Pruritus and Systemic Disease Differential Diagnoses
- Author: David F Butler, MD; Chief Editor: Dirk M Elston, MD more...
Cho YL, Liu HN, Huang TP, Tarng DC. Uremic pruritus: roles of parathyroid hormone and substance P. J Am Acad Dermatol. Apr 1997;36(4):538-43. [Medline].
Cowden JM, Zhang M, Dunford PJ, Thurmond RL. The histamine H4 receptor mediates inflammation and pruritus in Th2-dependent dermal inflammation. J Invest Dermatol. Apr 2010;130(4):1023-33. [Medline].
Chou FF, Ho JC, Huang SC, Sheen-Chen SM. A study on pruritus after parathyroidectomy for secondary hyperparathyroidism. J Am Coll Surg. Jan 2000;190(1):65-70. [Medline].
Hampers CL, Katz AI, Wilson RE, Merrill JP. Disappearance of "uremic" itching after subtotal parathyroidectomy. N Engl J Med. Sep 26 1968;279(13):695-7. [Medline].
Massry SG, Popovtzer MM, Coburn JW, Makoff DL, Maxwell MH, Kleeman CR. Intractable pruritus as a manifestation of secondary hyperparathyroidism in uremia. Disappearance of itching after subtotal parathyroidectomy. N Engl J Med. Sep 26 1968;279(13):697-700. [Medline].
Graf H, Kovarik J, Stummvoll HK, Wolf A. Disappearance of uraemic pruritus after lowering dialysate magnesium concentration. Br Med J. Dec 8 1979;2(6203):1478-9. [Medline].
Kyriazis J, Glotsos J. Dialysate calcium concentration ofNephron. Jan 2000;84(1):85-6. [Medline].
Hundley JL, Yosipovitch G. Mirtazapine for reducing nocturnal itch in patients with chronic pruritus: a pilot study. J Am Acad Dermatol. Jun 2004;50(6):889-91. [Medline].
Demierre MF, Taverna J. Mirtazapine and gabapentin for reducing pruritus in cutaneous T-cell lymphoma. J Am Acad Dermatol. Sep 2006;55(3):543-4. [Medline].
Yosipovitch G, Maibach HI, Rowbotham MC. Effect of EMLA pre-treatment on capsaicin-induced burning and hyperalgesia. Acta Derm Venereol. Mar 1999;79(2):118-21. [Medline].
Kuypers DR, Claes K, Evenepoel P, Maes B, Vanrenterghem Y. A prospective proof of concept study of the efficacy of tacrolimus ointment on uraemic pruritus (UP) in patients on chronic dialysis therapy. Nephrol Dial Transplant. Jul 2004;19(7):1895-901. [Medline].
Chen YC, Chiu WT, Wu MS. Therapeutic effect of topical gamma-linolenic acid on refractory uremic pruritus. Am J Kidney Dis. Jul 2006;48(1):69-76. [Medline].
Boardman LA, Cooper AS, Blais LR, Raker CA. Topical gabapentin in the treatment of localized and generalized vulvodynia. Obstet Gynecol. Sep 2008;112(3):579-85. [Medline].
Blachley JD, Blankenship DM, Menter A, Parker TF 3rd, Knochel JP. Uremic pruritus: skin divalent ion content and response to ultraviolet phototherapy. Am J Kidney Dis. May 1985;5(5):237-41. [Medline].
Gilchrest BA, Rowe JW, Brown RS, Steinman TI, Arndt KA. Ultraviolet phototherapy of uremic pruritus. Long-term results and possible mechanism of action. Ann Intern Med. Jul 1979;91(1):17-21. [Medline].
Giovannetti S, Barsotti G, Cupisti A, et al. Oral activated charcoal in patients with uremic pruritus. Nephron. 1995;70(2):193-6. [Medline].
Hiroshige K, Kabashima N, Takasugi M, Kuroiwa A. Optimal dialysis improves uremic pruritus. Am J Kidney Dis. Mar 1995;25(3):413-9. [Medline].
