Pruritus (Pruritus in the Elderly)
Özet
Pruritus is one of the most common dermatological symptoms in elderly individuals and can significantly impact quality of life. The etiology of pruritus in the elderly is complex and can be attributed to various factors such as skin dryness, dermatological disorders, systemic diseases, and medications. The assessment of chronic pruritus may require a comprehensive physical examination and medical history, along with various laboratory tests and imaging techniques. Understanding the underlying causes and mechanisms of pruritus in elderly patients is crucial for accurate evaluation. Treatment options for managing pruritus in elderly patients are similar to those used for younger adults.
Referanslar
Norman RA. Xerosis and pruritus in the elderly: recognition and management. Dermatol Ther. 2003;16(3):254-9. doi: 10.1046/j.1529-8019.2003.01635.x.
Valdes-Rodriguez R, Mollanazar NK, González-Muro J, Nattkemper L, Torres-Alvarez B, López-Esqueda FJ, Chan YH, Yosipovitch G. Itch prevalence and characteristics in a Hispanic geriatric population: a comprehensive study using a standardized itch questionnaire. Acta Derm Venereol. 2015 Apr;95(4):417-21. doi: 10.2340/00015555-1968.
Ständer S, Weisshaar E, Mettang T, Szepietowski JC, Carstens E, Ikoma A, Bergasa NV, Gieler U, Misery L, Wallengren J, Darsow U, Streit M, Metze D, Luger TA, Greaves MW, Schmelz M, Yosipovitch G, Bernhard JD. Clinical classification of itch: a position paper of the International Forum for the Study of Itch. Acta Derm Venereol. 2007;87(4):291-4. doi: 10.2340/00015555-0305.
Satoh T, Yokozeki H, Murota H, Tokura Y, Kabashima K, Takamori K, Shiohara T, Morita E, Aiba S, Aoyama Y, Hashimoto T, Katayama I. 2020 guidelines for the diagnosis and treatment of cutaneous pruritus. J Dermatol. 2021 Sep;48(9):e399-e413. doi: 10.1111/1346-8138.16066.
Silverberg JI, Hinami K, Trick WE, Cella D. Itch in the General Internal Medicine Setting: A Cross-Sectional Study of Prevalence and Quality-of-Life Effects. Am J Clin Dermatol. 2016 Dec;17(6):681-690. doi: 10.1007/s40257-016-0215-3.
Dyhre-Petersen N, Gazerani P. Presence and characteristics of senile pruritus among Danish elderly living in nursing homes. Future Sci OA. 2019 Jun 24;5(6):FSO399. doi: 10.2144/fsoa-2019-0036.
Norman RA, Henderson JN. Aging: an overview. Dermatol Ther. 2003;16(3):181-5. doi: 10.1046/j.1529-8019.2003.01627.x.
Yalçin B, Tamer E, Toy GG, Oztaş P, Hayran M, Alli N. The prevalence of skin diseases in the elderly: analysis of 4099 geriatric patients. Int J Dermatol. 2006 Jun;45(6):672-6. doi: 10.1111/j.1365-4632.2005.02607.x
Mollanazar NK, Sethi M, Rodriguez RV, Nattkemper LA, Ramsey FV, Zhao H, Yosipovitch G. Retrospective analysis of data from an itch center: Integrating validated tools in the electronic health record. J Am Acad Dermatol. 2016 Oct;75(4):842-844. doi: 10.1016/j.jaad.2016.05.035
Mollanazar NK, Smith PK, Yosipovitch G. Mediators of Chronic Pruritus in Atopic Dermatitis: Getting the Itch Out? Clin Rev Allergy Immunol. 2016 Dec;51(3):263-292. doi: 10.1007/s12016-015-8488-5.
Yosipovitch G, Bernhard JD. Clinical practice. Chronic pruritus. N Engl J Med. 2013 Apr 25;368(17):1625-34. doi: 10.1056/NEJMcp1208814.
Berger TG, Shive M, Harper GM. Pruritus in the older patient: a clinical review. JAMA. 2013 Dec 11;310(22):2443-50. doi: 10.1001/jama.2013.282023.
