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PubMed2003

Pruritus: scratching the surface.

Patients who are jaundiced have an accumulation of bile acids in the plasma, which can cause intense irritation. Pruritus associated with cholestasis is a difficult problem; the pathogenesis remains unknown. In severe cases, it can lead to sleep deprivation and contribute to significant psychological disturbances. Patients who have pancreatic cancer with unrelieved jaundice often say the itching is the worst symptom. Typically patients are prescribed Chlorpheniramine, an antihistamine, and Choleystiramine, which binds bile salts in the bowel and helps to facilitate their excretion. Choleystiramine only works if biliary obstruction is incomplete; it is not very palatable and can cause diarrhoea. A review of the literature revealed that certain drugs not intended for the treatment of pruritus associated with malignant cholestasis eased the symptoms considerably. There was very little relating to skin care in the majority of articles dealing with pruritus. Twycross (1997, Introducing Palliative Care, pp. 112-114) stated that most patients with advanced cancer and pruritus may never need an antihistamine if given appropriate skin care and that drugs are of little use in isolation. A regime of skin care was devised with the main aim of keeping the skin moist and cool. Factors were identified that would alleviate or aggravate the skin surface. With prompt treatment, symptoms were reduced and in some cases eradicated completely. The information gained has led to the planning of a trial to determine efficacy of skin care management and different drug therapies to relieve debilitating pruritus when established treatments fail. Key points include: (1) treatment of pruritus associated with malignant disease is directed towards effective management of the underlying cause; (2) given the subjective nature of pruritus, it is poorly understood and management presents a challenging problem; and (3) effective skin management can help to alleviate debilitating symptoms. Certain drugs not intended for treatment of pruritus associated with malignant cholestasis have proven to be effective.

Biliary Tract Neoplasms↗
PubMed2003

A prospective trial of fungal colonization after laser resurfacing of the face: correlation between culture positivity and symptoms of pruritus.

BACKGROUND: After full-face laser resurfacing of the face, patients often complain of pruritus, which may be intense. It has been suggested that some cases of postresurfacing pruritus may be associated with subclinical fungal infection. OBJECTIVE: To determine whether intense pruritus after laser resurfacing of the face is correlated with simultaneous fungal growth of the treated skin. METHODS: Twelve adult female patients undergoing combined full-face laser resurfacing with CO2 and erbium:YAG lasers for chronic photodamage or acne scarring were enrolled in a prospective study. Fungal cultures were obtained by swabbing the facial skin of each patient immediately before, 3 days after, and 6 days after the laser procedure. At the same points in time, investigators completed objective assessments of the patients' facial skin, and patients reported the sensations that they were experiencing. RESULTS: Six patients (50%) complained of significant pruritus (3 or greater on a scale of 0 to 5). In four of the six cases (67%), at least one of the three fungal cultures obtained grew fungal organisms, including Candida albicans (2 cultures), Candida parapsilosis, Aureobasidium pullulans, and Fusarium species. In no instances did culture positivity occur in the absence of significant pruritus. A statistically significant relationship (P=0.0143) was found to exist between at least one of the three cultures being positive and the emergence of significant posttreatment pruritus. Physician ratings of clinical signs did not correlate with patient reports of pruritus, other symptoms, or culture positivity. CONCLUSION: Colonization or subclinical infection with fungi, particularly Candida spp., may be associated with significant postlaser resurfacing pruritus. Antifungal prophylaxis may mitigate this discomfort. Further research is required to confirm and expand these results.

Adolescent↗
PubMed2006

Therapeutic effect of topical gamma-linolenic acid on refractory uremic pruritus.

