Chronic Pruritus in the Elderly: Pathophysiology, Diagnosis and Management

Drugs and Aging

Volumn 32, Issue 3, 2015, Pages 201-215

  Valdes Rodriguez, Rodrigo ^a   Stull, Carolyn ^a   Yosipovitch, Gil ^a  

^a TEMPLE UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

AMITRIPTYLINE; APREPITANT; BUTORPHANOL; CAPSAICIN; CETIRIZINE; CORTICOSTEROID; DIPHENHYDRAMINE; EMOLLIENT AGENT; FEXOFENADINE; FLUVOXAMINE; GABAPENTIN; HYDROXYZINE; KETAMINE; LORATADINE; MENTHOL; MIRTAZAPINE; NALFURAFINE; PAROXETINE; PIMECROLIMUS; PRAMOCAINE; PREGABALIN; SALICYLIC ACID; SERTRALINE; TACROLIMUS; THALIDOMIDE; UREA;

ACUPUNCTURE; BASAL CELL CARCINOMA; BATH; BLOOD CELL COUNT; CEREBROVASCULAR ACCIDENT; CHRONIC DISEASE; CHRONIC PRURITUS; CHRONIC URTICARIA; CHRONIC VEIN INSUFFICIENCY; COGNITIVE THERAPY; CONTACT DERMATITIS; CUTANEOUS PARAMETERS; CUTANEOUS T CELL LYMPHOMA; DRY SKIN; EPIDEMIOLOGY; ERYTHROCYTE SEDIMENTATION RATE; GERIATRIC DISORDER; HEPATOBILIARY DISEASE; HOLISTIC CARE; HUMAN; HUMAN IMMUNODEFICIENCY VIRUS INFECTION; HYPERTHYROIDISM; LIVER FUNCTION TEST; NUCLEAR MAGNETIC RESONANCE IMAGING; NUMMULAR DERMATITIS; OAT; PATHOPHYSIOLOGY; PATIENT EDUCATION; PHOTOTHERAPY; PHYSICAL EXAMINATION; POLYPHARMACY; PRIORITY JOURNAL; PRURITUS; PSORIASIS; PSYCHOGENIC PRURITUS; RANDOMIZED CONTROLLED TRIAL (TOPIC); REVIEW; SCABIES; SEBORRHEIC DERMATITIS; SYSTEMIC DISEASE; THYROID FUNCTION TEST; TRANSIENT ACANTHOLYTIC DERMATOSIS; ULTRAVIOLET A RADIATION; ULTRAVIOLET B RADIATION; XEROSIS; AGED; CHRONIC KIDNEY FAILURE; COMPLICATION; PATHOLOGY; QUALITY OF LIFE; SKIN; SKIN DISEASE;

AGED; HUMANS; PRURITUS; QUALITY OF LIFE; RENAL INSUFFICIENCY, CHRONIC; SKIN; SKIN DISEASES;

EID: 84925537808     PISSN: 1170229X     EISSN: 11791969     Source Type: Journal    
DOI: 10.1007/s40266-015-0246-0     Document Type: Review

References (159)

1. Valdes-Rodriguez R, Mollanazar NK, González-Muro J, Nattkemper L, Torres-Alvarez B, et al. Itch prevalence and characteristics in a Hispanic geriatric population: a comprehensive study using a standardized itch questionnaire. Acta Derm Venereol. 2014;. doi:10.2340/00015555-1968.
2. Berger TG, Steinhoff M. Pruritus in elderly patients—eruptions of senescence. Semin Cutan Med Surg. 2011;30(2):113–7.
3. Reich A, Ständer S, Szepietowski JC. Pruritus in the elderly. Clin Dermatol. 2011;29:15–23.
4. Berger TG, Shive M, Harper GM. Pruritus in the older patient: a clinical review. JAMA. 2013;310(22):2443–50.
5. Douglass CW, Jiménez MC. Our current geriatric population: demographic and oral health care utilization. Dent Clin North Am. 2014;58(4):717–28.
6. Arai H, Ouchi Y, Yokode M, Ito H, Uematsu H, Members of Subcommittee for Aging, et al. Toward the realization of a better aged society: messages from gerontology and geriatrics. Geriatr Gerontol Int. 2012;12(1):16–22.
7. Li CI, Lin CH, Lin WY, Liu CS, Chang CK, et al. Successful aging defined by health-related quality of life and its determinants in community-dwelling elders. BMC Public Health. 2014;14(1):1013.