Liu Z, Liang Q, Ren Y, Guo C, Ge X, Wang L, Cheng Q, Luo P, Zhang Y, Han X. Immunosenescence: molecular mechanisms and diseases. Signal Transduct Target Ther. 2023 May 13;8(1):200. doi: 10.1038/s41392-023-01451-2.
Polat M, Yalçin B, Calişkan D, Alli N. Complete dermatological examination in the elderly: an exploratory study from an outpatient clinic in Turkey. Gerontology. 2009;55(1):58-63. doi: 10.1159/000129683.
White-Chu EF, Reddy M. Dry skin in the elderly: complexities of a common problem. Clin Dermatol. 2011 Jan-Feb;29(1):37-42. doi: 10.1016/j.clindermatol.2010.07.005.
Simon M, Bernard D, Minondo AM, Camus C, Fiat F, Corcuff P, Schmidt R, Serre G. Persistence of both peripheral and non-peripheral corneodesmosomes in the upper stratum corneum of winter xerosis skin versus only peripheral in normal skin. J Invest Dermatol. 2001 Jan;116(1):23-30. doi: 10.1046/j.1523-1747.2001.00208.x.
Pappas A. Epidermal surface lipids. Dermatoendocrinol. 2009 Mar;1(2):72-6. doi: 10.4161/derm.1.2.7811.
Choi EH. Gender, Age, and Ethnicity as Factors That Can Influence Skin pH. Curr Probl Dermatol. 2018; 54:48-53. doi: 10.1159/000489517.
Ali SM, Yosipovitch G. Skin pH: from basic science to basic skin care. Acta Derm Venereol. 2013 May;93(3):261-7. doi: 10.2340/00015555-1531.
Feingold KR, Elias PM. Role of lipids in the formation and maintenance of the cutaneous permeability barrier. Biochim Biophys Acta. 2014 Mar;1841(3):280-94. doi: 10.1016/j.bbalip.2013.11.007.
Bonté F, Girard D, Archambault JC, Desmoulière A. Skin Changes During Ageing. Subcell Biochem. 2019;91:249-280. doi: 10.1007/978-981-13-3681-2_10.
Thornton MJ. Estrogens and aging skin. Dermatoendocrinol. 2013 Apr 1;5(2):264-70. doi: 10.4161/derm.23872.
Xu AZ, Tripathi SV, Kau AL, Schaffer A, Kim BS. Immune dysregulation underlies a subset of patients with chronic idiopathic pruritus. J Am Acad Dermatol. 2016 May;74(5):1017-20. doi: 10.1016/j.jaad.2015.11.029.
Oaklander AL. Neuropathic itch. Semin Cutan Med Surg. 2011 Jun;30(2):87-92. doi: 10.1016/j.sder.2011.04.006.
Liddell K. Letter: Post-herpetic pruritus. Br Med J. 1974 Oct 19;4(5937):165. doi: 10.1136/bmj.4.5937.165.
Yamaoka H, Sasaki H, Yamasaki H, Ogawa K, Ohta T, Furuta H, Nishi M, Nanjo K. Truncal pruritus of unknown origin may be a symptom of diabetic polyneuropathy. Diabetes Care. 2010 Jan;33(1):150-5. doi: 10.2337/dc09-0632.
Mirzoyev SA, Davis MD. Brachioradial pruritus: Mayo Clinic experience over the past decade. Br J Dermatol. 2013 Nov;169(5):1007-15. doi: 10.1111/bjd.12483.
Kwatra SG, Stander S, Bernhard JD, Weisshaar E, Yosipovitch G. Brachioradial pruritus: a trigger for generalization of itch. J Am Acad Dermatol. 2013 May;68(5):870-3. doi: 10.1016/j.jaad.2012.11.026.
Huesmann T, Cunha PR, Osada N, Huesmann M, Zanelato TP, Phan NQ, Gontijo GM, Marziniak M, Ständer S. Notalgia paraesthetica: a descriptive two-cohort study of 65 patients from Brazil and Germany. Acta Derm Venereol. 2012 Sep;92(5):535-40. doi: 10.2340/00015555-1344.
Massey EW. Unilateral neurogenic pruritus following stroke. Stroke. 1984 Sep-Oct;15(5):901-3. doi: 10.1161/01.str.15.5.901.
