User:Rx rlee/Senile pruritus

Senile Pruritus is one of the most common conditions in the elderly with an emerging itch that may have changes in temperature and textural characteristics. In the elderly, xerosis, is the most common cause for an itch due to the degradation of the skin barrier over time. However, the cause of senile pruritus is unknown.

== Classification == This type of itch is just one out of six different classifications.


 * Cutaneous diseases
 * Systemic diseases
 * Drug-induced pruritus
 * Neurological disorders
 * Psychiatric disorders
 * Unknown

Risk Factors
Risk factors of senile pruritus may include:


 * old age
 * smoking
 * monophagism
 * excessive drinking
 * xerosis, dry skin
 * medications
 * underlying diseases

Potential Causes
An itch can be caused by various reasons.

Signs and Symptoms
Senile pruritus can be caused by dry skin and it is common for skin to become more dry with age. The back, legs, arms, scalp, and genitalia are areas of the body that are commonly affected by senile pruritus. According to a study, most of the patients who experience pruritus daily have increased itching sensations and other associated symptoms during the night. Most studies reveal that senile pruritus is more common in men than women.

Common symptoms of senile pruritus include :


 * pain
 * heat sensation
 * cold sensation
 * bumps, blisters or spots
 * redness
 * scratch marks
 * patches that may be leathery or scaly

The relationship between senile pruritus and seasonal weather changes has been studied but the results have been inconsistent. Some studies reveal that senile pruritus is most prevalent during winter and fall while in other studies this correlation was not found to be significant.

If a patient is exhibiting signs and symptoms of senile pruritus, a laboratory exam may not be recommended by a doctor at the first patient encounter unless there are other indicators of an underlying disease. After being treated for xerosis and tested for scabies, if the senile pruritus persists, screening for an underlying systemic disease can be recommended.

While identifying the cause of senile pruritus can be challenging, there are some correlations between classifications/diagnosis of senile pruritus and clinical manifestation. For cutaneous diseases, the diagnosis could be dry skin (with flare ups at dry climate), irritant and allergic contact dermatitis (skin lesions), seborrheic dermatitis (skin lesions), atopic dermatitis (scratching, allokinesis, stinging, burning), psoriasis (skin lesions), urticaria (welts/skin swelling). Sometimes senile pruritus can manifest without a primary rash and with the absence of xerosis (Cite)

Systemic diseases can lead to a senile pruritus diagnosis. For example chronic kidney disease (generalized or localized pruritus), hepatobiliary diseases (generalized pruritus), thyroid disorders (urticaria), polycythemia vera (generalized pruritus), iron deficiency anemia  (skin lesions/scratching) and hodgkin’s lymphoma (the area where lymph nodes are affected) can all lead to clinical manifestations of pruritus. Various drugs can also induce pruritus which can manifest with or without a skin rash and can happen immediately or even months after the drug has been used by the patient. Neurological disorders such as postherpetic neuralgia, brachioradial pruritus and notalgia paraesthetica can also lead to senile pruritus with burning, stinging, scratching and/or lesions. Psychiatric disorders such as schizophrenia, somatoform disorders, dissociative disorders, hallucinations, and delusional parasitosis can cause severe lesions, burning, stinging, as well as sensations of bugs crawling on skin over the entire body. (Cite)

Treatment
Treatment usually consists of common remedies for age-related xerosis. However, repeated diagnosis requires further evaluation, taking into account a person's laboratory measurements and medical conditions. A medical history should be taken describing the severity of the pruritus on a scale of 0-10 (no itchiness to unbearable itchiness) and the location. Medication use must also be documented to narrow down the cause of the pruritus.

Phototherapy
Phototherapy can be considered under the guidance of a dermatologist. UV light phototherapy has been used to treat various pruritic symptoms such as pruritus resulting from renal disease, eczema, or just of unknown origin.

Anti-histamines/Anti-pruritic
First generation anti-histamines can be useful due to their sedating qualities in treating pruritus. However, the use is discouraged in elderly people because of their anticholinergic effects like constipation and dry mouth. Anticonvulsants like gabapentin have also found use as a substitute for oral antihistamines to treat senile pruritus, and can be adjusted accordingly to the individual needs and characteristics.

Soak and Smear Approach
Involves bathing for 15 minutes in a warm bath followed by applying a mixture of a topical steroid and heavy moisturizer (Aquaphor, Eucerin, etc.). Wrapping can be done onto the wet skin to maintain effectiveness of the treatment.