BACKGROUND: Pruritus is a bothersome symptom affecting up to 80% of dialysis patients. Lymphocyte and cytokine interaction has an important role in the pathogenesis of uremic pruritus. Gamma-linolenic acid (GLA) is associated with immune modulation of T lymphocytes and lymphokines. The aim of this study is to determine whether topical GLA can attenuate uremic pruritus. METHODS: Seventeen dialysis patients with refractory uremic pruritus who passed the screening criteria entered a prospective, randomized, double-blind, placebo-controlled, crossover study. They stopped all antipruritic therapy at least 2 weeks before the study and were randomly assigned to treatment with either GLA 2.2% cream or placebo-based cream applied to the entire body after taking a bath once a day and to pruritic sites 3 times a day for 2 weeks, and then the reverse treatment after a 2-week washout period. Severity of pruritus was evaluated by using a traditional visual analogue scale (VAS) and a modified questionnaire method (pruritus score [PS]). Hemogram, aspartate and alanine aminotransferases, bilirubin, albumin, blood urea nitrogen, creatinine, calcium, phosphate, and intact parathyroid hormone were measured. RESULTS: Sixteen patients completed the study; 1 patient was withdrawn because of an allergic skin reaction. There were no significant differences between groups except for sex distribution. Median VAS and PS values between groups did not differ significantly at baseline. There is a greater antipruritic effect of GLA based on evaluation with both the VAS and PS. There is persistence of a residual effect into the second treatment period after GLA treatment. CONCLUSION: GLA-rich cream is better than placebo-based cream for alleviating uremic pruritus. It is a useful adjuvant in the management of refractory uremic pruritus.

Administration, Topical↗
PubMed2001

Pruritus vulvae in prepubertal children.

BACKGROUND: Vulvar pruritus is a common complaint in females of all ages. However, little has been published on pruritus vulvae in children as a primary symptom. OBJECTIVE: Our purpose is to review the causes and treatments of vulvar pruritus in prepubertal girls and to retrospectively evaluate the causes and outcomes of the premenarchal children we studied. METHODS: The records of 44 premenarchal girls with vulvar pruritus were reviewed, and follow-up interviews were performed by telephone. RESULTS: Thirty-three patients (75%) had nonspecific pruritus. Lichen sclerosus, bacterial infections, yeast infection, and pinworm infestation were seen in a minority of patients. At follow-up, pruritus had cleared in 15 patients, been alleviated in 13, and remained the same in 4. CONCLUSION: Most of our patients had nonspecific pruritus, which was alleviated by or cleared with better hygiene and avoidance of irritants. In prepubertal girls, poor hygiene and irritants such as soap are major contributors to pruritus vulvae. All patients may benefit from following hygienic measures and irritant precautions in addition to specific therapy directed at underlying causes.

Adolescent↗
PubMed2004

Pruritus, personality traits and coping in long-term follow-up of burn-injured patients.

Pruritus is a major problem after burn injury; however, prevalence and predictors of prolonged pruritus are not known. The aims were to assess frequency of pruritus and the role of personality traits and coping in prolonged pruritus. The participants were burn patients injured 1-18 years earlier (n=248). Pruritus was assessed with an item from the Abbreviated Burn Specific Health Scale, personality was assessed with the Swedish universities Scales of Personality, and coping with the Coping with Burns Questionnaire. In all, 60% of the participants had pruritus at follow-up, however as the time after injury increased, the number of patients with persistent itch decreased. In logistic regression, 39% of the likelihood of having persistent pruritus was explained by greater extent of burn, less time after injury, and psychological features (being less assertive, and using more instrumental but less emotional support). In summary, chronic burn-related pruritus is rather common and psychological factors such as anxiety-related traits and coping are significantly associated with its presence.

Adaptation, Psychological↗
PubMed2006

Treatment of severe refractory pruritus with fractionated plasma separation and adsorption (Prometheus).

