2003, Number 1
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Med Cutan Iber Lat Am 2003; 31 (1)
Pruritus: from Etiopathogenia to Diagnostic and Therapeutic Strategies
Vieira R, Figueiredo A
Language: Portugués
References: 71
Page: 46-56
PDF size: 459.00 Kb.
ABSTRACT
Itch is the most common complain of patients observed by dermatologists. It is often related with a particular dermatosis but it can also be present at the patient without skin lesions. In the latter, an underlying disease such as a subclinical dermatosis, an internal disease, a neuropsychiatric condition or even a drug-induced disturb may be found.
After few considerations about main physiopathologic and etiologic aspects, the diagnostic investigation and treatment strategies are exposed with a particular focus in the generalized pruritus without skin lesions.
REFERENCES
Lorette G, Vaillant L: Prurit. In:. Saurat JH, Grosshans E, Laugier P, Lachapelle JM, eds. Dermatologie et maladies sexuellement transmissibles. 3d ed. Paris: Masson, 1999;903-9
Twycross R, Greaves MW, Handwerker H et al: Itch: scratching more than surface. QJM 2003;96:7-26
Tuckett RP: Neurophysiology and neuroanatomy of pruritus. In: Bernhard JD, ed. Itch. McGraw-Hill, 1994;1-22
Lerner E: Chemical mediators of itching. In: Bernhard JD, ed. Itch. McGraw-Hill, 1994; 23-34
Lewis T: The Blood Vessels of the Human Skin and Their responses. London: Shaw & Sons, 1927
Bernhard JD: Pruritus in skin disease. In: Bernhard JD, ed. Itch. McGraw-Hill, 1994;37-51
Pujol RM, Gallardo F, Llistosella E et al: Invisible mycosis fungoides: A diagnostic challenge. J Am Acad Dermatol 2000;42:324-8
Bowen GM, Stevens SR, Dubin HV, Siddiqui J, Cooper KD: Diagnosis of Sezary syndrome in a patient with generalized pruritus based on early molecular study and flow cytometry. J Am Acad Dermatol 1995;33:678-80
Ghent CN: Cholestatic pruritus. In: Bernhard JD, ed. Itch. McGraw-Hill, 1994; 229-42
Carmichael AJ: Renal itch. In: Bernhard JD, ed. Itch. McGraw-Hill, 1994; 217-28
Murphy M, Carmichael, AJ: Renal itch. Clin Exp Dermatol 2000;25:103-6
Robertson KE, Mueller BA: Uremic pruritus. Am J Health Syst Pharm 1996;53:2159-70;2215-6
Fantini F, Baraldi A, Sevignani C, Spattini A, Pincelli C, Giannetti A: Cutaneous innervation in chronic renal failure patients. An immunohistochemical study. Acta Derm Venereol 1992;72:102-5
Bernhard JD: Neurogenic pruritus and strange skin sensations. In: Bernhard JD, ed. Itch. McGraw-Hill, 1994;185-201
Arnold LM, Auschenbach MB, McElroy SL: Psychogenic excoriation. Clinical features, proposed diagnostic criteria, epidemiology and approaches to treatment. CNS Drugs 2001;15:351-9
16.Taniguchi S, Yamamoto N, Kono T, Hamada T: Generalized pruritus in anorexia nervosa. Br J Dermatol 1996;134:510-11
17.Sheehan-Dare RA, Henderson MJ, Cotteril JA: Anxiety and depression in patients with chronic urticaria and generalized pruritus. Br J Dermatol 1990;123:769-74
Holme AS, Anstey AV: Aquagenic pruritus responding to intermittent photochemotherapy. Clin Exp Dermatol 2001;26:40-1
Adams SJ: Iron deficiency and other hematological causes of generalized pruritus. In: Bernhard JD, ed. Itch. McGraw-Hill, 1994;243-50
Handfield-Jones SE, Hills RJ, Ive FA, Greaves MW: Aquagenic pruritus associated with juvenile xanthogranuloma. Clin Exp Dermatol 1993;18:253-5
