engleski

Treatment of generalized pruritus

Pruritus or itching can be defined as an unpleasant sensation that provokes the desire of scratch. Pruritus is the major symptom of many skin diseases and a prominent symptom in pathologies such as inflammation, hipersensitivity, metabolic abnormalities, tumors, and degenerative disorders. The generalized pruritus can be caused by a number of external causes, by liver disease, renal insufficiency, diabetes mellitus, haematologic disorders, pregnancy, AIDS and others. Unfortunately, the pathogenesis of pruritus is still poorly understood. The last decade has witnessed a lot of information on the mechanisms by which different pruritogenic mediators act on afferent sensitive nerves. Among the mediators are histamin, substance P, proteases, opioids, prostaglandins, IL 2, products of the eosinophils. The therapy of generalized pruritus can be one of the most challenging problems for the physician. In establishing the diagnosis cannot be overstated the importance of a carefully history, of an accurate clinical examination, laboratory investigations and skin biopsy. The etiological treatment can be advocated but sometimes is useful the symptomatic regardless the origin. The treatment can be topically or systemic acting on peripheric mediators or receptors and sometime on the central nervous system. Topical anesthetics, capsaicin, corticosteroids, PUVA therapy can be effective in most form of itching. Oral antihistamines with sedating effect, or new non sedating such ketotifen, loratadine, terfenadine provide usually relief. Patients with cholestatic pruritus may benefit from cholestyramine, antibiotics, serotonine antagonists plasmapheresis, or opiate antagonists ; for patients on hemodyalisis oral activated charcoal, phosphate binding drugs or topical capsaicin my be indicated. Knowledge of the pathophysiologic mechanisms acting in the different types of pruritus are of importance in achieving maximal therapeutic results in patients with this unpleasant sensation. The itch can only be assessed by the patient himself ; therefore the development of a quantitative method for analyzing this sensation is of considerable importance.

treatment; generalised pruritus

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