Diagnosis and Treatment of Pruritus

Pruritus (Itching) Diagnosis and Treatment

Pruritus (itching) is a common symptom that induces the need to scratch due to a disturbing sensation on the skin. Itching can be a sign of various dermatological, systemic, or neurological diseases, or it can develop due to environmental factors. Pruritus should be treated according to the underlying cause, as it can significantly affect the quality of life when it becomes chronic.

Causes of Pruritus

1. Dermatological Causes:

• Skin disorders such as atopic dermatitis, contact dermatitis, urticaria, eczema, and psoriasis.
• Fungal or parasitic infections (e.g., scabies, tinea).

2. Systemic Diseases:

• Renal Failure: Uremic toxins can lead to itching.
• Liver Diseases: Accumulation of bile acids can cause pruritus (e.g., cholestatic pruritus).
• Hematological Diseases: Can be associated with iron deficiency, polycythemia vera, or lymphomas.
• Thyroid Diseases: Itching may be seen in hyperthyroidism or hypothyroidism.

3. Neurological Causes:

• Nerve damage, diseases such as multiple sclerosis, and shingles.

4. Psychological Causes:

• Conditions such as stress, anxiety, and depression can exacerbate itching.

5. Medications and Chemicals:

• Opioids, antibiotics, and some blood pressure medications can cause itching.

6. Environmental and Allergic Causes:

• Irritants such as extreme temperatures, sweating, dry air, or detergents can affect the skin.

Symptoms of Pruritus

• Localized Itching: Limited to a specific area.
• Generalized Itching: Affects a wide area of the body.
• Chronic Itching: Lasts longer than 6 weeks and can affect sleep.
• Skin Damage and Infection: Continuous scratching can lead to irritation, sores, and infections.
• Additional Symptoms: Itching may accompany redness, rashes, swelling, or scaling of the skin.

Diagnosis of Pruritus

1. Patient History and Physical Examination:

• The duration, extent, and triggers of itching are evaluated.
• If systemic disease is suspected, the patient is thoroughly questioned.

2. Laboratory Tests:

• Blood Tests: Liver and kidney function tests, thyroid tests, complete blood count.
• Immunological Tests: Specific tests are performed if allergic reactions are suspected.

3. Biopsy and Imaging:

• A skin biopsy may be performed if dermatological causes are suspected.
• Imaging methods are used if systemic disease is suspected.

Treatment of Pruritus

1. Treatment of Underlying Causes:

• Renal or Liver Failure: Uremic pruritus can be controlled with dialysis or medications.
• Bile Duct Obstructions: Treated with medications like ursodeoxycholic acid.
• Allergic Causes: Antihistamines are used.

2. Medication Treatment:

• Antihistamines: Used for acute and allergic itching (e.g., loratadine, cetirizine).
• Topical Steroids: Reduce itching in inflammatory skin diseases.
• Moisturizers and Emollients: Help alleviate itching by preventing skin dryness.
• Antidepressants: Low-dose antidepressants may be used for chronic and neurological pruritus.
• Gabapentin and Pregabalin: Can be effective for neuropathic itching.

3. Light Therapy (Phototherapy):

• UVB light therapy can be applied for itching caused by psoriasis and atopic dermatitis.

4. Lifestyle and Skin Care:

• Skin Care: Non-soap cleansers and moisturizers should be preferred.
• Avoid Scratching: The skin should be protected from irritation; nails should be kept short if necessary.
• Cool Environment: Warm environments can increase itching; cool and humid environments are preferred.
• Stress Management: Activities like yoga and meditation can help relieve pruritus.

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