Jimenez-Alonso J, Tercedor J, Jaimez L, Garcia-Lora E: Antimalarial drug-induced aquagenic-type pruritus in patients with lupus. Arthritis Rheum 1998;41:744-5
Gobbi PG, Attardo-Parrinello G, Lattanzio G et al: Severe pruritus should be a B-symptom in Hodgkin’s disease. Cancer 1983;57:1934-6
Bernhard JD: Endocrin and metabolic itches. In: Bernhard JD, ed. Itch. McGraw-Hill, 1994;251-60
Shornick JK: Pruritus in pregnancy. In: Bernhard JD, ed. Itch. McGraw-Hill, 1994;261-79
Goldman BD, Koh HK: Pruritus and malignancy. In: Bernhard JD, ed. Itch. McGraw-Hill, 1994;299-319
Cockerell CJ: The itches of HIV infection and AIDS. In: Bernhard JD, ed. Itch. McGraw-Hill, 1994;281-95
Hevia O, Jimenez-Acosta F, Ceballos PI, Gould EW, Penneys NS: Pruritic papular eruption of the acquired immunodeficiency syndrome: a clinicopathologic study. J Am Acad Dermatol 1991;24:231-5
Ishii N, Nishiyama T, Sugita Y, Nakjima H, Aoki I: Pruritic papular eruption of the acquired immunodeficiency syndrome. Acta Derm Venereol 1994;74:219-20
Sarno AM, Bernhard JD: Drug-induced pruritus without a rash. In: Bernhard JD, ed. Itch. McGraw-Hill, 1994;329-35
Guillet G, Zampetti A, Czarlewski W, Guillet MH: Increased histamine release and skin hypersensitivity to histamine in senile pruritus: study of 60 patients. J Eur Acad Dermatol Venereol 2000;14:65 (letter)
Long C, Marks R: Stratum corneum changes in patients with senile pruritus. J Am Acad Dermatol 1992;27:560-4
Bernard JD: Do anti-basement membrane zone antibodies cause some cases of “senile pruritus”? Arch Dermatol 1997;133:1049-50 (letter)
Kantor GR: Diagnostic evaluation of the patient with generalized pruritus. In: Bernhard JD, ed. Itch. McGraw-Hill, 1994;337-46
Nowak MA, Tsoukas MM, Delmus FA, Falanga V, Brodell RT: Generalized pruritus without primary lesions. Differential diagnosis and approach to treatment. Postgrad Med 2000;107:41-2, 45-6
Greco PJ, Ende J: Pruritus: a practical approach. J Gen Intern Med 1992;7: 340-9
Kantor GR: Diagnostic evaluation of the patient with generalized pruritus. In: Bernhard JD, ed. Itch. McGraw-Hill, 1994;337-46
Kantor GR: Evaluation and treatment of generalized pruritus. Cleve Clin J Med 1990;57:521-6
Yosipovitch G, David M: The diagnostic and therapeutic approach to idiopathic generalized pruritus. Int J Dermatol 1999;38:881-7
O’donnel BF, Alton B, Carney D, O’loughlin S: Generalized pruritus: when to investigate further. J Am Acad Dermatol 1993;28:117
Bernhard JD: General principles, overview, and miscellaneous treatments of itching. In: Bernhard JD, ed. Itch. McGraw-Hill, 1994;367-81
Fleischer AB: Pruritus in the elderly: management by senior dermatologists. J Am Acad Dermatol 1993;28:603-9
Adebayo RA, Sofowora GG, Onayemi O, Udoh SJ, Ajayi AA: Chloroquine-induced pruritus in malaria fever: contribution of malaria parasitaemia and the effects of prednisolone, niacin, and their combination, compared with antihistamine. Br J Clin Pharmacol 1997;44:157-61
Wallengreen J: Treatment of notalgia paresthetica with topical capsaicin. J Am Acad Dermatol 1991;24:286-8
Bernstein JE: Capsaicin and substance P. Clin dermatol 1992;9:497-503
Bernstein JE, Korman NJ, Bickers DR, et al: Topical capsaicin treatment of chronic postherpetic neuralgia. J Am Acad Dermatol 1989;21:265-70
Kurkcuoglu N, Alaybeyi F: Topical capsaicin for psoriasis. Br J Dermatol 1990;123:549-50