Ward RE, Veerula VL, Ezra N, Travers JB, Mousdicas N. Multilevel symmetric neuropathic pruritus (MSNP) presenting as recalcitrant "generalized" pruritus. J Am Acad Dermatol. 2016 Oct;75(4):774-781. doi: 10.1016/j.jaad.2016.05.027.
Reich A, Ständer S, Szepietowski JC. Pruritus in the elderly. Clin Dermatol. 2011 Jan-Feb;29(1):15-23. doi: 10.1016/j.clindermatol.2010.07.002.
Farage MA, Miller KW, Berardesca E, Maibach HI. Clinical implications of aging skin: cutaneous disorders in the elderly. Am J Clin Dermatol. 2009;10(2):73-86. doi: 10.2165/00128071-200910020-00001.
Prakash AV, Davis MD. Contact dermatitis in older adults: a review of the literature. Am J Clin Dermatol. 2010 Dec 1;11(6):373-81. doi: 10.2165/11319290-000000000-00000.
Duque MI, Yosipovitch G, Chan YH, Smith R, Levy P. Itch, pain, and burning sensation are common symptoms in mild to moderate chronic venous insufficiency with an impact on quality of life. J Am Acad Dermatol. 2005 Sep;53(3):504-8. doi: 10.1016/j.jaad.2005.04.079.
Kwon HH, Kwon IH, Youn JI. Clinical study of psoriasis occurring over the age of 60 years: is elderly-onset psoriasis a distinct subtype? Int J Dermatol. 2012 Jan;51(1):53-8. doi: 10.1111/j.1365-4632.2011.04979.x
Wilson MM, Philpott CD, Breer WA. Atypical presentation of scabies among nursing home residents. J Gerontol A Biol Sci Med Sci. 2001 Jul;56(7):M424-7. doi: 10.1093/gerona/56.7.m424. PMID: 11445601.
Yosipovitch G, Mills KC, Nattkemper LA, Feneran A, Tey HL, Lowenthal BM, Pearce DJ, Williford PM, Sangueza OP, D'Agostino RB Jr. Association of pain and itch with depth of invasion and inflammatory cell constitution in skin cancer: results of a large clinicopathologic study. JAMA Dermatol. 2014 Nov;150(11):1160-6. doi: 10.1001/jamadermatol.2014.895.
Singer EM, Shin DB, Nattkemper LA, Benoit BM, Klein RS, Didigu CA, Loren AW, Dentchev T, Wysocka M, Yosipovitch G, Rook AH. IL-31 is produced by the malignant T-cell population in cutaneous T-Cell lymphoma and correlates with CTCL pruritus. J Invest Dermatol. 2013 Dec;133(12):2783-2785. doi: 10.1038/jid.2013.227.
Schmidt T, Sitaru C, Amber K, Hertl M. BP180- and BP230-specific IgG autoantibodies in pruritic disorders of the elderly: a preclinical stage of bullous pemphigoid? Br J Dermatol. 2014 Aug;171(2):212-9. doi: 10.1111/bjd.12936.
Patel TS, Freedman BI, Yosipovitch G. An update on pruritus associated with CKD. Am J Kidney Dis. 2007 Jul;50(1):11-20. doi: 10.1053/j.ajkd.2007.03.010.
Kremer AE, van Dijk R, Leckie P, Schaap FG, Kuiper EM, Mettang T, Reiners KS, Raap U, van Buuren HR, van Erpecum KJ, Davies NA, Rust C, Engert A, Jalan R, Oude Elferink RP, Beuers U. Serum autotaxin is increased in pruritus of cholestasis, but not of other origin, and responds to therapeutic interventions. Hepatology. 2012 Oct;56(4):1391-400. doi: 10.1002/hep.25748.
Artantaş S, Gül U, Kiliç A, Güler S. Skin findings in thyroid diseases. Eur J Intern Med. 2009 Mar;20(2):158-61. doi: 10.1016/j.ejim.2007.09.021.
Weisshaar E, Weiss M, Mettang T, Yosipovitch G, Zylicz Z; Special Interest Group of the International Forum on the Study of Itch. Paraneoplastic itch: an expert position statement from the Special Interest Group (SIG) of the International Forum on the Study of Itch (IFSI). Acta Derm Venereol. 2015 Mar;95(3):261-5. doi: 10.2340/00015555-1959.
