics: Adolescent; Adult; Aged; Algorithms; Chronic Disease; Cooperative Behavior; Cross-Sectional Studies; Diagnosis, Differential; Female; Humans; Interdisciplinary Communication; Male; Middle Aged; Prognosis; Pruritus; Young Adult
PubMed: 24983197
DOI: 10.1055/s-0034-1370150 -
Seminars in Dermatology Dec 1988
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Deutsches Arzteblatt International Dec 2014Pruritus is a rare but troublesome symptom in palliative-care patients with a variety of underlying diseases. The pharmacotherapy of pruritus is often off-label, and an... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pruritus is a rare but troublesome symptom in palliative-care patients with a variety of underlying diseases. The pharmacotherapy of pruritus is often off-label, and an evidence-based evaluation is needed.
METHODS
A Cochrane Review published in 2013 was updated with a systematic literature search up to January 2014. Randomized and controlled trials (RCTs) with adult palliative-care patients were included.
RESULTS
In the 43 RCTs that were analyzed, three of which were more recent than the Cochrane Review, 8 clinically relevant active substances were investigated in a total of 19 RCTs. Effective drugs for pruritus in palliative-care patients included paroxetine for pruritus of diverse origins (1 RCT; strong effect) and indomethacin for HIV-induced prutitus (1 RCT; median effect = moderate reduction). Effective drugs for pruritus in uremia were gabapentin (2 RCTs; strong effect), nalfurafin (3 RCTs; moderate effect), naltrexone (3 RCTs; heterogeneous effects, ranging from weak to strong), and cromoglicic acid (2 RCTs; moderate to strong effect). Effective drugs for cholestatic pruritus were rifampicin (3 RCTs; moderate effect), flumecinol (2 RCTs; weak to moderate effect), and naltrexone (2 RCTs; moderate to strong effect). Undesired effects were most common with naltrexone (dizziness: 0% -50% , nausea: 0% -50% ) and nalfurafin (nasopharyngitis: 8% -12% , insomnia: 7% -15%).
CONCLUSION
In view of the diverse etiologies of pruritus in palliative-care patients, careful consideration should be given to the choice of drug used to treat it. The substances listed here have moderate to strong antipruritic effects and merit further study in RCTs of high methodological quality.
Topics: Adult; Anti-Inflammatory Agents; Causality; Comorbidity; Dermatologic Agents; Evidence-Based Medicine; Female; Humans; Male; Palliative Care; Prevalence; Pruritus; Treatment Outcome
PubMed: 25585583
DOI: 10.3238/arztebl.2014.0863 -
Digestive Diseases (Basel, Switzerland) 2014Chronic pruritus is a burdensome feature of numerous hepatobiliary disorders such as primary biliary cirrhosis, primary sclerosing cholangitis, cholangiocarcinoma,... (Review)
Review
Chronic pruritus is a burdensome feature of numerous hepatobiliary disorders such as primary biliary cirrhosis, primary sclerosing cholangitis, cholangiocarcinoma, inherited forms of cholestasis and intrahepatic cholestasis of pregnancy. Bile salts, μ-opioids, serotonin, histamine and steroids have been controversially discussed in the pathogenesis of cholestatic pruritus. However, for these substances neither a correlation with itch severity nor a causative link has ever been established. Recent findings indicate that the potent neuronal activator lysophosphatidic acid and autotaxin, the enzyme forming lysophosphatidic acid, may play a key element in the pathogenesis of cholestatic pruritus. Serum activity of autotaxin correlated with itch intensity and response to antipruritic treatment in patients with cholestatic pruritus, but not other forms of pruritus. Autotaxin activity thereby represents the first biomarker for pruritus and had a positive predictive value of 70% in differentiating cholestatic pruritus from other forms of pruritus. Treatment options for patients with cholestatic pruritus include the anion exchange resin colestyramine, the PXR agonist rifampicin, the μ-opioid antagonist naltrexone, and the serotonin reuptake inhibitor sertraline. These drugs are recommended by evidence-based guidelines as a stepwise therapeutic approach. Patients unresponsive to these drugs should be referred to specialized centers to receive experimental approaches such as UVB phototherapy, albumin dialysis, plasmapheresis or nasobiliary drainage. This review discusses pruritogen candidates in cholestasis, gives novel insights into the neuronal signaling pathway of pruritus and summarizes evidence-based treatment options for patients suffering from pruritus in cholestasis.
Topics: Cholestasis; Clinical Trials as Topic; Humans; Models, Biological; Pruritus; Signal Transduction
PubMed: 25034299
DOI: 10.1159/000360518 -
Seminars in Dermatology Dec 1995
Review
Topics: Aging; Dermatologic Agents; Humans; Pruritus
PubMed: 8679438
DOI: 10.1016/s1085-5629(05)80054-9 -
Journal of Pain and Symptom Management Feb 2001Many pruritic conditions do not originate in the skin, but are the result of systemic abnormality. Among the diseases that can cause pruritus are renal insufficiency,... (Review)
Review
Many pruritic conditions do not originate in the skin, but are the result of systemic abnormality. Among the diseases that can cause pruritus are renal insufficiency, cholestasis, Hodgkin's lymphoma, polycythemia vera, solid tumors, and many others. Other pruritic conditions appear to be iatrogenic; opioid-induced pruritus may be the most important in palliative medicine. Successful treatment of the underlying condition usually relieves itch. But, with time, many diseases progress and treatment of the cause will be impossible. Topical treatments may be of limited value. Strategies involving systemic treatments include use of antidepressants, oral opioid antagonists, or cholestyramine. There is no one cure for all pruritic symptoms. Better understanding of mechanisms of pruritus may help develop better treatments.
Topics: Humans; Nervous System; Pain; Palliative Care; Pruritus
PubMed: 11226766
DOI: 10.1016/s0885-3924(00)00256-6 -
La Revue Du Praticien Mar 2023
Topics: Humans; Pruritus
PubMed: 37289127
DOI: No ID Found