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  Pruritus

Pruritus is a word that means itch and is a description of a symptom used by dermatologists and primary physicians. Pruritus is an itchy sensation. Scratching is appropriate for removing noxious stimulus from the skin. Pruritus causes a good amount of discomfort in patients. Pruritus can be a challenge to medical practitioners because the diagnosis and successful treatment can be evasive.

Pruritus
Pruritus


Symptoms:

The symptom of Pruritus is excessive itchy skin. Associated conditions will have other symptoms, but basically the symptom of purities is itchiness.

Cause:

To understand the causes, it is useful to look at the body’s mechanism for causing the sensation of itch. There are three different mechanisms involved: physical stimuli and neural pathways, chemical mediators, and the central itch mechanism.

The body is an amazing, beautiful machine that responds to external stimulus for protection, information and enjoyment. Mechanical stimuli such as a gentle touch, vibration, clothing and pressure can cause an itch. The itch sensation is accepted by a free nerve ending (one that is not occupied with other stimulus). Pain and itch are not transmitted along the same neural pathway. The brain responds to the signal and the desire to itch is begun.

Chemical mediators of itch are called histamines. Histamine’s are stored and created in mast cells of the skin. Histamine is released when the nerves detect dangerous stimuli. Histamine acts on the H1 receptors of nerves to create the desire to itch. Other bodily chemicals have been discovered to be associated with the desire to itch – neurpeptides, pruritogens, prostaglandins and opiates.

The central itch mechanism is still theoretical. Lesions and tumors on the central nervous system have been known to cause extremely annoying pruritus. It is believed that the central itch mechanism responds to pruritogens in the blood

Diagnosis:

Itching is caused by systemic and dermatologic triggers. It is important for physicians to determine if the pruritus came before the appearance of a skin eruption. Vigorous scratching can cause changes to the skin such as dryness, bleeding, eczema and infection.

Diagnosis the cause of itching requires a detailed history of the patient.

The factors a physician should look at are

• onset
• extent – local itching or general, whole body itching
• severity
• quality – burning or prickling
• Time line – for example – is it seasonal? Occurring after baths?
• exercise schedule related to itching
• cosmetics and lotions
• detailed medical history
• occupation
• digestive complications
• prescription and over the counter drug use
• medical allergies

Systemic conditions associated with pruritus are:

• Chronic Renal Disease
• Diabetes
• Cholestasis- liver diseases such as cirrhosis, obstructive gallstone disease
• Polycythemia Vera – or bath itch
• Iron deficiency anemia
• Endocrine disorders
• Human immunodeficiency virus disease
• Aquagenic Pruritus similar to polycythemia vera
• Hodgkin’s disease
• Leukemia
• Atopic Eczema
• Pregnancy

Hodgkin’s disease has the strongest association with pruritus. Itching may precede Hodgkin’s disease and the onset of cutaneous T-cell lymphoma. Pruritus has also been experienced by patients with lung, colon, breast, uterine, prostate cancers and leukemia.

Psychogenic pruritus is diagnosed only when all systemic and cutaneous causes have been investigated and eliminated. Patients with psychogenic pruritus require psychiatric/psychological counseling and antidepressants or anxiolic drugs.

Treatment:

Identifying the underlying cause is the most important in order to treat pruritus correctly and effectively

Pruritus from dry skin responds well to emollient based lotions and creams, such as petrolatum jelly. Hot baths and excessive soap use should be avoided. Corticosteroid creams should only be used when inflammation is present. HIV disease, aquagenic pruritus and uremic pruritus respond well to ultraviolet B phototherapy. Prurituses due to renal and cholestatic diseases respond to opioid receptor antagonists. Accupuncture and trans-cutaneous electrical nerve stimulation have also been tried as treatment for pruritus.

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