OBJECTIVE: Severe pruritus is a serious complication of cholestatic liver disease. Prometheus is a recently introduced extracorporeal liver support system with direct toxin adsorption of the patient's albumin fraction (FPSA; fractionated plasma separation and adsorption). Here we report on the effect of Prometheus therapy in patients with intractable cholestatic pruritus. MATERIAL AND METHODS: Seven patients with different liver diseases and severe pruritus refractory to all medical treatment efforts for more than 4 weeks were treated with Prometheus (3-5 times, 18+/-3 h total). Pruritus intensity was assessed using the visual analogue scale (VAS; from 0 = no pruritus to 10 = unbearable pruritus), and VAS, serum bile acids and total bilirubin were evaluated directly before and after Prometheus treatment, as well as 4 weeks later. RESULTS: After Prometheus therapy, VAS values had dropped significantly from 9+/-1 to 3+/-3 (p<0.001). Likewise, serum bile acids decreased (from 248+/-192 to 101+/-85 micromol/l; p<0.03). All patients, with the exception of one with no initial bile acid elevation, reported a pronounced improvement in pruritus with Prometheus therapy, although in two anicteric patients the amelioration lasted only a few days. In the other four patients a distinct benefit was still observed 4 weeks after the treatment. CONCLUSIONS: Prometheus therapy significantly improved refractory pruritus in all patients with elevated bile acid levels, but in some patients the clinical benefit was of short duration. The clinical findings suggest that we have to better characterize those patients who might derive a long-lasting benefit from this invasive and expensive treatment.

Adsorption↗
PubMed2006

Study of the prophylactic effect of droperidol, alizapride, propofol and promethazine on spinal morphine-induced pruritus.

BACKGROUND: We have compared the use of alizapride, propofol, droperidol and promethazine for the prevention of spinal morphine-induced pruritus. METHODS: Three hundred ASA I or II women undergoing Caesarean section under spinal anaesthesia, in which morphine 0.2 mg was added to a local anaesthetic, were assigned randomly to receive i.v., in the operating room, just after delivery of the baby, alizapride 100 mg, propofol 20 mg, droperidol 1.25 mg, promethazine 50 mg or saline 2 ml (control group). In the postoperative period, the women were assessed for pruritus (absent, mild, moderate or severe) or other untoward symptoms by blinded observers. We used 95% confidence limits (95% CI) for the cumulative incidence of moderate and severe pruritus to compare the groups, and the NNT and 95% CI to compare droperidol, propofol and alizapride as for their effectiveness in preventing pruritus. For other untoward effects, the chi(2)-test was used, results being considered significant when P<0.05. RESULTS: The droperidol, propofol and alizapride groups had significantly lower incidences of pruritus compared with the control and promethazine groups, while the incidence of pruritus was similar among the patients assigned to the promethazine and control groups. As for the prevention of moderate and severe pruritus, droperidol had the lowest NNT (3.52; 95% CI: 3.37-3.67), followed by propofol (4.61; 95% CI: 4.45-4.77) and alizapride (5.43; 95% CI: 5.27-5.59). As for untoward effects, droperidol and promethazine increased the incidence of somnolence, which seemed more severe with promethazine. Otherwise, there were no differences between the groups. CONCLUSION: Droperidol, propofol and alizapride, in a decreasing order of effectiveness in the doses used in this study, reduced the incidence of pruritus induced by the use of morphine 0.2 mg intrathecally. On the other hand, promethazine 50 mg was shown to be ineffective.

Adolescent↗
PubMed1996

Naloxone versus nalbuphine infusion for prophylaxis of epidural morphine-induced pruritus.

This randomized, double-blind study compared the efficacy of two mu-receptor antagonists, naloxone and nalbuphine, in the prophylactic management of pruritus in postcesarean section patients receiving epidural morphine. Dosages of study drugs were individualized by the use of a patient self-administration (PSA) device. All 51 patients were healthy women who received a uniform epidural anesthetic and epidural morphine (5 mg). Coded solutions were infused for 24 h, with 5-min PSA lockout times: Group A (n = 17), nalbuphine 2.5 mg/h, PSA nalbuphine 1 mg; Group B (n = 16), naloxone 50 micrograms/hr, PSA saline; Group C (n = 18), naloxone 50 micrograms/h, PSA naloxone 40 micrograms. Patients were assessed for pruritus and pain every 8 h for 24 h. Both naloxone and nalbuphine provided good relief for pruritus; median pain and pruritus scores were in the none-to-mild range (0-3) for all groups at all assessment intervals. The pruritus scores of the PSA saline group were higher during the 16- to 24-h period (P < 0.05) than the scores of either group receiving A-receptor antagonist by PSA. There was evidence of shortening of the duration of analgesia in patients receiving naloxone who required treatment for pruritus after 16 h. Patients who self-administered large doses of nalbuphine over the first 8 h also reported pain scores consistent with reversal of analgesia. The potency ratio for naloxone:nalbuphine for antagonism of the pruritic effects of epidural morphine was approximately 40:1. Intervention to treat either unrelieved pruritus or pain, respectively, was necessary in the following numbers of patients: Group A, 0/1; Group B, 1/1; Group C, 2/2. Prophylactic infusions offer the potential for labor cost savings by minimizing the need for episodic therapeutic interventions to treat pruritus.

