PRURITUS/ITCH: THE SCIENCE AND TREATMENT
Patients with renal failure, usually end-stage renal disease (ESRD), commonly are afflicted
by severe pruritus. The pathogenesis of ESRD pruritus is unknown, but improving the
quality of dialysis can reduce the prevalence and severity of ESRD pruritus. Topical and
systemic agents as well as broadband ultraviolet phototherapy can be extremely beneficial.
Gabapentin has been recently discovered as an effective agent for the patient with ESRD
pruritus. Kappa opiate agonists are promising new therapeutic options.
Semin Cutan Med Surg 30:99-100 © 2011 Published by Elsevier Inc.
Pruritus will affect a majority of HIV-infected adults in the course of their disease, impacting
their quality of life. Itchy skin conditions in the HIV-infected patient may be atypical in
appearance and pose diagnostic and treatment challenges. Skin changes because of
chronic scratching or the absence of skin findings despite ongoing pruritus should prompt
investigations for underlying causes. The presence of pruritus or pruritic skin conditions
and their response to therapy may be a barometer for changes in systemic inflammation,
immune activation, and dysregulation because of infection with HIV and treatment with
Semin Cutan Med Surg 30:101-106 © 2011 Elsevier Inc. All rights reserved.
Itch represents a common and significant source of morbidity in the oncological setting.
Itch sometimes can be associated with an underlying malignancy, most commonly leukemia
or lymphoma. Alternatively, itch may present secondary to malignant invasion causing
hepatic or renal dysfunction. Finally, itch may be related to therapeutic regimens for the
underlying malignancy. This article seeks to review the clinical scenarios in which itch
affects the oncological patient, to briefly present the latest understanding of the molecular
and cellular mechanisms of malignancy-related itch, and to review currently available
Semin Cutan Med Surg 30:107-112 © 2011 Published by Elsevier Inc.
Geriatric patients are frequently afflicted by pruritic dermatoses. Most pruritic elderly
patients present with a skin eruption. The high prevalence of pruritic inflammatory skin
disorders in elderly patients is a consequence of three physiological changes that occur
with aging: (1) the epidermal barrier repair is diminished; (2) the immune systems of elderly
patients are activated and have defective Th1 function along with enhanced Th2 function
(immunosenescense); and (3) neurodegenerative disorders may lead to pruritus by their
central or peripheral effects. These consequences of aging may all afflict the same patient,
explaining why elderly people often have multiple overlapping skin conditions. The following
article outlines the pathogenesis of the most common forms of pruritic skin disease in
elderly patients and the hallmarks that allow the dermatologist to establish an accurate
diagnosis and also suggests a management strategy for each common type of pruritic skin
disease in the elderly patient.
Semin Cutan Med Surg 30:113-117 © 2011 Published by Elsevier Inc.
Itch, or pruritus, is the predominant symptom associated with acute and chronic cutaneous
disease, and in some cases may be debilitating. To date, there is no single universally
effective anti-itch treatment. Because the pathophysiology of itch in most cutaneous or
systemic disorders remains unclear, antipruritic therapy is often directed against a variety
of targets, including the epidermal barrier, immune system, or the nervous system. Topical
therapy is the mainstay of dermatologic management of acute or localized itch or in patients
with contraindications to systemic therapies. This review will summarize current topical
therapies to treat pruritus and discuss potential future therapies.
Semin Cutan Med Surg 30:118-126 © 2011 Elsevier Inc. All rights reserved.