Chronic Pruritus in the Elderly: Pathophysiology, Diagnosis and Management

Abstract

Chronic itch in the elderly is a common problem, with a significant impact on quality of life and sleep in elderly patients. Chronic itch may be attributable to several causes, including dry skin, immunosenescence and neural degeneration. Itch may also be caused by skin diseases, such as seborrhoeic dermatitis and stasis dermatitis; systemic conditions, such as end-stage renal disease and diabetes; and psychogenic conditions, such as depression and anxiety. The use of polypharmacy may also cause itch, with or without a rash. Specifically, thiazides and calcium channel blockers have been known to cause itch in elderly patients. Management should be tailored according to the underlying dermatological or systemic aetiology of itch. Topical treatment is the mainstay of therapy, providing special emphasis on skin hydration and barrier repair. In addition, topical and oral medications that target the nervous system and reduce neuronal hypersensitization, such as gabapentin and selective antidepressants, have a role in treating patients with severe chronic itch. Furthermore, management must account for changes in metabolism and pharmacokinetics of drugs in the aging population in order to prevent the occurrence of adverse effects.

Immune dysregulation underlies a subset of patients with chronic idiopathic pruritus

“…Chronic pruritus is a highly debilitating condition that disproportionately affects the elderly, many of whom experience chronic idiopathic pruritus (CIP), or itch of unknown origin lasting greater than six weeks [1, 2]. Multiple factors are believed to underlie CIP, including aging-associated skin barrier dysfunction, sensory neuropathy, and immunosenescence, the waning of immune function that results in an “allergic,” T helper type 2 (Th2) cell response [1, 2].…”

“…Multiple factors are believed to underlie CIP, including aging-associated skin barrier dysfunction, sensory neuropathy, and immunosenescence, the waning of immune function that results in an “allergic,” T helper type 2 (Th2) cell response [1, 2]. However, the immunologic profile of CIP patients remains poorly understood.…”

Efficacy of a Rhealba® Oat Extract‐based emollient on chronic pruritus in elderly French outpatients

“…Chronic pruritus in the elderly appears to be due to age‐related changes in skin barrier function, immunosenescence, and changes in neurological and psychological function . Xerosis (dry skin), which can affect more than half of adults 65 years of age and older, has been proposed to be the main underlying cause of chronic pruritus . Other common causes include dermatological disorders and systemic, neurodegenerative and psychological illnesses.…”

“…Emollients are recommended as the first‐line approach for chronic pruritus in the elderly . However, there is little published clinical evidence supporting the use of specific products.…”

A New Dermocosmetic Balm for the Management of Xerosis: Results from a Non-Interventional, Non-Comparative, Prospective Multicenter Study

“…In general, dry skin is dull and tight, and in very dry skin and in the elderly, it is often combined with pruritus. 10,11 Chronic pruritus frequently leads to mechanical reactions such as scratching, rubbing or pinching. Scratching may induce variable types of damage to the skin including excoriations, crusts, lichenification, papules and nodules.…”