Pruritus and Systemic Disease Questions & Answers

Updated: Mar 03, 2020
  • Author: David F Butler, MD; Chief Editor: William D James, MD  more...
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Questions & Answers

Overview

What is pruritus and how is it classified?

Which dermatologic conditions cause pruritus?

How is the sensation of pruritus transmitted?

What modulates the sensation of pruritus?

Who is at increased risk for renal pruritus?

What is the role of antihistamines in the treatment of renal pruritus?

What is the pathogenesis of renal pruritus?

What is a possible CNS manifestation of renal pruritus?

What may worsen renal pruritus?

What is the role of enolase-positive sensory nerves in the pathogenesis of renal pruritus?

What is the role of opioids in the pathogenesis of renal pruritus?

What is the immune hypothesis of the pathogenesis of renal pruritus?

What is cholestatic pruritus?

What is the role of iron deficiency in the pathogenesis of hematologic pruritus?

What is the role of polycythemia vera in the pathogenesis of hematologic pruritus?

What is the role of hyperthyroidism in the pathogenesis of endocrine pruritus?

What is the role of hypothyroidism in the pathophysiology of endocrine pruritus?

What is the role of diabetes mellitus in the pathogenesis of endocrine pruritus?

What is the role of malignancy in the pathogenesis of pruritus?

What causes renal pruritus?

What causes cholestatic pruritus?

Which conditions may cause hematologic pruritus?

Which disorders may cause endocrine pruritus?

Which malignancies may cause pruritus?

Which systemic disorders may cause pruritus?

What is the prevalence of pruritus in the US?

What is the global prevalence of pruritus?

How does the prevalence of pruritus vary by sex?

How does the prevalence of pruritus vary by age?

What is the prognosis of pruritus?

What is the prognosis of renal pruritus?

How is pruritus cured?

What education about pruritus should patients receive?

What are treatment options for reducing pruritus symptoms?

What is the itch-scratch cycle managed?

Presentation

Which dermatologic disorders should be excluded before considering a systemic cause of pruritus?

How is a systematic disease etiology of pruritus diagnosed?

What are the signs and symptoms of renal pruritus?

What are the signs and symptoms of cholestatic pruritus?

What are the signs and symptoms of hematologic pruritus?

What are the signs and symptoms of endocrine pruritus?

How do the symptoms of pruritus vary among different malignancies?

How are dermatologic causes of pruritus differentiated from systematic causes in the physical exam?

Which physical findings suggest a systemic cause of pruritus?

What are complications of pruritus?

DDX

What are the primary dermatologic causes of pruritus?

Workup

What is the role of lab testing in the diagnosis of systemic causes of pruritus?

Which lab tests may be performed in the workup of systemic pruritus?

What is the role of imaging studies in the workup of systemic pruritus?

Which additional lab tests may be performed when initial findings are negative but a systemic cause of pruritus is still suspected?

What is the role of endoscopic retrograde cholangiopancreatography in the diagnosis of cholestatic pruritus?

What is the role of skin biopsy in the workup of pruritus?

Which histologic findings suggest a systemic cause of pruritus?

Treatment

What are the treatment options for pruritus of systemic diseases?

What are the treatment options for renal pruritus?

What is the role of topical therapy for renal pruritus?

What systemic therapy is used in the treatment of renal pruritus?

What is the role of dialysis in the treatment of renal pruritus?

What is the efficacy of thalidomide as a treatment for renal pruritus?

What is the efficacy of oral opioid antagonists as a treatment for renal pruritus?

What is the efficacy of erythropoietin for the treatment of renal pruritus?

Which medications may be used to treat renal pruritus?

What is the efficacy of oral zinc sulfate for the treatment of renal pruritus?

What are the treatment options for cholestatic pruritus?

What are the treatment options for hematologic pruritus?

What are the treatment options for endocrine pruritus?

What are general treatment options for treating pruritus of systemic diseases?

What is the role of surgery in the treatment of pruritus of systemic disease?

Which specialist consultations may be helpful for the treatment of pruritus of systemic disease?

Which dietary restrictions may be useful in the treatment of renal pruritus?

Medications

What are the goals of drug therapy for pruritus of systemic disease?

Which medications in the drug class Immunosuppressant agents are used in the treatment of Pruritus and Systemic Disease?

Which medications in the drug class Analgesic opioid agents are used in the treatment of Pruritus and Systemic Disease?

Which medications in the drug class Antidepressant agents are used in the treatment of Pruritus and Systemic Disease?

Which medications in the drug class Anti-inflammatory agents are used in the treatment of Pruritus and Systemic Disease?

Which medications in the drug class Opioid antagonist agents are used in the treatment of Pruritus and Systemic Disease?

Which medications in the drug class Hepatic enzyme inducing agents are used in the treatment of Pruritus and Systemic Disease?

Which medications in the drug class Bile Acid Lowering Agents are used in the treatment of Pruritus and Systemic Disease?

Which medications in the drug class Immunomodulatory agents are used in the treatment of Pruritus and Systemic Disease?

Which medications in the drug class Topical agents are used in the treatment of Pruritus and Systemic Disease?

Which medications in the drug class Detoxifying agents are used in the treatment of Pruritus and Systemic Disease?