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Pruritus and Systemic Disease Follow-up

  • Author: David F Butler, MD; Chief Editor: William D James, MD  more...
 
Updated: Mar 08, 2016
 

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

The prognosis is dependent on the underlying systemic illness that is causing the pruritus. 

Renal pruritus is an independent marker for mortality at 3 years for patients on hemodialysis. 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. For severe cases, the patient can perform the soak and smear technique, which is the process of hydrating the skin for 20 minutes prior to bedtime, followed by the application of ointment to the wet skin.[53]

The following techniques have been found helpful in reducing pruritus in general:

  • Avoid hot showers or baths; use tepid water for bathing.
  • Use a mild, oilated soap or soap-free cleanser to bathe.
  • Apply a moisturizing lotion to the skin after bathing.
  • A camphor and menthol lotion is available over the counter (OTC) and may be applied several times a day to relieve itching.
  • A low-dose antihistamine like diphenhydramine is available OTC and may be taken several times a day for itching.

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 eMedicineHealth's Skin Conditions & Beauty Center.

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Contributor Information and Disclosures
Author

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

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

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

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

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania 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, Society for Investigative Dermatology, Association of Professors of Dermatology, North American Hair Research Society

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Franklin Flowers, MD Department of Dermatology, Professor Emeritus Affiliate Associate Professor of Pathology, University of Florida College of Medicine

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

Disclosure: Nothing to disclose.

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