8. Thapa DP, Jha AK, Kharel C, Shrestha S. Dermatological problems in geriatric patients: a hospital based study. Nepal Med Coll J. 2012;14:193–5.
9. Yalçin B, Tamer E, Toy GG, Oztaş P, Hayran M, et al. The prevalence of skin diseases in the elderly: analysis of 4099 geriatric patients. Int J Dermatol. 2006;45:672–6.
10. Rubegni P, Poggiali S, Nami N, Rubegni M, Fimiani M. Skin diseases in geriatric patients: our experience from a public skin outpatient clinic in Siena. G Ital Dermatol Venereol. 2012;147:631–6.
11. Darjani A, Mohtasham-Amiri Z, Mohammad Amini K, Golchai J, Sadre-Eshkevari S, et al. Skin disorders among elder patients in a referral center in northern Iran (2011). Dermatol Res Pract. 2013;2013:193205.
12. Beauregard S, Gilchrest BA. A survey of skin problems and skin care regimens in the elderly. Arch Dermatol. 1987;123:1638–43.
13. Sayal SK, Rajbhandari S, Malik AK, Gupta CM. A study of dermatological disorders in geriatric age group. Indian J Dermatol Venereol Leprol. 1998;64(6):270–2.
14. Polat M, Yalçin B, Calişkan D, Alli N. Complete dermatological examination in the elderly: an exploratory study from an outpatient clinic in Turkey. Gerontology. 2009;55(1):58–63.
15. Paul C, Maumus-Robert S, Mazereeuw-Hautier J, Guyen CN, Saudez X, et al. Prevalence and risk factors for xerosis in the elderly: a cross-sectional epidemiological study in primary care. Dermatology. 2011;223(3):260–5.
16. White-Chu EF, Reddy M. Dry skin in the elderly: complexities of a common problem. Clin Dermatol. 2011;29(1):37–42.
17. Yosipovitch G. Dry skin and impairment of barrier function associated with itch—new insights. Int J Cosmet Sci. 2004;26(1):1–7.
18. Seyfarth F, Schliemann S, Antonov D, Elsner P. Dry skin, barrier function, and irritant contact dermatitis in the elderly. Clin Dermatol. 2011;29(1):31–6.
19. Saint-Léger D, François AM, Lévêque JL, Stoudemayer TJ, Kligman AM, et al. Stratum corneum lipids in skin xerosis. Dermatologica. 1989;178(3):151–5.
20. Simon M, Bernard D, Minondo AM, Camus C, Fiat F, et al. Persistence of both peripheral and non-peripheral corneodesmosomes in the upper stratum corneum of winter xerosis skin versus only peripheral in normal skin. J Invest Dermatol. 2001;116(1):23–30.
21. Long CC, Marks R. Stratum corneum changes in patients with senile pruritus. J Am Acad Dermatol. 1992;27(4):560–4.
22. Elias PM, Ghadially R. The aged epidermal permeability barrier: basis for functional abnormalities. Clin Geriatr Med. 2002;18(1):103–20, vii.
23. Pappas A. Epidermal surface lipids. Dermatoendocrinol. 2009;1(2):72–6.
24. Jensen JM, Förl M, Winoto-Morbach S, Seite S, Schunck M, et al. Acid and neutral sphingomyelinase, ceramide synthase, and acid ceramidase activities in cutaneous aging. Exp Dermatol. 2005;14(8):609–18.
25. Ghadially R, Brown BE, Sequeira-Martin SM, Feingold KR, Elias PM. The aged epidermal permeability barrier: structural, functional, and lipid biochemical abnormalities in humans and a senescent murine model. J Clin Invest. 1995;95(5):2281–90.
26. Ma T, Hara M, Sougrat R, Verbavatz JM, Verkman AS. Impaired stratum corneum hydration in mice lacking epidermal water channel aquaporin-3. J Biol Chem. 2002;277(19):17147–53.
27. Li J, Tang H, Hu X, Chen M, Xie H. Aquaporin-3 gene and protein expression in sun-protected human skin decreases with skin ageing. Australas J Dermatol. 2010;51(2):106–12.
28. Wilhelm KP, Cua AB, Maibach HI. Skin aging: effect on transepidermal water loss, stratum corneum hydration, skin surface pH, and casual sebum content. Arch Dermatol. 1991;127(12):1806–9.
