Pruritus and Systemic Disease Follow-up

  • Author: David F Butler, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: May 21, 2010
 

Complications

Debilitating sleep deprivation and suicidal ideation may occur in patients with severe pruritus. Women with untreated intrahepatic cholestasis of pregnancy that begins before 33 weeks of gestation have increased rates of preterm deliveries and stillbirths. Other complications of pruritus include lichen simplex chronicus, prurigo nodules, and excoriations (which can become secondarily infected).

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Prognosis

Renal pruritus is an independent marker for mortality at 3 years for patients on HD. Patients with severe generalized pruritus and Hodgkin disease have a poor prognosis. Pruritus that recurs after treatment is useful in detecting recurrence of the cancer.

Many of the therapeutic modalities listed in the Treatment and Medication sections offer only symptomatic control. Only cure of the underlying condition results in complete resolution of pruritus. During treatment to relieve symptoms, every effort should be made to treat the underlying systemic disease.

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Patient Education

Patients should be given a clear explanation of their disease and its relationship to pruritus. Patients should be taught how to manage xerosis because this condition may worsen pruritus. Instructions should include keeping the skin well moisturized and avoiding excessive bathing in hot water, low ambient humidity, use of alkaline soaps, and exposure to irritating fabrics.

The itch-scratch cycle should be discussed, and patients should be encouraged to apply cool washcloths or gentle pressure to the areas and to resist the urge the scratch. Reduction or elimination of stressful factors should be discussed because stress appears to worsen itching.

Patients should be made aware that psychiatrists, social workers, and counselors are available to help them cope with the problems created by pruritus.

For excellent patient education resources, please see eMedicine's Skin, Hair, and Nails Center.

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Contributor Information and Disclosures
Author

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

Jared J Lund, MD  Dermatology Resident, Department of Dermatology, Marshfield Clinic, St Joseph's Hospital

Disclosure: Nothing to disclose.

Specialty Editor Board

Franklin Flowers, MD  Chief, Division of Dermatology, Professor, Department of Medicine and Otolaryngology, Affiliate Associate Professor of Pediatrics and Pathology, University of Florida College of Medicine

Franklin Flowers, MD, is a member of the following medical societies: American College of Mohs Micrographic Surgery and Cutaneous Oncology

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD  Associate Professor of Dermatology, Penn State University College of Medicine; Staff Dermatologist, Penn State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Professors of Dermatology, North American Hair Research Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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