Breneman DL, Cardone JS, Blumsack RF et al: Topical capsaicin for treatment of hemodialysis-related pruritus. J Am Acad Dermatol 1992;26:91-4
Lotti T, Teofoli P, Tsampau D: Treatment of aquagenic pruritus with topical capsaicin cream. J Am Acad Dermatol 1994;30:232-5
Tan CC, Wong KS, Thirumoorthy T et al: A randomized crossover trial of Sarna and Eurax lotions in the treatment of haemodialysis patients with uremic pruritus. J Dermatol Treat 1990;1:235-8
Herman L: Antihistamines. In: Bernhard JD, ed. Itch. McGraw-Hill, 1994;413-35
Drake L. Breneman D, Greene S, et al: Effects of topical doxepin 5% cream on pruritic eczema. J Invest Dermatol 1992;98:605
Datta DV, Sherlock S: Cholestyramine for long term relief of the pruritus complicating intrahepatic cholestasis. Gastroenterology 1966;50:323-32
Heathcote EJ: Management of primary biliary cirrhosis. The American Association for the Study of Liver Diseases practice guidelines. Hepatology 2000;31:1005-13
Silverberg, DS, IAINA A, REISIN E, et al: Cholestyramine in uremic pruritus. BMJ 1977;1:752-3
Chanarin I, SZUR L: Relief of intractable pruritus in polycythaemia rubra vera with cholestyramine. Br J Haematol 1975;29:669
Pederson JÁ, Matter BJ, Czerwinski AW, et al: Relief of idiopathic generalized pruritus in dyalisis patients treated with activated charcoal. Ann Intern med 1980;93:446-8
Yatzidis H, Digenis P, Tountas C: Heparin treatment of uremic itching. JAMA 1972;222:1183
Marchi SD, Cecchin E, Villatta D, et al: Relief of pruritus and decrease in plasma histamine concentrations during erythropoietin therapy in patients with uremia. N Engl J Med 1992;326:969
Balaskas EV, Uldall RP: Erythropoietin treatment does not improve uremic pruritus. Perit Dial Int 1992;12:330
Bergasa NV, Jones EA: A controlled trial of naloxone infusions for the pruritus of chronic cholestasis. Gastroenterology 1992;102:544-9
Bergasa NV, Alling DW, Talbot TL, Wells MC, Jones EA: Oral nalmefene therapy reduces scratching activity due to the pruritus of cholestasis: a controlled study. J Am Acad Dermatol 1999;41:431-4
Schworer H, Ramadori G: Treatment of pruritus: a new indication for serotonin type 3 receptor antagonists. Clin Investig 1993;71:659-62
Ghent CN, Carruthers SG: Treatment of pruritus in primary biliary cirrhosis with rifampin: Results of a double-blinded crossover randomized trial. Gastroenterology 1988;94:488-93
Fjellner B, Hagemark O: Pruritus in polycythemia: Treatment with aspirin and possibility of platelet involvement. Acta Derm Venereol 1979;61:505
Soter NA, Austen KF, Wasserman SI: Oral disodium cromoglycate in the treatment of systemic mastocytosis. N Engl J Med 1979;301:465-9
Leven A, Naysmith A, Dickens S, et al: Sodium cromoglycate and Hodgkin’s pruritus. BMJ 1979;2:896
Lebwohl M: Phototherapy of pruritus. In: Bernhard JD, ed. Itch. McGraw-Hill, 1994;399-411
Koblenzer CS: Psychologic and psychiatric aspects of itching. In: Bernhard JD, ed. Itch. McGraw-Hill, 1994;347-65
Daly BM, Shuster S: Antipruritic action of thalidomide. Acta Derm Venereol 2000;80:24-5
Lundeberg T, Bondesson L, Thomas M: Effect of acupuncture on experimentally induced itch. Br J Dermatol 1987;117:771-7
Ely H: Shocking therapy: Uses of transcutaneous electric nerve stimulation in dermatology. Dermatol Clin 1991;9:189-97