29. Lambers H, Piessens S, Bloem A, Pronk H, Finkel P. Natural skin surface pH is on average below 5, which is beneficial for its resident flora. Int J Cosmet Sci. 2006;28(5):359–70.
30. Luebberding S, Krueger N, Kerscher M. Age-related changes in male skin: quantitative evaluation of one hundred and fifty male subjects. Skin Pharmacol Physiol. 2014;27(1):9–17.
31. Yosipovitch G, Xiong GL, Haus E, Sackett-Lundeen L, Ashkenazi I, et al. Time-dependent variations of the skin barrier function in humans: transepidermal water loss, stratum corneum hydration, skin surface pH, and skin temperature. J Invest Dermatol. 1998;110(1):20–3.
32. Jensen JM, Förl M, Winoto-Morbach S, Seite S, Schunck M, et al. Acid and neutral sphingomyelinase, ceramide synthase, and acid ceramidase activities in cutaneous aging. Exp Dermatol. 2005;14(8):609–18.
33. Choi EH, Man MQ, Xu P, Xin S, Liu Z, et al. Stratum corneum acidification is impaired in moderately aged human and murine skin. J Invest Dermatol. 2007;127(12):2847–56.
34. Ali SM, Yosipovitch G. Skin pH: from basic science to basic skin care. Acta Derm Venereol. 2013;93(3):261–7.
35. Feingold KR, Elias PM. Role of lipids in the formation and maintenance of the cutaneous permeability barrier. Biochim Biophys Acta. 2014;1841(3):280–94.
36. Rawlings AV, Voegeli R. Stratum corneum proteases and dry skin conditions. Cell Tissue Res. 2013;351(2):217–35.
37. Komatsu N, Saijoh K, Sidiropoulos M, Tsai B, Levesque MA, et al. Quantification of human tissue kallikreins in the stratum corneum: dependence on age and gender. J Invest Dermatol. 2005;125(6):1182–9.
38. Theodosat A. Skin diseases of the lower extremities in the elderly. Dermatol Clin. 2004;22(1):13–21.
39. Fenske NA, Lober CW. Structural and functional changes of normal aging skin. J Am Acad Dermatol. 1986;15(4 Pt 1):571–85.
40. Thornton MJ. Estrogens and aging skin. Dermatoendocrinol. 2013;5(2):264–70.
41. Schmidt T, Sitaru C, Amber K, Hertl M. BP180- and BP230-specific IgG autoantibodies in pruritic disorders of the elderly: a preclinical stage of bullous pemphigoid? Br J Dermatol. 2014;171(2):212–9.
42. Stumpf A, Ständer S. Neuropathic itch: diagnosis and management. Dermatol Ther. 2013;26(2):104–9.
43. Oaklander AL. Neuropathic itch. Semin Cutan Med Surg. 2011;30(2):87–92.
44. Liao YH, Chen KH, Tseng MP, Sun CC. Pattern of skin diseases in a geriatric patient group in Taiwan: a 7-year survey from the outpatient clinic of a university medical center. Dermatology. 2001;203(4):308–13.
45. Liddell K. Letter: post-herpetic pruritus. Br Med J. 1974;4(5937):165.
46. Oaklander AL. Mechanisms of pain and itch caused by herpes zoster (shingles). J Pain. 2008;9(1 Suppl 1):S10–8.
47. Yamaoka H, Sasaki H, Yamasaki H, Ogawa K, Ohta T, et al. Truncal pruritus of unknown origin may be a symptom of diabetic polyneuropathy. Diabetes Care. 2010;33(1):150–5.
48. Bin Saif GA, Ericson ME, Yosipovitch G. The itchy scalp—scratching for an explanation. Exp Dermatol. 2011;20(12):959–68.
49. Marziniak M, Phan NQ, Raap U, Siepmann D, Schürmeyer-Horst F, et al. Brachioradial pruritus as a result of cervical spine pathology: the results of a magnetic resonance tomography study. J Am Acad Dermatol. 2011;65(4):756–62.
50. Kwatra SG, Stander S, Bernhard JD, Weisshaar E, Yosipovitch G. Brachioradial pruritus: a trigger for generalization of itch. J Am Acad Dermatol. 2013;68(5):870–3.
51. Wolking S, Lerche H, Dihné M. Episodic itch in a case of spinal glioma. BMC Neurol. 2013;13:124.
52. Huesmann T, Cunha PR, Osada N, Huesmann M, Zanelato TP, et al. Notalgia paraesthetica: a descriptive two-cohort study of 65 patients from Brazil and Germany. Acta Derm Venereol. 2012;92(5):535–40.