Analgesia, Epidural↗
PubMed2002

Prophylactic ondansetron reduces the incidence of intrathecal fentanyl-induced pruritus.

UNLABELLED: We investigated the effectiveness of prophylactic IV ondansetron in preventing intrathecal fentanyl-induced pruritus. One-hundred-fifty ASA status I-II patients undergoing spinal anesthesia with 7-10 mg of hyperbaric bupivacaine and 25 micro g of fentanyl were randomized to receive ondansetron 8 mg IV or normal saline IV before the commencement of spinal anesthesia. Evaluations were performed every 15 min in the first hour after the injection of study drugs and at 1, 2, 3, 4, 5, and 6 h after the administration of the study drug. Statistical analysis was performed by using chi(2) tests and Student's t-test, as appropriate. The incidence of pruritus was significantly more frequent in the placebo group compared with the ondansetron group (68% versus 39%) (P = 0.001). Time to pruritus was similar in both groups (placebo group, 55 +/- 32 min versus ondansetron group, 50 +/- 31 min). Duration of pruritus was also similar in both groups (placebo group, 98 +/- 60 min versus ondansetron group, 103 +/- 58 min). Ondansetron prophylaxis significantly reduced the incidence of intrathecal fentanyl-induced pruritus in patients undergoing surgery under bupivacaine spinal anesthesia. IMPLICATIONS: Pruritus is a commonly reported side effect after intrathecal fentanyl administration during spinal anesthesia. This study was performed in a prospective, randomized, double-blinded, placebo-controlled manner to investigate the efficacy of prophylactic IV ondansetron in the prevention of pruritus after intrathecal fentanyl administration during spinal anesthesia. The incidence of pruritus was significantly more frequent in the placebo group compared with the ondansetron group (68% versus 39%) (P = 0.001).

Adult↗
PubMed2000

Long-term outcome after partial external biliary diversion for intractable pruritus in patients with intrahepatic cholestasis.

BACKGROUND: Chronic intrahepatic cholestasis is associated with severe pruritus that is often refractory to maximal medical management and leads to significantly impaired quality of life. The hypothesis in this study was that partial external biliary diversion (PEBD) can substantially improve intractable pruritus secondary to intrahepatic cholestasis with subsequent improvement of functional quality of life. METHODS: Parents' and/or patients' clinical rating of pruritus, growth percentiles, biochemical parameters, and liver biopsies performed before and after surgery were compared in a retrospective medical record review. RESULTS: Eight children underwent PEBD from 1990 through 1997. Complete follow-up data were available for seven patients. Before surgery, all patients had intense pruritus, which was not responsive to maximal medical therapy. Specimens obtained in preoperative liver biopsies showed moderate (n = 1), minimal (n = 6), or no (n = 1) portal fibrosis. After PEBD, all patients received ursodeoxycholic acid (10-15 mg/kg/dose two to three times daily) until resolution of pruritus. Of the seven patients with complete follow-up data, six had complete resolution of pruritus and sustained resolution up to 8 years after surgery. The patient with mild to moderate residual pruritus was the youngest to undergo PEBD. Growth improved from below the 5th percentile before surgery to the 5th through the 25th percentiles for five of six patients with more than 6 years' follow-up. All families reported improved quality of life, defined by school attendance and ability to resume normal activity with peers. There has been no clinical evidence of progression of liver disease. CONCLUSION: Partial external biliary diversion is effective in the long-term treatment of pruritus refractory to medical therapy and provides a favorable outcome in a select group of patients with chronic intrahepatic cholestasis without cirrhosis.