Pederson JA, Matter BJ, Czerwinski AW, Llach F. Relief of idiopathic generalized pruritus in dialysis patients treated with activated oral charcoal. Ann Intern Med. Sep 1980;93(3):446-8. [Medline].
Zucker I, Yosipovitch G, David M, Gafter U, Boner G. Prevalence and characterization of uremic pruritus in patients undergoing hemodialysis: uremic pruritus is still a major problem for patients with end-stage renal disease. J Am Acad Dermatol. Nov 2003;49(5):842-6. [Medline].
Jedras M, Zakrzewska-Pniewska B, Wardyn K, Switalski M. [Uremic neuropathy--II. Is pruritus in dialyzed patients related to neuropathy?]. Pol Arch Med Wewn. Jun 1998;99(6):462-9. [Medline].
Silva SR, Viana PC, Lugon NV, Hoette M, Ruzany F, Lugon JR. Thalidomide for the treatment of uremic pruritus: a crossover randomized double-blind trial. Nephron. 1994;67(3):270-3. [Medline].
Legroux-Crespel E, Cledes J, Misery L. A comparative study on the effects of naltrexone and loratadine on uremic pruritus. Dermatology. 2004;208(4):326-30. [Medline].
Pauli-Magnus C, Mikus G, Alscher DM, et al. Naltrexone does not relieve uremic pruritus: results of a randomized, double-blind, placebo-controlled crossover study. J Am Soc Nephrol. Mar 2000;11(3):514-9. [Medline].
Balaskas EV, Uldall RP. Erythropoietin treatment does not improve uremic pruritus. Perit Dial Int. 1992;12(3):330-1. [Medline].
De Marchi S, Cecchin E, Villalta D, Sepiacci G, Santini G, Bartoli E. Relief of pruritus and decreases in plasma histamine concentrations during erythropoietin therapy in patients with uremia. N Engl J Med. Apr 9 1992;326(15):969-74. [Medline].
Manenti L, Vaglio A, Costantino E, et al. Gabapentin in the treatment of uremic itch: an index case and a pilot evaluation. J Nephrol. Jan-Feb 2005;18(1):86-91. [Medline].
Dawn AG, Yosipovitch G. Butorphanol for treatment of intractable pruritus. J Am Acad Dermatol. Mar 2006;54(3):527-31. [Medline].
Kumagai H, Ebata T, Takamori K, Muramatsu T, Nakamoto H, Suzuki H. Effect of a novel kappa-receptor agonist, nalfurafine hydrochloride, on severe itch in 337 haemodialysis patients: a Phase III, randomized, double-blind, placebo-controlled study. Nephrol Dial Transplant. Apr 2010;25(4):1251-7. [Medline].
Cynamon HA, Andres JM, Iafrate RP. Rifampin relieves pruritus in children with cholestatic liver disease. Gastroenterology. Apr 1990;98(4):1013-6. [Medline].
Ghent CN, Carruthers SG. Treatment of pruritus in primary biliary cirrhosis with rifampin. Results of a double-blind, crossover, randomized trial. Gastroenterology. Feb 1988;94(2):488-93. [Medline].
Bergasa NV, Alling DW, Talbot TL, et al. Effects of naloxone infusions in patients with the pruritus of cholestasis. A double-blind, randomized, controlled trial. Ann Intern Med. Aug 1 1995;123(3):161-7. [Medline].
Peer G, Kivity S, Agami O, et al. Randomised crossover trial of naltrexone in uraemic pruritus. Lancet. Dec 7 1996;348(9041):1552-4. [Medline].
Terg R, Coronel E, Sorda J, Munoz AE, Findor J. Efficacy and safety of oral naltrexone treatment for pruritus of cholestasis, a crossover, double blind, placebo-controlled study. J Hepatol. Dec 2002;37(6):717-22. [Medline].
Wolfhagen FH, Sternieri E, Hop WC, Vitale G, Bertolotti M, Van Buuren HR. Oral naltrexone treatment for cholestatic pruritus: a double-blind, placebo-controlled study. Gastroenterology. Oct 1997;113(4):1264-9. [Medline].
