Drugs & Aging

, Volume 32, Issue 3, pp 201–215 | Cite as

Chronic Pruritus in the Elderly: Pathophysiology, Diagnosis and Management

  • Rodrigo Valdes-Rodriguez
  • Carolyn Stull
  • Gil Yosipovitch
Review Article


Chronic itch in the elderly is a common problem, with a significant impact on quality of life and sleep in elderly patients. Chronic itch may be attributable to several causes, including dry skin, immunosenescence and neural degeneration. Itch may also be caused by skin diseases, such as seborrhoeic dermatitis and stasis dermatitis; systemic conditions, such as end-stage renal disease and diabetes; and psychogenic conditions, such as depression and anxiety. The use of polypharmacy may also cause itch, with or without a rash. Specifically, thiazides and calcium channel blockers have been known to cause itch in elderly patients. Management should be tailored according to the underlying dermatological or systemic aetiology of itch. Topical treatment is the mainstay of therapy, providing special emphasis on skin hydration and barrier repair. In addition, topical and oral medications that target the nervous system and reduce neuronal hypersensitization, such as gabapentin and selective antidepressants, have a role in treating patients with severe chronic itch. Furthermore, management must account for changes in metabolism and pharmacokinetics of drugs in the aging population in order to prevent the occurrence of adverse effects.


Chronic Kidney Disease Atopic Dermatitis Stratum Corneum Aprepitant Bullous Pemphigoid 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors thank Eilen Flores Ortiz for assistance in preparing Fig. 1.


No sources of funding were used to support the preparation of this article.

Conflicts of interest

Rodrigo Valdes-Rodriguez and Carolyn Stull declare no conflicts of interest. Gil Yosipovitch is a member of scientific advisory boards for Cosmoderm, TREVI, Velocity and Creabilis and is funded by GSK-Stiefel and the LEO Foundation.