Reich A, Ständer S, Szepietowski JC. Drug-induced pruritus: a review. Acta Derm Venereol. 2009;89(3):236-44. doi: 10.2340/00015555-0650.
Fischer A, Rosen AC, Ensslin CJ, Wu S, Lacouture ME. Pruritus to anticancer agents targeting the EGFR, BRAF, and CTLA-4. Dermatol Ther. 2013 Mar-Apr;26(2):135-48. doi: 10.1111/dth.12027.
Raksha MP, Marfatia YS. Clinical study of cutaneous drug eruptions in 200 patients. Indian J Dermatol Venereol Leprol. 2008 Jan-Feb;74(1):80. doi: 10.4103/0378-6323.38431.
Gum AM, King-Kallimanis B, Kohn R. Prevalence of mood, anxiety, and substance-abuse disorders for older Americans in the national comorbidity survey-replication. Am J Geriatr Psychiatry. 2009 Sep;17(9):769-81. doi: 10.1097/JGP.0b013e3181ad4f5a.
Krishnan A, Koo J. Psyche, opioids, and itch: therapeutic consequences. Dermatol Ther. 2005 Jul-Aug;18(4):314-22. doi: 10.1111/j.1529-8019.2005.00038.x.
Yosipovitch G, Samuel LS. Neuropathic and psychogenic itch. Dermatol Ther. 2008 Jan-Feb;21(1):32-41. doi: 10.1111/j.1529-8019.2008.00167.x.
Shevchenko A, Valdes-Rodriguez R, Yosipovitch G. Causes, pathophysiology, and treatment of pruritus in the mature patient. Clin Dermatol. 2018 Mar-Apr;36(2):140-151. doi: 10.1016/j.clindermatol.2017.10.005.
Valdes-Rodriguez R, Stull C, Yosipovitch G. Chronic pruritus in the elderly: pathophysiology, diagnosis and management. Drugs Aging. 2015 Mar;32(3):201-15. doi: 10.1007/s40266-015-0246-0.
Steinhoff M, Al-Khawaga S, Buddenkotte J. Itch in elderly patients: Origin, diagnostics, management. J Allergy Clin Immunol. 2023 Jul;152(1):42-49. doi: 10.1016/j.jaci.2023.05.009.
Fourzali KM, Yosipovitch G. Management of Itch in the Elderly: A Review. Dermatol Ther (Heidelb). 2019 Dec;9(4):639-653. doi: 10.1007/s13555-019-00326-1. Epub 2019 Sep 23.
Ständer S, Schürmeyer-Horst F, Luger TA, Weisshaar E. Treatment of pruritic diseases with topical calcineurin inhibitors. Ther Clin Risk Manag. 2006 Jun;2(2):213-8. doi: 10.2147/tcrm.2006.2.2.213
Drake LA, Fallon JD, Sober A. Relief of pruritus in patients with atopic dermatitis after treatment with topical doxepin cream. The Doxepin Study Group. J Am Acad Dermatol. 1994 Oct;31(4):613-6. doi: 10.1016/s0190-9622(94)70225-x.
Zhai H, Hannon W, Hahn GS, Harper RA, Pelosi A, Maibach HI. Strontium nitrate decreased histamine-induced itch magnitude and duration in man. Dermatology. 2000;200(3):244-6. doi: 10.1159/000018367.
Lee HG, Grossman SK, Valdes-Rodriguez R, Berenato F, Korbutov J, Chan YH, Lavery MJ, Yosipovitch G. Topical ketamine-amitriptyline-lidocaine for chronic pruritus: A retrospective study assessing efficacy and tolerability. J Am Acad Dermatol. 2017 Apr;76(4):760-761. doi: 10.1016/j.jaad.2016.10.030.
Andersen HH, Marker JB, Hoeck EA, Elberling J, Arendt-Nielsen L. Antipruritic effect of pretreatment with topical capsaicin 8% on histamine- and cowhage-evoked itch in healthy volunteers: a randomized, vehicle-controlled, proof-of-concept trial. Br J Dermatol. 2017 Jul;177(1):107-116. doi: 10.1111/bjd.15335.
