Kaşıntılı Hastaya Yaklaşım
Özet
Kaşıntı (pruritus), kaşıma isteğini tetikleyen hoş olmayan bir duyumdur ve altı haftadan uzun sürmesi kronik pruritus olarak tanımlanır. Kronik kaşıntı dermatolojik hastalıkların yanı sıra sistemik, nöropatik ve psikojenik nedenlere bağlı gelişebilir ve yaşam kalitesi, uyku ve psikososyal işlevler üzerinde önemli olumsuz etkiler oluşturur. Sistemik nedenler arasında hepatobiliyer hastalıklar, kronik böbrek hastalığı, hematolojik hastalıklar, maligniteler, endokrin bozukluklar ve enfeksiyonlar yer alır. Nöropatik pruritus periferik veya santral sinir sistemi hasarına bağlı gelişirken, psikojenik pruritus diğer nedenlerin dışlanmasından sonra değerlendirilir. Tanısal yaklaşım ayrıntılı öykü, fizik muayene ve klinik bulgulara göre uygun laboratuvar ve görüntüleme incelemelerini içerir. Tedavide temel amaç altta yatan nedenin belirlenmesi ve düzeltilmesidir. Nemlendiriciler ve genel deri bakımı tüm hastalarda önem taşırken, topikal anestezikler, kapsaisin, antihistaminikler, gabapentinoidler, opioid reseptörlerini hedefleyen ilaçlar, antidepresanlar ve fototerapi seçilmiş hastalarda kullanılabilir. Sistemik hastalık şüphesi bulunan veya tedaviye dirençli kronik kaşıntılı hastalar ileri değerlendirme ve tedavi amacıyla ilgili uzmanlık merkezlerine yönlendirilmelidir.
Referanslar
Ikoma A, Steinhoff M, Ständer S, et al. The neurobiology of itch. Nature Reviews Neurosciences; 2006;7(7):535-547. doi: 10.1038/nrn1950.
Ständer S, Stumpf A, Osada N, et al. Gender differences in chronic pruritus: women present different morbidity, more scratch lesions and higher burden. British Journal of Dermatology; 2013;168(6):1273-1280. doi: 10.1111/bjd.12267.
Lipman ZM, Ingrasci G, Yosipovitch G. Approach to the Patient with Chronic Pruritus. Medical Clinics of North America; 2021;105(4):699-721. doi: 10.1016/j.mcna.2021.04.007.
Reamy BV, Bunt CW, Fletcher S. A diagnostic approach to pruritus. American Family Physician; 2011;15;84(2):195-202.
Shive M, Linos E, Berger T, et al. Itch as a patient-reported symptom in ambulatory care visits in the United States. Journal of the American Academy of Dermatology;2013;69(4):550–556.
Ständer S, Pereira MP, Weisshaar E, et al. Pruritus and Dysesthesia. In: Callen J. P., Cowen E. W., Duncan K. et al. (eds.) Dermatology, International Edition, Authors. Bolognia JL, Schaffer JV, Cerroni L. 5th ed. Publisher: Elsevier. 2024. P.123-144
Song J, Xian D, Yang L, et al. Pruritus: Progress toward Pathogenesis and Treatment. BioMed Research International; 2018;11;9625936. doi: 10.1155/2018/9625936.
Lee JS, Han JS, Lee K, et al. The peripheral and central mechanisms underlying itch. Biochemistry and Molecular Biology Reports; 2016;49(9):474-487. doi: 10.5483/bmbrep.2016.49.9.108.
Golpanian, R. S., Gonzalez, J. M., Yosipovitch, G. Practical approach for the diagnosis and treatment of chronic pruritus. The journal for nurse practitioners; 2020;16.8: 590-596.
Rupert J, Honeycutt JD. Pruritus: Diagnosis and Management. American Family Physician; 2022;105(1):55-64.
Weisshaar E, Müller S, Szepietowski JC, et al. European S2k Guideline on Chronic Pruritus. Acta Dermato-Venereologica; 2025;22;105:adv44220. doi: 10.2340/actadv.v105.44220.
Marenco-Flores A, Sierra L, Goyes D, et al. Managing pruritus in chronic liver disease: An in-depth narrative review. Clinical Liver Disease (Hoboken);2024;23(1):e0187.doi:10.1097/CLD.0000000000000187.
Cevikbas F, Lerner EA. Physiology and Pathophysiology of Itch. Physiological Reviews; 2020;100(3):945-982. doi:10.1152/physrev.00017.2019
Hayani K, Weiss M, Weisshaar E. Clinical Findings and Provision of Care in Haemodialysis Patients with Chronic Itch: New Results from the German Epidemiological Haemodialysis Itch Study. Acta Dermato-Venereologica; 2016;96(3):361-366. doi: 10.2340/00015555-2280.
Osakwe N, Rout P. Uremic Pruritus Evaluation and Treatment. [Updated 2024 Aug 8]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK587340/ Accessed 30th May.
Le Gall-Ianotto, C., & Misery, L. "Pruritus in hematological diseases (including aquagenic pruritus)." Pruritus. Cham: Springer International Publishing, 2016. p. 271-281.
Saini S, Jain AK, Agarwal S, et al. Iron Deficiency and Pruritus: A Cross-Sectional Analysis to Assess Its Association and Relationship. Indian Journal of Dermatology; 2021;66(6):705. doi: 10.4103/ijd.ijd_326_21.
Akiska YM, Gandhi I, Adler R, et al. Pathogenesis and Therapeutics for Chronic Pruritus of Unknown Origin: A Systematic Review. International Journal of Dermatology; 2026;65(4):706-723. doi:10.1111/ijd.70259
Saini KS, Patnaik MM, Tefferi A. Polycythemia vera-associated pruritus and its management. European Journal of Clinical Investigation; 2010;40(9):828-834. doi: 10.1111/j.1365-2362.2010.02334.x.
Rowe B, Yosipovitch G. Malignancy-associated pruritus. European Journal of Pain; 2016;20(1):19-23. doi: 10.1002/ejp.760.
Nowak DA, Yeung J. Diagnosis and treatment of pruritus. Canadian Family Physician; 2017;63(12):918-924.
Abate MCMO, Aroucha PMT, Nóbrega DVMD, et al. Cutaneous manifestations of diabetes mellitus: a narrative review. Einstein (Sao Paulo); 2025;23:eRW1193. doi:10.31744/einstein_journal/2025RW1193.
Tarikci N, Kocatürk E, Güngör Ş, et al. Pruritus in Systemic Diseases: A Review of Etiological Factors and New Treatment Modalities. Scientific World Journal; 2015;2015:803752. doi: 10.1155/2015/803752.
Kwatra SG, Kambala A, Dong X. Neuropathic pruritus. Journal of Allergy and Clinical Immunology; 2023;152(1):36-38. doi:10.1016/j.jaci.2023.04.006
Buteau A, Reichenberg J. Psychogenic Pruritus and Its Management. Dermatologic Clinics;
2018;36(3):309-314. doi: 10.1016/j.det.2018.02.015.