53. Raison-Peyron N, Meunier L, Acevedo M, Meynadier J. Notalgia paresthetica: clinical, physiopathological and therapeutic aspects. A study of 12 cases. J Eur Acad Dermatol Venereol. 1999;12(3):215–21.
54. Lo Schiavo A, Peccerillo F, Mascolo M, La Montagna M, Caccavale T, et al. Inverse notalgia paresthetica: a strange case of professional disease. Int J Dermatol. 2014.
55. Farage MA, Miller KW, Berardesca E, Maibach HI. Clinical implications of aging skin: cutaneous disorders in the elderly. Am J Clin Dermatol. 2009;10(2):73–86.
56. Solak O, Kulac M, Yaman M, Karaca S, Toktas H, et al. Lichen simplex chronicus as a symptom of neuropathy. Clin Exp Dermatol. 2009;34(4):476–80.
57. Cohen AD, Andrews ID, Medvedovsky E, Peleg R, Vardy DA. Similarities between neuropathic pruritus sites and lichen simplex chronicus sites. Isr Med Assoc J. 2014;16(2):88–90.
58. Konuk N, Koca R, Atik L, Muhtar S, Atasoy N, et al. Psychopathology, depression and dissociative experiences in patients with lichen simplex chronicus. Gen Hosp Psychiatry. 2007;29(3):232–5.
59. Zivin K, Llewellyn DJ, Lang IA, Vijan S, Kabeto MU, et al. Depression among older adults in the United States and England. Am J Geriatr Psychiatry. 2010;18(11):1036–44.
60. Fitzpatrick JE. Common inflammatory skin diseases of the elderly. Geriatrics. 1989;44(7):40–6.
61. Ward JR, Bernhard JD. Willan’s itch and other causes of pruritus in the elderly. Int J Dermatol. 2005;44(4):267–73.
62. Britt H, Pan Y, Miller GC, Valenti L, Charles J, et al. Presentations of ‘itch’ in Australian general practice. Aust Fam Physician. 2004;33(7):488.
63. Arsic Arsenijevic VS, Milobratovic D, Barac AM, Vekic B, Marinkovic J, et al. A laboratory-based study on patients with Parkinson’s disease and seborrheic dermatitis: the presence and density of Malassezia yeasts, their different species and enzymes production. BMC Dermatol. 2014;14:5.
64. Cömert A, Akbaş B, Kılıç EZ, Akın Ö, Gökçe E, et al. Psychiatric comorbidities and alexithymia in patients with seborrheic dermatitis: a questionnaire study in Turkey. Am J Clin Dermatol. 2013;14(4):335–42.
65. Prakash AV, Davis MD. Contact dermatitis in older adults: a review of the literature. Am J Clin Dermatol. 2010;11(6):373–81.
66. Balato A, Balato N, Di Costanzo L, Ayala F. Contact sensitization in the elderly. Clin Dermatol. 2011;29(1):24–30.
67. Seyfarth F, Schliemann S, Antonov D, Elsner P. Dry skin, barrier function, and irritant contact dermatitis in the elderly. Clin Dermatol. 2011;29(1):31–6.
68. Farage MA, Miller KW, Berardesca E, Maibach HI. Clinical implications of aging skin: cutaneous disorders in the elderly. Am J Clin Dermatol. 2009;10(2):73–86.
69. Ozkaya E. Adult-onset atopic dermatitis. J Am Acad Dermatol. 2005;52(4):579–82.
70. Maddison B, Parsons A, Sangueza O, Sheehan DJ, Yosipovitch G. Retrospective study of intraepidermal nerve fiber distribution in biopsies of patients with nummular eczema. Am J Dermatopathol. 2011;33(6):621–3.
71. Gøransson LG, Mellgren SI, Lindal S, Omdal R. The effect of age and gender on epidermal nerve fiber density. Neurology. 2004;62(5):774–7.
72. Duque MI, Yosipovitch G, Chan YH, Smith R, Levy P. Itch, pain, and burning sensation are common symptoms in mild to moderate chronic venous insufficiency with an impact on quality of life. J Am Acad Dermatol. 2005;53(3):504–8.