Kailas A. Crisaborole: A new and effective nonsteroidal topical drug for atopic dermatitis. Dermatol Ther. 2017 Sep;30(5). doi: 10.1111/dth.12533.
Chung BY, Um JY, Kim JC, Kang SY, Park CW, Kim HO. Pathophysiology and Treatment of Pruritus in Elderly. Int J Mol Sci. 2020 Dec 26;22(1):174. doi: 10.3390/ijms22010174.
Phan NQ, Bernhard JD, Luger TA, Ständer S. Antipruritic treatment with systemic μ-opioid receptor antagonists: a review. J Am Acad Dermatol. 2010 Oct;63(4):680-8. doi: 10.1016/j.jaad.2009.08.052.
Kumagai H, Ebata T, Takamori K, Muramatsu T, Nakamoto H, Suzuki H. Effect of a novel kappa-receptor agonist, nalfurafine hydrochloride, on severe itch in 337 haemodialysis patients: a Phase III, randomized, double-blind, placebo-controlled study. Nephrol Dial Transplant. 2010 Apr;25(4):1251-7. doi: 10.1093/ndt/gfp588.
Hundley JL, Yosipovitch G. Mirtazapine for reducing nocturnal itch in patients with chronic pruritus: a pilot study. J Am Acad Dermatol. 2004 Jun;50(6):889-91. doi: 10.1016/j.jaad.2004.01.045.
Razeghi E, Eskandari D, Ganji MR, Meysamie AP, Togha M, Khashayar P. Gabapentin and uremic pruritus in hemodialysis patients. Ren Fail. 2009;31(2):85-90. doi: 10.1080/08860220802595476.
Pojawa-Gołąb M, Jaworecka K, Reich A. NK-1 Receptor Antagonists and Pruritus: Review of Current Literature. Dermatol Ther (Heidelb). 2019 Sep;9(3):391-405. doi: 10.1007/s13555-019-0305-2.
Sharma D, Kwatra SG. Thalidomide for the treatment of chronic refractory pruritus. J Am Acad Dermatol. 2016 Feb;74(2):363-9. doi: 10.1016/j.jaad.2015.09.039.
Bulur I, Erdogan HK, Aksu AE, Karapınar T, Saracoglu ZN. The efficacy and safety of phototherapy in geriatric patients: a retrospective study. An Bras Dermatol. 2018 Jan-Feb;93(1):33-38. doi: 10.1590/abd1806-4841.20185468.
Torres T, Sohrt Petersen A, Ivens U, Bosch Vilaro A, Stinson J, Carrascosa JM. Matching-Adjusted Indirect Comparison of the Efficacy at Week 32 of Tralokinumab and Dupilumab in the Treatment of Moderate-to-Severe Atopic Dermatitis. Dermatol Ther (Heidelb). 2024 Apr;14(4):983-992. doi: 10.1007/s13555-024-01143-x.
Tsoi LC, Hacini-Rachinel F, Fogel P, Rousseau F, Xing X, Patrick MT, Billi AC, Berthier CC, Kahlenberg JM, Lazzari A, Wiegmann H, Ständer S, Piketty C, Julia V, Krishnaswamy JK, Gudjonsson JE. Transcriptomic characterization of prurigo nodularis and the therapeutic response to nemolizumab. J Allergy Clin Immunol. 2022 Apr;149(4):1329-1339. doi: 10.1016/j.jaci.2021.10.004.
Sobell JM, Foley P, Toth D, Mrowietz U, Girolomoni G, Goncalves J, Day RM, Chen R, Yosipovitch G. Effects of Apremilast on Pruritus and Skin Discomfort/Pain Correlate With Improvements in Quality of Life in Patients With Moderate to Severe Plaque Psoriasis. Acta Derm Venereol. 2016 May;96(4):514-20. doi: 10.2340/00015555-2360.
Drucker AM, Morra DE, Prieto-Merino D, Ellis AG, Yiu ZZN, Rochwerg B, Di Giorgio S, Arents BWM, Burton T, Spuls PI, Schmitt J, Flohr C. Systemic Immunomodulatory Treatments for Atopic Dermatitis: Update of a Living Systematic Review and Network Meta-analysis. JAMA Dermatol. 2022 May 1;158(5):523-532. doi: 10.1001/jamadermatol.2022.0455.
