Diagnosis and management of chronic pruritus: An expert consensus review

Abstract

The aim of this study is to formulate the best clinical practice in the diagnosis and management of chronic pruritus (CP). We searched PubMed, EMBASE, Scopus, Web of Science, and the WHO's regional databases, for studies on “Diagnosis and management of chronic pruritus” from January 1, 2014, to July 31, 2015. We included programmatic reports and hand-searched references of published reviews and articles. Two independent reviewers screened articles and extracted data. We screened 87 of 95 studies that contained qualitative data. Avoid: Dry climate, heat, alcohol compress, ice packs, frequent bathing and washing, intake of very hot and spicy food, intake of alcohol, contact with irritant substances, excitement, strain and stress, and allergens. Using: Mild nonalkaline soaps, moisturizers, bathing oils, lukewarm water while bathing, soft cotton clothing and night creams/lotions, relaxation therapy, autogenic training, psychosocial education, educating patients to cope with itching and scratching, and educational programs. Especially use of moisturizers is considered important. In addition, symptomatic treatment options include systemic H1 antihistamines and topical corticosteroids. Symptomatic therapy directed toward the cause (hepatic, renal, atopic, polycythemia, etc.). If refractory or cause is unknown, consider capsaicin, calcineurin inhibitors for localized pruritus and naltrexone, pregabalin, ultraviolet therapy, Cyclosporine for generalized itching. CP is quite frequent finding associated with skin and systemic diseases in the overall population. It is known to significantly affect quality life score of an individual and also adds burden on the health-care cost. A specific recommendation for treatment of CP is difficult as a result of varied and diverse possibility of underlying diseases associated with CP.

Validation of ‘ItchApp©’ in Poland and in the USA: multicentre validation study of an electronical diary for the assessment of pruritus

“…Despite the fact that CP affects 16–23% in the general population, a specific treatment that successfully eliminates the desire to scratch is still needed . The assessment of pruritus in randomized controlled trials (RCTs) remains difficult due to its subjectivity and diversity . A uniform instrument for recording subjects’ itch intensities is still missing .…”

“…6 The assessment of pruritus in randomized controlled trials (RCTs) remains difficult due to its subjectivity and diversity. 7,8 A uniform instrument for recording subjects' itch intensities is still missing. 7,9 Validated measurement instruments allow for the assessment of the most important study outcomes like quality of life and pruritus intensity.…”

“…7,8 A uniform instrument for recording subjects' itch intensities is still missing. 7,9 Validated measurement instruments allow for the assessment of the most important study outcomes like quality of life and pruritus intensity. 3,6 The most frequently used validated instruments to assess pruritus intensity are the visual analog scale (VAS) and the numerical rating scale (NRS), 8,10,11 and the ItchyQoL is used for measuring the impairment of quality of life in patients with CP.…”

Skin prick test for the evaluation of patients with idiopathic generalized pruritus: preliminary results

“…Pruritus is the unpleasant sensation that leads to scratching and irritation of the skin [1]. Pruritus may be generalized or localized [2].…”

Randomized Controlled Study Comparing the Efficacy and Tolerance of Bepotastine, a New 2nd Generation Antihistamine, to Fexofenadine, in Symptomatic Relief of Patients with Pruritic Cutaneous Disorders

“…Pruritis is a common symptom, of many skin conditions like chronic urticaria, eczema, atopic dermatitis, psoriasis, as well as skin infections which can greatly impair the patient's day to day functioning [1]. Itching maybe associated with redness (erythema), and in case of urticaria, also wheals and sometimes angioedema [2,3].…”