Bile Acids and Salts↗
PubMed1999

The pathogenesis and treatment of pruritus and fatigue in patients with PBC.

The pathogenesis of the pruritus that complicates cholestasis in patients with primary biliary cirrhosis (PBC) is uncertain. The limited and inconsistent efficacy of conventional empiric therapies, such as anion exchange resins and rifampicin, has led to inconclusive trials of invasive experimental therapies, such as plasmapheresis, charcoal haemoperfusion and partial external diversion of bile. However, some double-blind, placebo-controlled trials that used a subjective primary efficacy end-point (the perception of pruritus) have suggested that certain drugs that affect the metabolism of many compounds, for example rifampicin, may be efficacious. The potential mechanisms by which such drugs may mediate a beneficial effect have not been determined. There is a paucity of data to indicate whether peripheral events, such as the accumulation of bile acids in interstitial fluid of the skin, initiate the neural events which mediate this form of pruritus. Recent findings suggest that central events in the brain, specifically an increase in neurotransmission/ neuromodulation mediated by endogenous opioid agonists (increased opioidergic tone), may be implicated. This hypothesis is supported by three lines of evidence. (1) Opioid receptor ligands with agonist properties (e.g. morphine) mediate pruritus. (2) Endogenous opioid-mediated neurotransmission/neuromodulation in the central nervous system (CNS) is increased in cholestasis. (3) Controlled trials have shown that opiate antagonists induce ameliorations of the behavioural consequence of the pruritus of cholestasis (scratching activity). In such trials, measurements of scratching activity independent of limb movements constituted an objective quantitative primary efficacy end-point. Potent opiate antagonists, that are bioavailable when given by mouth, such as nalmefene and naltrexone, may have a place in the long-term management of pruritus in patients with PBC. Evidence that increased serotoninergic neurotransmission also contributes to the pruritus is at present less strong than that implicating an involvement of the opioid system, and further investigation is needed to determine whether specific serotonin receptor subtype ligands have a place in the treatment of pruritus in patients with PBC. There is some evidence which suggests that increased serotoninergic neurotransmission in the CNS contributes to fatigue of central origin, but whether there is a causal relationship between altered serotoninergic neurotransmission and the profound fatigue that occurs in many patients with PBC is currently uncertain.

Animals↗
PubMed1998

Pruritus gravidarum: a clinical and laboratory study.

Five hundred pregnant women attending obstetrics OPD were screened for the presence of pruritus. The patients with other dermatological causes of pruritus (other than specific dermatosis of pregnancy) were excluded from the study. The selected patients were further subjected to routine laboratory investigations including liver function tests and IIBs Ag detection. The prevalence of pruritus in pregnancy was found to be 4.6% (23 cases). Ten patients were found to have specific dermatoses of pregnancy, including four cases of pruritus gravidarum and four of pruritic urticarial papules and papules of pregnancy. The prevalence of pruritus gravidarum was 0.8% of pregnancies. All the patients with pruritus gravidarum were primigravidae and had no clinical overlap with other specific dermatoses of pregnancy, jaundice, or intrahepatic cholestasis. One case of perinatal death was recorded among the pruritus gravidarum cases. This study has been helpful in determining the prevalence and severity of pruritus gravidarum in South India.

Adult↗
PubMed2005

A controlled trial of ondansetron in the pruritus of cholestasis.

BACKGROUND: In patients with pruritus of cholestasis, response to conventional drug treatment may be unsatisfactory. Activation of 5-hydroxytryptamine receptors on dermal sensory nerve-endings plays a role in the perception of pruritus. The 5-hydroxytryptamine(3) receptor antagonist, ondansetron, has been used in the treatment of pruritus of cholestasis, but there are few controlled data. AIM: To determine whether ondansetron is effective in treating the pruritus of cholestasis. METHODS: A total of 19 patients with resistant pruritus were randomized, double blind, to receive either ondansetron 8 mg or placebo as a single intravenous bolus, followed by oral ondansetron 8 mg or placebo twice daily for 5 days. Patients' perception of pruritus was recorded hourly using a visual analogue scale, and scratching activity measured by means of a piezo-electric crystal attached to the fingernail. RESULTS: Mean pruritus score using visual analogue scale and scratching activity were reduced on the first treatment day compared with baseline in both the ondansetron and placebo groups (P < 0.05), but there were no significant differences in mean pruritus perception or scratching activity between the two groups. CONCLUSION: Ondansetron was of no benefit in this group of pruritic patients during short-term treatment.