  1. 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.PubMedGoogle Scholar
  2. 2.
    Berger TG, Steinhoff M. Pruritus in elderly patients—eruptions of senescence. Semin Cutan Med Surg. 2011;30(2):113–7.PubMedCentralPubMedGoogle Scholar
  3. 3.
    Reich A, Ständer S, Szepietowski JC. Pruritus in the elderly. Clin Dermatol. 2011;29:15–23.PubMedGoogle Scholar
  4. 4.
    Berger TG, Shive M, Harper GM. Pruritus in the older patient: a clinical review. JAMA. 2013;310(22):2443–50.PubMedGoogle Scholar
  5. 5.
    Douglass CW, Jiménez MC. Our current geriatric population: demographic and oral health care utilization. Dent Clin North Am. 2014;58(4):717–28.PubMedGoogle Scholar
  6. 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.PubMedGoogle Scholar
  7. 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.PubMedCentralPubMedGoogle Scholar
  8. 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.PubMedGoogle Scholar
  9. 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.PubMedGoogle Scholar
  10. 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.PubMedGoogle Scholar
  11. 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.PubMedCentralPubMedGoogle Scholar
  12. 12.
    Beauregard S, Gilchrest BA. A survey of skin problems and skin care regimens in the elderly. Arch Dermatol. 1987;123:1638–43.PubMedGoogle Scholar
  13. 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.PubMedGoogle Scholar
  14. 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.PubMedGoogle Scholar
  15. 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.PubMedGoogle Scholar
  16. 16.
    White-Chu EF, Reddy M. Dry skin in the elderly: complexities of a common problem. Clin Dermatol. 2011;29(1):37–42.PubMedGoogle Scholar
  17. 17.
    Yosipovitch G. Dry skin and impairment of barrier function associated with itch—new insights. Int J Cosmet Sci. 2004;26(1):1–7.PubMedGoogle Scholar
  18. 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.PubMedGoogle Scholar
  19. 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.PubMedGoogle Scholar
  20. 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.PubMedGoogle Scholar
  21. 21.
    Long CC, Marks R. Stratum corneum changes in patients with senile pruritus. J Am Acad Dermatol. 1992;27(4):560–4.PubMedGoogle Scholar
  22. 22.
    Elias PM, Ghadially R. The aged epidermal permeability barrier: basis for functional abnormalities. Clin Geriatr Med. 2002;18(1):103–20, vii.Google Scholar
  23. 23.
    Pappas A. Epidermal surface lipids. Dermatoendocrinol. 2009;1(2):72–6.PubMedCentralPubMedGoogle Scholar
  24. 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.PubMedGoogle Scholar
  25. 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.PubMedCentralPubMedGoogle Scholar
  26. 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.PubMedGoogle Scholar
  27. 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.PubMedGoogle Scholar
  28. 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.PubMedGoogle Scholar
  29. 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.PubMedGoogle Scholar
  30. 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.PubMedGoogle Scholar
  31. 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.PubMedGoogle Scholar
  32. 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.PubMedGoogle Scholar
  33. 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.PubMedGoogle Scholar
  34. 34.
    Ali SM, Yosipovitch G. Skin pH: from basic science to basic skin care. Acta Derm Venereol. 2013;93(3):261–7.PubMedGoogle Scholar
  35. 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.PubMedGoogle Scholar
  36. 36.
    Rawlings AV, Voegeli R. Stratum corneum proteases and dry skin conditions. Cell Tissue Res. 2013;351(2):217–35.PubMedGoogle Scholar
  37. 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.PubMedGoogle Scholar
  38. 38.
    Theodosat A. Skin diseases of the lower extremities in the elderly. Dermatol Clin. 2004;22(1):13–21.PubMedGoogle Scholar
  39. 39.
    Fenske NA, Lober CW. Structural and functional changes of normal aging skin. J Am Acad Dermatol. 1986;15(4 Pt 1):571–85.PubMedGoogle Scholar
  40. 40.
    Thornton MJ. Estrogens and aging skin. Dermatoendocrinol. 2013;5(2):264–70.PubMedCentralPubMedGoogle Scholar
  41. 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.PubMedGoogle Scholar
  42. 42.
    Stumpf A, Ständer S. Neuropathic itch: diagnosis and management. Dermatol Ther. 2013;26(2):104–9.PubMedGoogle Scholar
  43. 43.
    Oaklander AL. Neuropathic itch. Semin Cutan Med Surg. 2011;30(2):87–92.PubMedCentralPubMedGoogle Scholar
  44. 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.PubMedGoogle Scholar
  45. 45.
    Liddell K. Letter: post-herpetic pruritus. Br Med J. 1974;4(5937):165.PubMedCentralPubMedGoogle Scholar
  46. 46.
    Oaklander AL. Mechanisms of pain and itch caused by herpes zoster (shingles). J Pain. 2008;9(1 Suppl 1):S10–8.PubMedGoogle Scholar
  47. 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.PubMedCentralPubMedGoogle Scholar
  48. 48.
    Bin Saif GA, Ericson ME, Yosipovitch G. The itchy scalp—scratching for an explanation. Exp Dermatol. 2011;20(12):959–68.PubMedGoogle Scholar
  49. 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.PubMedGoogle Scholar
  50. 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.PubMedGoogle Scholar
  51. 51.
    Wolking S, Lerche H, Dihné M. Episodic itch in a case of spinal glioma. BMC Neurol. 2013;13:124.PubMedCentralPubMedGoogle Scholar
  52. 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.PubMedGoogle Scholar