73. Kwon HH, Kwon IH, Youn JI. Clinical study of psoriasis occurring over the age of 60 years: is elderly-onset psoriasis a distinct subtype? Int J Dermatol. 2012;51(1):53–8.
74. Grozdev IS, Van Voorhees AS, Gottlieb AB, Hsu S, Lebwohl MG, et al. National Psoriasis Foundation. Psoriasis in the elderly: from the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol. 2011;65(3):537–45.
75. Meeuwis KA, van de Kerkhof PC, Massuger LF, de Hullu JA, van Rossum MM. Patients’ experience of psoriasis in the genital area. Dermatology. 2012;224(3):271–6.
76. Yosipovitch G, Ansari N, Goon A, Chan YH, Goh CL. Clinical characteristics of pruritus in chronic idiopathic urticaria. Br J Dermatol. 2002;147(1):32–6.
77. Quirk CJ, Heenan PJ. Grover’s disease: 34 years on. Australas J Dermatol. 2004;45(2):83–6 quiz 87–8.
78. Yosipovitch G. Chronic pruritus: a paraneoplastic sign. Dermatol Ther. 2010;23(6):590–6.
79. Norman R, Chau V. Use of etanercept in treating pruritus and preventing new lesions in Grover disease. J Am Acad Dermatol. 2011;64(4):796–8.
80. Elgart ML. Skin infections and infestations in geriatric patients. Clin Geriatr Med. 2002;18(1):89–101, vi.
81. Arlian LG, Estes SA, Vyszenski-Moher DL. Prevalence of Sarcoptes scabiei in the homes and nursing homes of scabietic patients. J Am Acad Dermatol. 1988;19(5 Pt 1):806–11.
82. Hicks MI, Elston DM. Scabies. Dermatol Ther. 2009;22(4):279–92.
83. Hopper AH, Salisbury J, Jegadeva AN, Scott B, Bennett GC. Epidemic Norwegian scabies in a geriatric unit. Age Ageing. 1990;19(2):125–7.
84. Reinau D, Surber C, Jick SS, Meier CR. Epidemiology of basal cell carcinoma in the United Kingdom: incidence, lifestyle factors, and comorbidities. Br J Cancer. 2014;111(1):203–6.
85. Yosipovitch G, Mills KC, Nattkemper LA, Feneran A, Liang TH, et al. Association of pain and itch with depth of invasion and inflammatory cell constitution in skin cancer: results of a large clinicopathologic study. JAMA Dermatol. 2014;150(11):1160–6.
86. Singer EM, Shin DB, Nattkemper LA, Benoit BM, Klein RS, et al. IL-31 is produced by the malignant T-cell population in cutaneous T-cell lymphoma and correlates with CTCL pruritus. J Invest Dermatol. 2013;133(12):2783–5.
87. Pisoni RL, Wikström B, Elder SJ, Akizawa T, Asano Y, et al. Pruritus in haemodialysis patients: international results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant. 2006;21(12):3495–505.
88. Berger NA, Savvides P, Koroukian SM, Kahana EF, Deimling GT, et al. Cancer in the elderly. Trans Am Clin Climatol Assoc. 2006;117:147–55 discussion 155–6.
89. Weisshaar E, Weiss M, Mettang T, Yosipovitch G, Zylicz Z. Paraneoplastic itch: an expert position statement of the Special Interest Group (SIG) of the International Forum on the Study of Itch (IFSI). Acta Derm Venereol. Epub. 2014;. doi:10.2340/00015555-1959.
90. Lober CW. Pruritus and malignancy. Clin Dermatol. 1993;11(1):125–8.
91. Paul R, Paul R, Jansen CT. Itch and malignancy prognosis in generalized pruritus: a 6-year follow-up of 125 patients. J Am Acad Dermatol. 1987;16(6):1179–82.
92. Fett N, Haynes K, Propert KJ, Margolis DJ. Five-year malignancy incidence in patients with chronic pruritus: a population-based cohort study aimed at limiting unnecessary screening practices. J Am Acad Dermatol. 2014;70(4):651–8.
93. Paredes-Suárez C, Fernández-Redondo V, Blanco MV, Sánchez-Aguilar D, Toribio J. Multiple myeloma with scleroderma-like changes. J Eur Acad Dermatol Venereol. 2005;19(4):500–2.
94. Huesmann M, Huesmann T, Osada N, Phan NQ, Kremer AE, et al. Cholestatic pruritus: a retrospective analysis on clinical characteristics and treatment response. J Dtsch Dermatol Ges. 2013;11(2):158–68.
