1 / 22

pruritus

pruritus. By:Dr Neda adibi Researcher and dermatologist in IUMS. pruritus. The pruritus is an unpleasant sensation which may lead to scratch The most common complaint in dermatology With or without skin lesion Can be a manifestation of systemic disease(10-50%). Systemic etiology like:

abiba
Download Presentation

pruritus

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. pruritus By:Dr Neda adibi Researcher and dermatologist in IUMS

  2. pruritus • The pruritus is an unpleasant sensation which may lead to scratch • The most common complaint in dermatology • With or without skin lesion • Can be a manifestation of systemic disease(10-50%)

  3. Systemic etiology like: • Metabolic disorder,hematologic disease,malignancy ,HIV,complication of pharmacologic agents,neuropsychiatry disease

  4. Prevalance in systemic disease • Psoriasis <85% • ESRD 60-80% • CTCL 70-80% • Hodgkin 10-30% • Pregnanacy 20% • Herpes zooster 60%

  5. Hx • Localized or generalized lesion is not predictive or systemic disease • Acute onset ,without skin lesion less likely to be systemic • Butterfly sign:sparing of the upper mid back may rule out skin problems (it may be psychogenic or systemic)

  6. Most non dermatologic pruritic patients show only excoriation but not primary lesion • Urticaria and mastocytosis have rubbing and pressing not scratching • Involvement of several family members may be due to scabies • Exacerbation after bath may be due to polycytemia or aquagenic pruritus

  7. Nocturnal generalized pruritus,chill and fever may detect hodgkin (pruritus may be up to 5 year before lymphoma) • Most pruritus interferes with sleep except psychogenic

  8. Carefull examination of nail,scalp,hair and lymph node ,liver and spleen • No geneneral need for LAB • Generalized pruritus of unknown etiology • ESR,CBCdiff ,LFT,FBS,TFT,fe and ferritin • Stool for parasite • CXR

  9. Priritus in dermatologic disease • Scabies:local or general with a burning component,starts 3-6 week after first infestation • Pediculosis • Atopic disease :attacks-heat,perspiration,wool,stress,contact with air may provoke • Summer type and winter type

  10. Patients with psoriasis y for rarely respond to antihistamines • Prurigo nodularis:more in middle aged women • Atopy,psychological stress , may be underlying • Most effective treatment is thalidomide • 200 mg/d for at least 6 months

  11. Aquagenic pruritus • It is independent of water temperature or its salinity • It starts 30 minute following water contact and lasts for 2 hours • Begin in lower extremity and then generalized with sparing of head ,palm,sole and mucosa • Treatment cimetidine,colestiramin cyproheptadin,PUVA,UVB,topical capcaiecin two times per week for 4 week

  12. infection • Folliculitis and impetigo may cause pruritus • HSV,varicella,HIV and viral exanthems

  13. Pruritus in aged skin • DM,hepatic dysfunction,renal dysfunction and tyroid problem • Polypharmacy • Lice and scabies • Most common cause is xerosis

  14. Decrease the frequency of cold and hot bath and alkaline soap • Decrease the frequency of bath • Moisturizers • Post CVA using amitriptelyne and carbamazepin

  15. Pruritus Ani • 1-5 % of people more in men • 25-90 % are primary • Cause:dietary like excessive coffee intake,poor heigiene,psychogenic • Rule out of anxiety and depression,patch test,colonoscopy in refractive cases • pinworm in children

  16. Treat with cool compress,sitz bath,fragrance free soap,mild corticosteroid cream • Topical capcaiecin

  17. Pruritus vulvi and scroti • Acute:infection and ACD and ICD • Chronic:dermatosis like psoriasis ,LSA,malignancy

  18. Scalp folliculitis seborhoeic dermatitis,psoriasis and folliculitis • Wound healing may cause pruritus • Post burn pruritus • Renal failure:gabapentine ,ranal transplant • Hepatic diseas

  19. hematologic • Myelodysplasia • Iron defficiency • Polycythemia • Lymphoma and lukemia

  20. endocrine • Thyroid disease • Diabetes:genital and perianal pruritus is common in women with uncontrolled diabetes • HIV

  21. Drug related:estrogen,captopril,co amoxiclav,phenytoin,beta blockers,retinoid.,lithium

  22. treatment • Topical like corticosteroid,menthol,coal tar and anasthetics ,urea. • Topical doxepin • Capcaiecin • Tacrolimus and pimecrolimus • PUVA and UVB

More Related