Adult↗
PubMed1991

Elevated plasma histamine in chronic uremia. Effects of ketotifen on pruritus.

A role for histamine in the pathogenesis of uremic pruritus was investigated in maintenance hemodialysis patients. Venous plasma histamine levels, as determined by radioenzymatic assay, were significantly higher (p less than 0.05) in hemodialysis patients with pruritus (368 +/- 103 pg/ml [mean +/- SEM], n = 6) than in those without pruritus (146 +/- 22 pg/ml, n = 5) and in normal controls (142 +/- 16, n = 5). Arteriovenous fistula histamine levels (202 +/- 52 pg/ml, n = 6) were significantly lower (p less than 0.05) than simultaneously drawn venous samples. Markedly elevated histamine-degrading enzyme (histaminase) activities were found in both hemodialysis patients with (2.95 +/- 0.18 pg histamine degraded/minute) and without (2.44 +/- 0.28) pruritus, but was undetectable in normal controls. Histaminase activities did not significantly differ in simultaneously drawn venous and fistula samples. With hemodialysis, histaminase activities fell significantly (p less than 0.01), whereas plasma histamine did not change. We further examined the effects of ketotifen, a putative mast cell stabilizer, on severe uremic pruritus. Five of five patients had significant (p less than 0.01) reductions in pruritus, as judged on a six-point pruritus index, after 8 weeks of drug (x = 2.3), as compared to conventional therapy (x = 5.9). Despite these improvements, no significant differences were noted in pre- versus post-drug plasma histamine levels, histaminase activities, or the histamine content per gram of skin biopsy specimen. These data support prior hypotheses that mast cell activation contributes to the pruritus of uremia.

Chronic Disease↗
PubMed2005

Prophylactic intravenous ondansetron and dolasetron in intrathecal morphine-induced pruritus: a randomized, double-blinded, placebo-controlled study.

Pruritus is the most common side effect of intrathecal morphine for postoperative pain relief. Activation of central 5-hydroxytryptamine subtype 3 (5-HT3) receptors is one of its possible mechanisms. The role of 5-HT3 antagonists in the prevention of pruritus has not been clearly established. In a prospective, randomized, double-blind, placebo-controlled study, we evaluated the efficacy of prophylactic administration of ondansetron and dolasetron for the prevention of intrathecal morphine-induced pruritus. The patients were randomized into 3 groups to receive either 4 mg ondansetron IV (group O, n = 35), 12.5 mg dolasetron IV (group D, n = 35) or 5 mL placebo (group P, n = 35) 30 min before administration of spinal anesthesia with 10 to 17.5 mg of 0.5% hyperbaric bupivacaine and 0.25 mg of morphine for urologic, orthopedic, or vascular surgery. Patients were evaluated for incidence and severity of pruritus at arrival to the postanesthesia care unit and at 2, 4, 8, and 24 h postoperatively. The incidence and severity of pruritus was significantly less frequent in the ondansetron and dolasetron groups compared with placebo (34%, 20%, and 66% respectively, P < 0.01). Patients who received 5-HT3 antagonist reported significantly less total severity of pruritus compared with placebo during the first 8 h and the severe pruritus was observed only in patients within P group (P group: 4 of 35; 11%, O or D group: 0 of 35; 0%, P < 0.05). We conclude that the prophylactic use of ondansetron and dolasetron helps to reduce the incidence and severity of intrathecal morphine-induced pruritus.

Adult↗
PubMed2006

Uremic pruritus is associated with higher kt/V and serum calcium concentration.