  53. 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.PubMedGoogle Scholar
  54. 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.Google Scholar
  55. 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.PubMedGoogle Scholar
  56. 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.PubMedGoogle Scholar
  57. 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.PubMedGoogle Scholar
  58. 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.PubMedGoogle Scholar
  59. 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.PubMedCentralPubMedGoogle Scholar
  60. 60.
    Fitzpatrick JE. Common inflammatory skin diseases of the elderly. Geriatrics. 1989;44(7):40–6.PubMedGoogle Scholar
  61. 61.
    Ward JR, Bernhard JD. Willan’s itch and other causes of pruritus in the elderly. Int J Dermatol. 2005;44(4):267–73.PubMedGoogle Scholar
  62. 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.PubMedGoogle Scholar
  63. 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.PubMedCentralPubMedGoogle Scholar
  64. 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.PubMedGoogle Scholar
  65. 65.
    Prakash AV, Davis MD. Contact dermatitis in older adults: a review of the literature. Am J Clin Dermatol. 2010;11(6):373–81.PubMedGoogle Scholar
  66. 66.
    Balato A, Balato N, Di Costanzo L, Ayala F. Contact sensitization in the elderly. Clin Dermatol. 2011;29(1):24–30.PubMedGoogle Scholar
  67. 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.PubMedGoogle Scholar
  68. 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.PubMedGoogle Scholar
  69. 69.
    Ozkaya E. Adult-onset atopic dermatitis. J Am Acad Dermatol. 2005;52(4):579–82.PubMedGoogle Scholar
  70. 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.PubMedGoogle Scholar
  71. 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.PubMedGoogle Scholar
  72. 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.PubMedGoogle Scholar
  73. 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.PubMedGoogle Scholar
  74. 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.PubMedGoogle Scholar
  75. 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.PubMedGoogle Scholar
  76. 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.PubMedGoogle Scholar
  77. 77.
    Quirk CJ, Heenan PJ. Grover’s disease: 34 years on. Australas J Dermatol. 2004;45(2):83–6 quiz 87–8.PubMedGoogle Scholar
  78. 78.
    Yosipovitch G. Chronic pruritus: a paraneoplastic sign. Dermatol Ther. 2010;23(6):590–6.PubMedCentralPubMedGoogle Scholar
  79. 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.PubMedGoogle Scholar
  80. 80.
    Elgart ML. Skin infections and infestations in geriatric patients. Clin Geriatr Med. 2002;18(1):89–101, vi.Google Scholar
  81. 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.PubMedGoogle Scholar
  82. 82.
    Hicks MI, Elston DM. Scabies. Dermatol Ther. 2009;22(4):279–92.PubMedGoogle Scholar
  83. 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.PubMedGoogle Scholar
  84. 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.PubMedGoogle Scholar
  85. 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.PubMedCentralPubMedGoogle Scholar
  86. 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.PubMedGoogle Scholar
  87. 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.PubMedGoogle Scholar
  88. 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.PubMedCentralPubMedGoogle Scholar
  89. 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.Google Scholar
  90. 90.
    Lober CW. Pruritus and malignancy. Clin Dermatol. 1993;11(1):125–8.PubMedGoogle Scholar
  91. 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.PubMedGoogle Scholar
  92. 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.PubMedGoogle Scholar
  93. 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.PubMedGoogle Scholar
  94. 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.PubMedGoogle Scholar
  95. 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.PubMedGoogle Scholar
  96. 96.
    Bolier AR, Peri S, Oude Elferink RP, Beuers U. The challenge of cholestatic pruritus. Acta Gastroenterol Belg. 2012;75(4):399–404.PubMedGoogle Scholar
  97. 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.PubMedCentralPubMedGoogle Scholar
  98. 98.
    Massey EW. Unilateral neurogenic pruritus following stroke. Stroke. 1984;15(5):901–3.PubMedGoogle Scholar
  99. 99.
    Oaklander AL. Neuropathic pruritus following Wallenberg syndrome. Neurology. 2009;73(19):1605 author reply 1605–6.PubMedGoogle Scholar
  100. 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.PubMedGoogle Scholar
  101. 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.Google Scholar
  102. 102.
    Nguyen N, Holodniy M. HIV infection in the elderly. Clin Interv Aging. 2008;3(3):453–72.PubMedCentralPubMedGoogle Scholar
  103. 103.
    Artantaş S, Gül U, Kiliç A, Güler S. Skin findings in thyroid diseases. Eur J Intern Med. 2009;20(2):158–61.PubMedGoogle Scholar
  104. 104.
    Reich A, Ständer S, Szepietowski JC. Drug-induced pruritus: a review. Acta Derm Venereol. 2009;89(3):236–44.PubMedGoogle Scholar
  105. 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.PubMedGoogle Scholar
  106. 106.
    Levine N. Pruritic lesions on extremities. Could this persistent eruption be related to hypertension medication? Geriatrics. 1997;52(9):89.PubMedGoogle Scholar
  107. 107.
    Raksha MP, Marfatia YS. Clinical study of cutaneous drug eruptions in 200 patients. Indian J Dermatol Venereol Leprol. 2008;74(1):80.PubMedGoogle Scholar
  108. 108.