95. Kremer AE, van Dijk R, Leckie P, Schaap FG, Kuiper EM, et al. Serum autotaxin is increased in pruritus of cholestasis, but not of other origin, and responds to therapeutic interventions. Hepatology. 2012;56(4):1391–400.
96. Bolier AR, Peri S, Oude Elferink RP, Beuers U. The challenge of cholestatic pruritus. Acta Gastroenterol Belg. 2012;75(4):399–404.
97. Krishnamurthi RV, Feigin VL, Forouzanfar MH, Mensah GA, Connor M, GBD Stroke Experts Group, et al. Global Burden of Diseases, Injuries, Risk Factors Study 2010 (GBD 2010). Lancet Glob Health. 2013;1(5):e259–81.
98. Massey EW. Unilateral neurogenic pruritus following stroke. Stroke. 1984;15(5):901–3.
99. Oaklander AL. Neuropathic pruritus following Wallenberg syndrome. Neurology. 2009;73(19):1605 author reply 1605–6.
100. Kaushik SB, Cerci FB, Miracle J, Pokharel A, Chen SC, et al. Chronic pruritus in HIV-positive patients in the southeastern United States: its prevalence and effect on quality of life. J Am Acad Dermatol. 2014;70(4):659–64.
101. Nasi M, Pinti M, De Biasi S, Gibellini L, Ferraro D, et al. Aging with HIV infection: a journey to the center of inflammAIDS, immunosenescence and neuroHIV. Immunol Lett. 2014;162(1 Pt B):329–33.
102. Nguyen N, Holodniy M. HIV infection in the elderly. Clin Interv Aging. 2008;3(3):453–72.
103. Artantaş S, Gül U, Kiliç A, Güler S. Skin findings in thyroid diseases. Eur J Intern Med. 2009;20(2):158–61.
104. Reich A, Ständer S, Szepietowski JC. Drug-induced pruritus: a review. Acta Derm Venereol. 2009;89(3):236–44.
105. Joly P, Benoit-Corven C, Baricault S, Lambert A, Hellot MF, et al. Chronic eczematous eruptions of the elderly are associated with chronic exposure to calcium channel blockers: results from a case–control study. J Invest Dermatol. 2007;127(12):2766–71.
106. Levine N. Pruritic lesions on extremities. Could this persistent eruption be related to hypertension medication? Geriatrics. 1997;52(9):89.
107. Raksha MP, Marfatia YS. Clinical study of cutaneous drug eruptions in 200 patients. Indian J Dermatol Venereol Leprol. 2008;74(1):80.
108. Yosipovitch G, Samuel LS. Neuropathic and psychogenic itch. Dermatol Ther. 2008;21(1):32–41.
109. Ferm I, Sterner M, Wallengren J. Somatic and psychiatric comorbidity in patients with chronic pruritus. Acta Derm Venereol. 2010;90(4):395–400.
110. Krishnan A, Koo J. Psyche, opioids, and itch: therapeutic consequences. Dermatol Ther. 2005;18(4):314–22.
111. Gum AM, King-Kallimanis B, Kohn R. Prevalence of mood, anxiety, and substance-abuse disorders for older Americans in the national comorbidity survey-replication. Am J Geriatr Psychiatry. 2009;17:769–81.
112. Skoog I. Psychiatric disorders in the elderly. Can J Psychiatry. 2011;56(7):387–97.
113. Zivin K, Llewellyn DJ, Lang IA, Vijan S, Kabeto MU, et al. Depression among older adults in the United States and England. Am J Geriatr Psychiatry. 2010;18(11):1036–44.
114. Gupta MA, Gupta AK, Schork NJ, Ellis CN. Depression modulates pruritus perception: a study of pruritus in psoriasis, atopic dermatitis, and chronic idiopathic urticaria. Psychosom Med. 1994;56(1):36–40.
115. Fjellner B, Arnetz BB. Psychological predictors of pruritus during mental stress. Acta Derm Venereol. 1985;65(6):504–8.
116. Liao YH, Lin CC, Tsai PP, Shen WC, Sung FC, et al. Increased risk of lichen simplex chronicus in people with anxiety disorder: a nationwide population-based retrospective cohort study. Br J Dermatol. 2014;170(4):890–4.