Bergasa NV, Alling DW, Talbot TL, Wells MC, Jones EA. Oral nalmefene therapy reduces scratching activity due to the pruritus of cholestasis: a controlled study. J Am Acad Dermatol. Sep 1999;41(3 Pt 1):431-4. [Medline].
Palma J, Reyes H, Ribalta J, et al. Ursodeoxycholic acid in the treatment of cholestasis of pregnancy: a randomized, double-blind study controlled with placebo. J Hepatol. Dec 1997;27(6):1022-8. [Medline].
Roncaglia N, Locatelli A, Arreghini A, et al. A randomised controlled trial of ursodeoxycholic acid and S-adenosyl-l-methionine in the treatment of gestational cholestasis. BJOG. Jan 2004;111(1):17-21. [Medline].
Bellmann R, Feistritzer C, Zoller H, et al. Treatment of intractable pruritus in drug induced cholestasis with albumin dialysis: a report of two cases. ASAIO J. Jul-Aug 2004;50(4):387-91. [Medline].
Bellmann R, Graziadei IW, Feistritzer C, et al. Treatment of refractory cholestatic pruritus after liver transplantation with albumin dialysis. Liver Transpl. Jan 2004;10(1):107-14. [Medline].
Hernandez-Nunez A, Dauden E, Cordoba S, Aragues M, Garcia-Diez A. Water-induced pruritus in haematologically controlled polycythaemia vera: response to phototherapy. J Dermatolog Treat. Jun 2001;12(2):107-9. [Medline].
Morison WL, Nesbitt JA 3rd. Oral psoralen photochemotherapy (PUVA) for pruritus associated with polycythemia vera and myelofibrosis. Am J Hematol. Apr 1993;42(4):409-10. [Medline].
Finelli C, Gugliotta L, Gamberi B, Vianelli N, Visani G, Tura S. Relief of intractable pruritus in polycythemia vera with recombinant interferon alfa. Am J Hematol. Aug 1993;43(4):316-8. [Medline].
Gonçalves F. Thalidomide for the Control of Severe Paraneoplastic Pruritus Associated With Hodgkin's Disease. Am J Hosp Palliat Care. Mar 15 2010;[Medline].
Adams SJ. Iron deficiency and other hematological causes of generalized pruritus. In: Itch: Mechanisms and Management of Pruritus. 1994:243-50.
Bergasa NV. Pruritus in chronic liver disease: mechanisms and treatment. Curr Gastroenterol Rep. Feb 2004;6(1):10-6. [Medline].
Bernhard JD. Endocrine and metabolic itches. In: Itch: Mechanisms and Management of Pruritus. 1994:251-60.
Bernhard JD. General principles, overview, and miscellaneous treatments of itching. In: Itch: Mechanisms and Management of Pruritus. 1994:367-81.
Browning J, Combes B, Mayo MJ. Long-term efficacy of sertraline as a treatment for cholestatic pruritus in patients with primary biliary cirrhosis. Am J Gastroenterol. Dec 2003;98(12):2736-41. [Medline].
Carmichael AJ. Renal itch. In: Itch: Mechanisms and Management of Pruritus. 1994:217-28.
Carmichael AJ, McHugh MI, Martin AM. Renal itch as an indicator of poor outcome. Lancet. May 18 1991;337(8751):1225-6. [Medline].
Diehn F, Tefferi A. Pruritus in polycythaemia vera: prevalence, laboratory correlates and management. Br J Haematol. Dec 2001;115(3):619-21. [Medline].
Ghent CN. Cholestatic pruritus. In: Itch: Mechanisms and Management of Pruritus. 1994:229-42.
Goldman BD, Koh HK. Pruritus and malignancy. In: Itch: Mechanisms and Management of Pruritus. 1994:299-319.
Jackson N, Burt D, Crocker J, Boughton B. Skin mast cells in polycythaemia vera: relationship to the pathogenesis and treatment of pruritus. Br J Dermatol. Jan 1987;116(1):21-9. [Medline].
Jones EA, Neuberger J, Bergasa NV. Opiate antagonist therapy for the pruritus of cholestasis: the avoidance of opioid withdrawal-like reactions. QJM. Aug 2002;95(8):547-52. [Medline].