    Yosipovitch G, Samuel LS. Neuropathic and psychogenic itch. Dermatol Ther. 2008;21(1):32–41.PubMedGoogle Scholar
  109. 109.
    Ferm I, Sterner M, Wallengren J. Somatic and psychiatric comorbidity in patients with chronic pruritus. Acta Derm Venereol. 2010;90(4):395–400.PubMedGoogle Scholar
  110. 110.
    Krishnan A, Koo J. Psyche, opioids, and itch: therapeutic consequences. Dermatol Ther. 2005;18(4):314–22.PubMedGoogle Scholar
  111. 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.PubMedGoogle Scholar
  112. 112.
    Skoog I. Psychiatric disorders in the elderly. Can J Psychiatry. 2011;56(7):387–97.PubMedGoogle Scholar
  113. 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.PubMedCentralPubMedGoogle Scholar
  114. 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.PubMedGoogle Scholar
  115. 115.
    Fjellner B, Arnetz BB. Psychological predictors of pruritus during mental stress. Acta Derm Venereol. 1985;65(6):504–8.PubMedGoogle Scholar
  116. 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.PubMedGoogle Scholar
  117. 117.
    Yosipovitch G, Bernhard JD. Clinical practice. Chronic pruritus. N Engl J Med. 2013;368(17):1625–34.PubMedGoogle Scholar
  118. 118.
    Wolking S, Lerche H, Dihné M. Episodic itch in a case of spinal glioma. BMC Neurol. 2013;13:124.PubMedCentralPubMedGoogle Scholar
  119. 119.
    Weisshaar E. Intractable chronic pruritus in a 67-year-old man. Acta Derm Venereol. 2008;88(5):488–90.PubMedGoogle Scholar
  120. 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.Google Scholar
  121. 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.PubMedGoogle Scholar
  122. 122.
    Patel T, Yosipovitch G. The management of chronic pruritus in the elderly. Skin Therapy Lett. 2010;15(8):5–9.PubMedGoogle Scholar
  123. 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.PubMedGoogle Scholar
  124. 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.PubMedGoogle Scholar
  125. 125.
    Yosipovitch G, Papoiu AD. What causes itch in atopic dermatitis? Curr Allergy Asthma Rep. 2008;4:306–11.Google Scholar
  126. 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.PubMedGoogle Scholar
  127. 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.PubMedGoogle Scholar
  128. 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.PubMedGoogle Scholar
  129. 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.PubMedGoogle Scholar
  130. 130.
    Patel T, Ishiuji Y, Yosipovitch G. Menthol: a refreshing look at this ancient compound. J Am Acad Dermatol. 2007;57(5):873–8.PubMedGoogle Scholar
  131. 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.PubMedCentralPubMedGoogle Scholar
  132. 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.PubMedGoogle Scholar
  133. 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.PubMedGoogle Scholar
  134. 134.
    Kligman AM, Frosch PJ. Steroid addiction. Int J Dermatol. 1979;18(1):23–31.PubMedGoogle Scholar
  135. 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.PubMedCentralPubMedGoogle Scholar
  136. 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.PubMedGoogle Scholar
  137. 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.PubMedGoogle Scholar
  138. 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.PubMedGoogle Scholar
  139. 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.Google Scholar
  140. 140.
    O’Donoghue M, Tharp MD. Antihistamines and their role as antipruritics. Dermatol Ther. 2005;18(4):333–40.PubMedGoogle Scholar
  141. 141.
    Asero R, Tedeschi A, Cugno M. Treatment of chronic urticaria. Immunol Allergy Clin North Am. 2014;34(1):105–16.PubMedGoogle Scholar
  142. 142.
    Davis MP, Frandsen JL, Walsh D, et al. Mirtazapine for pruritus. J Pain Symptom Manage. 2003;25(3):288–91.PubMedGoogle Scholar
  143. 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.PubMedGoogle Scholar
  144. 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.PubMedGoogle Scholar
  145. 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.PubMedGoogle Scholar
  146. 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.PubMedGoogle Scholar
  147. 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.PubMedGoogle Scholar
  148. 148.
    Dawn AG, Yosipovitch G. Butorphanol for treatment of intractable pruritus. J Am Acad Dermatol. 2006;54(3):527–31.PubMedGoogle Scholar
  149. 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.PubMedGoogle Scholar
  150. 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.PubMedGoogle Scholar
  151. 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.PubMedGoogle Scholar
  152. 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.PubMedGoogle Scholar
  153. 153.
    Wood GJ, Akiyama T, Carstens E, Oaklander AL, Yosipovitch G. An insatiable itch. J Pain. 2009;10(8):792–7.PubMedGoogle Scholar
  154. 154.
    Ehrchen J, Stander S. Pregabalin in the treatment of chronic pruritus. J Am Acad Dermatol. 2008;58(2):S36–7.PubMedGoogle Scholar
  155. 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.PubMedGoogle Scholar
  156. 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.PubMedGoogle Scholar
  157. 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.PubMedGoogle Scholar
  158. 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.PubMedCentralPubMedGoogle Scholar
  159. 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.PubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Rodrigo Valdes-Rodriguez
    • 1
  • Carolyn Stull
    • 1
  • Gil Yosipovitch
    • 1
  1. 1.Department of Dermatology and Itch CenterTemple University School of MedicinePhiladelphiaUSA

Personalised recommendations