117. Yosipovitch G, Bernhard JD. Clinical practice. Chronic pruritus. N Engl J Med. 2013;368(17):1625–34.
118. Wolking S, Lerche H, Dihné M. Episodic itch in a case of spinal glioma. BMC Neurol. 2013;13:124.
119. Weisshaar E. Intractable chronic pruritus in a 67-year-old man. Acta Derm Venereol. 2008;88(5):488–90.
120. Endo JO, Wong JW, Norman RA, Geriatric dermatology: part I. Geriatric pharmacology for the dermatologist. J Am Acad Dermatol. 2013;68(4):521.e1–10; quiz 531–2.
121. van Os-Medendorp H, Ros WJ, Eland-de Kok PC, Kennedy C, Thio BH, et al. Effectiveness of the nursing programme ‘Coping with Itch’: a randomized controlled study in adults with chronic pruritic skin disease. Br J Dermatol. 2007;156:1235–44.
122. Patel T, Yosipovitch G. The management of chronic pruritus in the elderly. Skin Therapy Lett. 2010;15(8):5–9.
123. Morton CA, Lafferty M, Hau C, Henderson I, Jones M, et al. Pruritus and skin hydration during dialysis. Nephrol Dial Transplant. 1996;11(10):2031–6.
124. Steinhoff M, Neisius U, Ikoma A, Fartasch M, Heyer G, et al. Proteinase-activated receptor-2 mediates itch: a novel pathway for pruritus in human skin. J Neurosci. 2003;23(15):6176–80.
125. Yosipovitch G, Papoiu AD. What causes itch in atopic dermatitis? Curr Allergy Asthma Rep. 2008;4:306–11.
126. Pazyar N, Yaghoobi R, Kazerouni A, Feily A. Oatmeal in dermatology: a brief review. Indian J Dermatol Venereol Leprol. 2012;78(2):142–5.
127. Yosipovitch G, Sugeng MW, Chan YH, Goon A, Ngim S, et al. The effect of topically applied aspirin on localized circumscribed neurodermatitis. J Am Acad Dermatol. 2001;45(6):910–3.
128. Durrant-Finn U, Osten B, Mügge C, Nenoff P. Pruritus and dryness of the skin in chronic kidney insufficiency and dialysis patients—a review. Wien Med Wochenschr. 2009;159(13–14):317–26.
129. Pan M, Heinecke G, Bernardo S, Tsui C, Levitt J. Urea: a comprehensive review of the clinical literature. Dermatol Online J. 2013;19(11):20392.
130. Patel T, Ishiuji Y, Yosipovitch G. Menthol: a refreshing look at this ancient compound. J Am Acad Dermatol. 2007;57(5):873–8.
131. Imamachi N, Park GH, Lee H, Anderson DJ, Simon MI, et al. TRPV1-expressing primary afferents generate behavioral responses to pruritogens via multiple mechanisms. Proc Natl Acad Sci USA. 2009;106(27):11330–5.
132. Makhlough A, Ala S, Haj-Heydari Z, Kashi Z, Bari A. Topical capsaicin therapy for uremic pruritus in patients on hemodialysis. Iran J Kidney Dis. 2010;4(2):137–40.
133. Yosipovitch G, Maibach HI, Rowbotham MC. Effect of EMLA pre-treatment on capsaicin-induced burning and hyperalgesia. Acta Derm Venereol. 1999;79(2):118–21.
134. Kligman AM, Frosch PJ. Steroid addiction. Int J Dermatol. 1979;18(1):23–31.
135. Ständer S, Schürmeyer-Horst F, Luger TA, Weisshaar E. Treatment of pruritic diseases with topical calcineurin inhibitors. Ther Clin Risk Manag. 2006;2(2):213–8.
136. Young TA, Patel TS, Camacho F, Clark A, Freedman BI, et al. A pramoxine-based anti-itch lotion is more effective than a control lotion for the treatment of uremic pruritus in adult hemodialysis patients. J Dermatolog Treat. 2009;20(2):76–81.
137. Papoiu AD, Valdes-Rodriguez R, Nattkemper LA, Chan YH, Hahn GS, et al. A novel topical formulation containing strontium chloride significantly reduces the intensity and duration of cowhage-induced itch. Acta Derm Venereol. 2013;93(5):520–6.
138. Drake LA, Fallon JD, Sober A. Relief of pruritus in patients with atopic dermatitis after treatment with topical doxepin cream. J Am Acad Dermatol. 1994;31(10):613–6.
