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Chronic Pruritus in the Elderly: Pathophysiology, Diagnosis and Management

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Abstract

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.

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Acknowledgments

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

Funding

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.

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  1. Department of Dermatology and Itch Center, Temple University School of Medicine, 3322 North Broad Street, Medical Office Building, Suite 212, Philadelphia, PA, 19140, USA

    Rodrigo Valdes-Rodriguez, Carolyn Stull & Gil Yosipovitch

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  1. Rodrigo Valdes-Rodriguez
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  2. Carolyn Stull
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  3. Gil Yosipovitch
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Correspondence to Gil Yosipovitch.

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Valdes-Rodriguez, R., Stull, C. & Yosipovitch, G. Chronic Pruritus in the Elderly: Pathophysiology, Diagnosis and Management. Drugs Aging 32, 201–215 (2015). https://doi.org/10.1007/s40266-015-0246-0

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