BACKGROUND: The prevalence and characteristics of uremic pruritus have not recently been investigated in a US dialysis cohort. This study examined uremic pruritus and associated risk factors in hemodialysis patients treated in the year 2005. METHODS: The prevalence and characteristics of pruritus (short version McGill pain questionnaire), severity (10 cm visual analogue scale), and effect on quality of life (Skindex-16) were determined in thrice weekly hemodialysis patients. Daugirdas single-pool Kt/V, clinical and laboratory data were recorded. RESULTS: 105 of 307 screened hemodialysis patients met inclusion criteria and were evaluated, 49% (151) were excluded due to advanced age, 3% (9) other skin diseases, and 14% (42) refused. Participants were 55% male (58/105) and 65% African-American (68) with a mean +/- SD age of 48 +/- 11 years. The overall prevalence of pruritus was 57% (60/105, 95% CI 47 - 67%) and a positive correlation was observed between the presence of uremic itch and serum calcium concentration (p = 0.04). Intact PTH and serum phosphorus concentration were not associated with either the presence or intensity of itch. Intensity of pruritus was positively correlated with increasing months on dialysis (64 +/- 63 vs. 51 +/- 46 months for itch and non-itch, respectively; p = 0.02), higher Kt/V (1.82 +/- 0.7 vs. 1.70 +/- 0.56 for itch and non-itch, respectively; p = 0.01) and skin dryness (p = 0.01). Patients receiving statins were significantly less likely to report pruritus (p = 0.02) and uremic itch adversely impacted several aspects of quality of life. CONCLUSIONS: Pruritus remains a common and significant symptom in adequately hemodialyzed patients. Higher serum calcium concentrations, longer durations of ESRD and higher Kt/V appear to be important factors associated with uremic pruritus.

Adult↗
PubMed2003

[Hemodialysis-related pruritus. A study of 134 Moroccans ].

The prevalence of pruritus varies from 60% to 90% in patients receiving hemodialysis. The aim to this study was to evaluate the frequency of pruritus and its characteristics among moroccan patients receiving hemodialysis. Pruritus related to primary skin disease or other identified cause than chronic renal failure was excluded. Biological parameters were compared between patients with pruritus and those without. Pruritus occurred in 74.4% of hemodialysis patients and concerned 66 men and 68 women, mean age 44.8 + 14 years. Duration of hemodialysis varied between 5 months to 10 years. Main characteristics of pruritus were a general pattern in 70%, moderate intensity in 50%, appearance after dialysis in 81.2% and severe psychologic repercussion in 20.8%. Antihistamines first-line treatment was rarely effective. UVB radiation used in 7 cases leaded to a marked improvement. This study underlined the high frequency of pruritus in moroccan patients with chronic renal failure on maintenance hemodialysis. Hemodialysis can initiate this symptom as well as improve it. Biological parameters were not different between patients with or without pruritus. It also pointed out on therapeutic challenges. However, UVB radiation seems to be an effective therapy in intractable itching as well as increased frequency of weekly courses of hemodialysis. Long term skin hydratation should be also highly recommended.

Adult↗
PubMedDate not supplied

Frequency and aetiology of pruritus in admitted patients in a medical ward of Mayo Hospital, Lahore.

BACKGROUND: Prutitis or itching is a common complaint. It can be due to many dermatological and medical illnesses. This study was conducted to find out presence of pruritus in different diseases in patients admitted in a medical ward and to determine whether pruritus is more common due to medical causes or dermatological causes. METHODS: All patients admitted in North Medical Ward, Mayo Hospital, Lahore during March 2002 to November 2002 were included in the study. Complete medical history especially history of pruritus was taken. Physical examination was performed to diagnose the primary illness and to find cause of pruritus when present. RESULTS: 740 patients were included in the study. Sixty (8.1%) patients complained of pruritus. 5.4% had pruritus due to skin conditions. 2.7% had pruritus due to medical illnesses. CONCLUSION: The patients admitted in medical ward are having pruritus mainly due to medical diseases but skin conditions should not be ignored.

Female↗