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Query: UMLS:C0033774 (pruritus)
 14,546 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Generalised pruritus is common in the elderly. Idiopathic 'senile pruritus' is a diagnosis of exclusion, and an underlying systemic disorder should be sought. Thyroid disease, haematological malignancy, iron deficiency, cholestasis or renal impairment may be responsible for pruritus. Rarely pruritus may occur after cerebral infarction or as a paraneoplastic phenomenon. The mechanisms of pruritus are poorly understood. In systemic disorders, correction of the underlying disorder alleviates itch. However, when this cannot be achieved, a symptomatic approach is required. Response to treatment varies enormously and an empirical approach is often required. Topical applications are available to soothe the skin and bandaging techniques may improve their efficacy. A number of more targeted treatments are available for renal and cholestatic pruritus. Novel therapies such as thalidomide, opioid antagonists, ondansetron and phototherapy with ultraviolet (UV)-B radiation are now being used. Treatment of pruritus needs to be individualised, and the elderly present a particular challenge. Adequate delivery of simple emollients may be impossible because of physical impairment The elderly are more vulnerable to the adverse effects of treatments, comorbidities may alter the pharmacokinetics of drug metabolism and polypharmacy increases the likelihood of adverse drug interactions. Cognitive impairment can lead to poor compliance with treatment. The patient's general health, the severity of symptoms and the adverse effects of treatment all need to be considered. Most treatments are of benefit only to some patients; others derive only marginal improvement. Many of the newer treatments are unlicensed for pruritus and should preferably be administered under specialist supervision. We review the literature concerning the treatment of itch associated with systemic diseases, with particular emphasis on issues relevant to the elderly. Pruritus is a difficult symptom to treat. However, it is hoped that research into the mechanisms underlying the pruritus of systemic disease will allow a better understanding so that we should be able to look forward to more specific and effective therapies in the future.
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PMID:Treatment of pruritus associated with systemic disorders in the elderly: a review of the role of new therapies. 1257

Some psoriatic patients suffer from intensive itching, however, literature data on its prevalence and especially on clinical manifestation are very limited. This study was undertaken to evaluate the frequency and clinical characteristics of itching in patients with psoriasis and to correlate the presence and intensity of pruritus with clinical severity of psoriasis. One hundred psoriatic individuals (psoriasis vulgaris in 77% and arthropatic psoriasis in 23%) were included in the study. The severity of psoriasis was assessed according to PASI score. Itching was evaluated using two methods: visual analog scale (VAS) and a specially designed questionnaire method. Itching was found in 80% of psoriatic patients. The severity of psoriasis in pruritic patients was significantly (p<0.004) higher as compared to non-pruritic subjects. Significant correlations were found between PASI scores and intensity of itching, as assessed by both scales: VAS and the questionnaire method (r=0.29, p<0.01 for both analyses). The presence and intensity of itching did not depend on age and gender of patients, type of psoriasis, duration of disease, and last outbreak of psoriasis. Generalized itching was reported by 28.7% of pruritic patients. The most common sites of itching were lower limbs (50%), trunk (48.7%), upper limbs (48.7%) and scalp (35%). Face appeared to be the least commonly affected skin area by itching (only 1.2%). We conclude that itching is a common symptom in patients with psoriasis, and its intensity correlates with clinical severity of the disease.
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PMID:Itching in patients suffering from psoriasis. 1258 72

Insulinoma is a rare tumour, the main symptoms of which are related to hypoglycaemia. Generalized pruritus has been described in association with the multiple endocrine neoplasia syndrome (MEN II or Sipple's syndrome) as a paraneoplastic phenomenon. Further, pruritus is known to be part of the paraneoplastic syndrome in other solid tumours. This case describes a patient presenting with symptoms of Whipple's triad (hypoglycaemic symptoms during fasting, low fasting blood sugar levels and symptoms relieved by intravenous dextrose). Magnetic resonance scanning and selective mesenteric angiography demonstrated a probable pancreatic neuroendocrine tumour. Pituitary fossa imaging and endocrine profile excluded the MEN I syndrome. Symptoms resolved after surgical removal of the tumour. Histology confirmed a pancreatic neuroendocrine tumour. The association between pruritus and insulinoma appears to be a novel paraneoplastic phenomenon.
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PMID:Intractable pruritus associated with insulinoma in the absence of multiple endocrine neoplasia: a novel paraneoplastic phenomenon. 1282 79

