Evaluation and treatment of generalized pruritus

Kantor, Gary R.

doi:10.3949/ccjm.57.6.521

Cited by 6 publications

(2 citation statements)

References 38 publications

(39 reference statements)

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“…Systemic disease has been implicated in up to 50% of patients with generalized pruritus; however, most studies report the incidence closer to 20% 17 . A suggested screening regimen is listed in Table 4 18,19 . Clinical suspicion should drive additional testing, which might include serum protein electrophoresis, skin biopsy (special stains for mastocytosis and immunofluorescence for pemphigoid), stool for ova and parasites, urine 5‐HIAA, computed tomography (CT) scans of chest and abdomen, and HIV testing.…”

Section: Evaluation Of the Patientmentioning

confidence: 99%

“…17 A suggested screening regimen is listed in Table 4. 18,19 Clinical suspicion should drive additional testing, which might include serum protein electrophoresis, skin biopsy (special stains for mastocytosis and immunofluorescence for pemphigoid), stool for ova and parasites, urine 5-HIAA, computed tomography (CT) scans of chest and abdomen, and HIV testing. Figure 1 presents an approach to evaluation of the elderly patient with generalized pruritus.…”

Section: Laboratory and Radiologic Examinationsmentioning

confidence: 99%

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Willan's itch and other causes of pruritus in the elderly

Ward

Bernhard

2005

Int J Dermatology

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Itch in the elderly presents a diagnostic and therapeutic challenge. A thorough history, review of systems, and physical examination are critical to determining its cause. Examination of the skin may be misleading. There are frequently only secondary lesions, eczematous changes, lichenification, and excoriation, which may be misdiagnosed as a primary dermatitis. Xerosis may be the cause, but it is sometimes merely coincidental. If primary lesions are present, a skin biopsy can enable a diagnosis to be made. Systemic causes of itch, such as cholestasis, uremia, hyperthyroidism, medications, or lymphoma, must be considered. If the cause remains elusive, idiopathic itching of the elderly or so-called "senile pruritus" may be considered. However, we propose to discard the term "senile pruritus", which can be offensive and frightening. We propose to replace it with "Willan's itch". Robert Willan (1757-1812) is honored as one of the founders of modern dermatology thanks to his book, On Cutaneous Diseases, and its morphological approach to skin disease. He was probably the first to give a good clinical description of itching in the elderly. The diagnosis of Willan's itch should be reserved for generalized pruritus in the absence of xerosis or other recognizable cause. The pathophysiology of this form of pruritus is poorly understood, but it is likely that age-related changes of the skin, cutaneous nerves, and other parts of the nervous system play a role. Anecdotal and limited data suggest that gabapentin, cutaneous field stimulation, serotonin antagonists, and ultraviolet B phototherapy may attenuate itch in some of these patients.

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Section: Evaluation Of the Patientmentioning

confidence: 99%

Section: Laboratory and Radiologic Examinationsmentioning

confidence: 99%

Willan's itch and other causes of pruritus in the elderly

Ward

Bernhard

2005

Int J Dermatology

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Pruritus

Greco

Ende²

1992

J Gen Intern Med

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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.

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Itch complicating malignant diseases

Żylicz¹,

Krajnik²

2011

Supportive Oncology

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Evaluation and treatment of generalized pruritus

Cited by 6 publications

References 38 publications

Willan's itch and other causes of pruritus in the elderly

Willan's itch and other causes of pruritus in the elderly

Pruritus

Itch complicating malignant diseases

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