139. Poterucha TJ, Murphy SL, Sandroni PJ. Topical amitriptyline combined with topical ketamine for the management of recalcitrant localized pruritus: a retrospective pilot study. Am Acad Dermatol. 2013;69(2):320–1.
140. O’Donoghue M, Tharp MD. Antihistamines and their role as antipruritics. Dermatol Ther. 2005;18(4):333–40.
141. Asero R, Tedeschi A, Cugno M. Treatment of chronic urticaria. Immunol Allergy Clin North Am. 2014;34(1):105–16.
142. Davis MP, Frandsen JL, Walsh D, et al. Mirtazapine for pruritus. J Pain Symptom Manage. 2003;25(3):288–91.
143. Demierre MF, Taverna J. Mirtazapine and gabapentin for reducing pruritus in cutaneous T-cell lymphoma. J Am Acad Dermatol. 2006;55(3):543–4.
144. Hundley JL, Yosipovitch G. Mirtazapine for reducing nocturnal itch in patients with chronic pruritus: a pilot study. J Am Acad Dermatol. 2004;50(6):889–91.
145. Ständer S, Böckenholt B, Schürmeyer-Horst F, Weishaupt C, Heuft G, et al. Treatment of chronic pruritus with the selective serotonin re-uptake inhibitors paroxetine and fluvoxamine: results of an open-labelled, two-arm proof-of-concept study. Acta Derm Venereol. 2009;89(1):45–51.
146. Mayo MJ, Handem I, Saldana S, Jacobe H, Getachew Y, et al. Sertraline as a first-line treatment for cholestatic pruritus. Hepatology. 2007;45(3):666–74.
147. Phan NQ, Bernhard JD, Luger TA, Ständer S. Antipruritic treatment with systemic μ-opioid receptor antagonists: a review. J Am Acad Dermatol. 2010;63(4):680–8.
148. Dawn AG, Yosipovitch G. Butorphanol for treatment of intractable pruritus. J Am Acad Dermatol. 2006;54(3):527–31.
149. Papoiu AD, Kraft RA, Coghill RC, Yosipovitch G. Butorphanol suppression of histamine itch is mediated by nucleus accumbens and septal nuclei: a pharmacological fMRI study. J Invest Dermatol. 2015;135(2):560–8.
150. Wikström B, Gellert R, Ladefoged SD, Danda Y, Akai M, et al. Kappa-opioid system in uremic pruritus: multicenter, randomized, double-blind, placebo-controlled clinical studies. J Am Soc Nephrol. 2005;16(2):3742–7.
151. Gunal AI, Ozalp G, Yoldas TK, Gunal SY, Kirciman E, et al. Gabapentin therapy for pruritus in haemodialysis patients: a randomized, placebo-controlled, double-blind trial. Nephrol Dial Transplant. 2004;19(12):3137–9.
152. Manenti L, Vaglio A, Costantino E, Danisi D, Oliva B, et al. Gabapentin in the treatment of uremic itch: an index case and a pilot evaluation. J Nephrol. 2005;18(1):86–91.
153. Wood GJ, Akiyama T, Carstens E, Oaklander AL, Yosipovitch G. An insatiable itch. J Pain. 2009;10(8):792–7.
154. Ehrchen J, Stander S. Pregabalin in the treatment of chronic pruritus. J Am Acad Dermatol. 2008;58(2):S36–7.
155. Silva SR, Viana PC, Lugon NV, Hoette M, Ruzany F, et al. Thalidomide for the treatment of uremic pruritus: a crossover randomized double-blind trial. Nephron. 1994;67(3):270–3.
156. Torres T, Fernandes I, Selores M, Alves R, Lima M. Aprepitant: evidence of its effectiveness in patients with refractory pruritus continues. J Am Acad Dermatol. 2012;66(1):e14–5.
157. Szepietowski JC, Morita A, Tsuji T. Ultraviolet B induces mast cell apoptosis: a hypothetical mechanism of ultraviolet B treatment for uraemic pruritus. Med Hypotheses. 2002;58(2):167–70.
158. Garssen J, Vandebriel RJ, De Gruijl FR, Wolvers DA, Van Dijk M, et al. UVB exposure-induced systemic modulation of Th1- and Th2-mediated immune responses. Immunology. 1999;97(3):506–14.
159. Kim KH, Lee MS, Choi SM. Acupuncture for treating uremic pruritus in patients with end-stage renal disease: a systematic review. J Pain Symptom Manage. 2010;40(1):117–25.