Generalized pruritus secondary to cholestasis is a difficult dermatologic condition to treat. We present a case of a 17-month-old child with congenital biliary atresia with generalized pruritus refractory to treatment with oral antihistamines, topical steroids, cholestyramine, and rifampin but improved remarkably with the addition of naltrexone. Naltrexone is a well-tolerated medication with little adverse effects. We believe that naltrexone may be an effective adjuvant treatment in the management of cholestatic pruritus in the pediatric population.
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PMID:The use of naltrexone in the management of severe generalized pruritus in biliary atresia: report of a case. 1857 62

Generalised pruritus and acquired perforating dermatosis occurring in chronic kidney disease are not uncommon and are often debilitating. However, treatment options are limited. We present two patients with uremic pruritus and acquired perforating dermatosis who were successfully treated with amitriptyline.
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PMID:Effective treatment of uremic pruritus and acquired perforating dermatosis with amitriptyline. 2342 15

Itching is one of the most common skin symptoms. Generalized pruritus occurs in 1-8% of pregnant women. It can create unpleasant feeling for these women especially at nights. Most pregnant women avoid using synthetic drugs because of their side effects. Peppermint is a plant which has been used as a traditional drug in Iran. It decreases skin's temperature. This study was done to determine the effects of peppermint oil on symptomatic treatment of pruritus in pregnant women attending to Rasoul Akram Hospital in Rasht, 2011. In this triple-blind clinical trial, 96 randomly selected subjects diagnosed with pruritus gravidarum were studied (47 cases and 49 controls). A bottle containing 60 mL of peppermint oil 0.5% in sesame oil and identical placebos were provided to be taken twice a day during 2 weeks by the case and control groups, respectively. The severity of the itch was assessed and compared before and after the study by VAS system. The results were analyzed by SPSS. Statistical methods such as descriptive analysis, independent samples' t-test, paired samples' t-test and Chi-square were employed. The severity of the itch in the treated group with peppermint oil in comparison with the placebo group, showed a significant statistical difference (p = 0.003). In accordance with the results of this study, it seems that peppermint oil can be effective in reducing the severity of Pruritus Gravidarum. More studies with larger sample sizes are required to confidently declare the mentioned results.
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PMID:The effect of peppermint oil on symptomatic treatment of pruritus in pregnant women. 2425 May 39

Generalized pruritus is a common symptom in elderly, patients, with severe impact on the quality of life. The diagnosis of senile idiopathic pruritus is made after the exclusion of a systemic disease such as chronic renal disease, hepatobilliary disease with cholestasis, thyroid dysfunctions, drug-induced hypersensitivity reactions, visceral or hematological neoplasia, and primitive dermatological distinct conditions. The pathophysiological mechanisms are still unclear. A critical role is considered to be played by changes related to skin aging, cutaneous nerve supply and other nervous system components. The clinical approach requires a thorough assessment of general health status. In primary skin conditions, a biopsy and direct immunofluorescence (DIF) are required, while in pruritus associated with a systemic disorder, the assessment of hematological, biochemical and immunological parameters and imaging are necessary. The treatment of a patient with chronic pruritus is often palliative and individualized, with emollients, sedating and non-sedating antihistamines, tricyclic antidepressants, gabapentinum, and narrow-band UVB phototherapy. Pruritus associated with systemic disease may be alleviated by etiologic treatment.
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PMID:Pruritus in the elderly. Pathophysiological, clinical, laboratory and therapeutic approach. 2474 72


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