Kantor GR. Diagnostic evaluation of the patient with generalized pruritus. In: Itch: Mechanisms and Management of Pruritus. 1994:337-46.
Krajnik M, Zylicz Z. Understanding pruritus in systemic disease. J Pain Symptom Manage. Feb 2001;21(2):151-68. [Medline].
Lebwohl M. Mechanisms and Management of Pruritus. In: Itch: Phototherapy of pruritus. 1994:399-411.
Lidstone V, Thorns A. Pruritus in cancer patients. Cancer Treat Rev. Oct 2001;27(5):305-12. [Medline].
Lonsdale-Eccles A, Carmichael AJ. Treatment of pruritus associated with systemic disorders in the elderly: a review of the role of new therapies. Drugs Aging. 2003;20(3):197-208. [Medline].
Matsumoto M, Ichimaru K, Horie A. Pruritus and mast cell proliferation of the skin in end stage renal failure. Clin Nephrol. Jun 1985;23(6):285-8. [Medline].
Mettang T, Pauli-Magnus C, Alscher DM. Uraemic pruritus--new perspectives and insights from recent trials. Nephrol Dial Transplant. Sep 2002;17(9):1558-63. [Medline].
Moses S. Pruritus. Am Fam Physician. Sep 15 2003;68(6):1135-42. [Medline].
Mullally BA, Hansen WF. Intrahepatic cholestasis of pregnancy: review of the literature. Obstet Gynecol Surv. Jan 2002;57(1):47-52. [Medline].
Neiman RS, Bischel MD, Lukes RJ. Uraemia and mast-cell proliferation. Lancet. Apr 29 1972;1(7757):959. [Medline].
Sarifakioglu E, Gumus II. Efficacy of topical pimecrolimus in the treatment of chronic vulvar pruritus: a prospective case series--a non-controlled, open-label study. J Dermatolog Treat. 2006;17(5):276-8. [Medline].
Schwartz IF, Iaina A. Management of uremic pruritus. Semin Dial. May-Jun 2000;13(3):177-80. [Medline].
Schwartz IF, Iaina A. Uraemic pruritus. Nephrol Dial Transplant. Apr 1999;14(4):834-9. [Medline].
Stander S, Steinhoff M, Schmelz M, Weisshaar E, Metze D, Luger T. Neurophysiology of pruritus: cutaneous elicitation of itch. Arch Dermatol. Nov 2003;139(11):1463-70. [Medline].
Stockenhuber F, Kurz RW, Sertl K, Grimm G, Balcke P. Increased plasma histamine levels in uraemic pruritus. Clin Sci (Lond). Nov 1990;79(5):477-82. [Medline].
Ständer S, Reinhardt HW, Luger TA. [Topical cannabinoid agonists. An effective new possibility for treating chronic pruritus]. Hautarzt. Sep 2006;57(9):801-7. [Medline].
Tefferi A, Fonseca R. Selective serotonin reuptake inhibitors are effective in the treatment of polycythemia vera-associated pruritus. Blood. Apr 1 2002;99(7):2627. [Medline].
Thomas S, Harrington CI. Intractable pruritus as the presenting symptom of carcinoma of the bronchus: a case report and review of the literature. Clin Exp Dermatol. Sep 1983;8(5):459-61. [Medline].
Thornton JR, Losowsky MS. Opioid peptides and primary biliary cirrhosis. BMJ. Dec 10 1988;297(6662):1501-4. [Medline].
Twycross R, Greaves MW, Handwerker H, et al. Itch: scratching more than the surface. QJM. Jan 2003;96(1):7-26. [Medline].
Urbonas A, Schwartz RA, Szepietowski JC. Uremic pruritus--an update. Am J Nephrol. Sep-Oct 2001;21(5):343-50. [Medline].
Virga G, Visentin I, La Milia V, Bonadonna A. Inflammation and pruritus in haemodialysis patients. Nephrol Dial Transplant. Dec 2002;17(12):2164-9. [Medline].
Yosipovitch G, Fleischer A. Itch associated with skin disease: advances in pathophysiology and emerging therapies. Am J Clin Dermatol. 2003;4(9):617-22. [Medline].

