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Treatment of Pruritus Associated with Systemic Disorders in the Elderly

A Review of the Role of New Therapies

  • Therapy in Practice
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Abstract

Generalised pruritus is common in the elderly. Idiopathic ‘senile pruritus’ is a diagnosis of exclusion, and an underlying systemic disorder should be sought. Thyroid disease, haematological malignancy, iron deficiency, cholestasis or renal impairment may be responsible for pruritus. Rarely pruritus may occur after cerebral infarction or as a paraneoplastic phenomenon.

The mechanisms of pruritus are poorly understood. In systemic disorders, correction of the underlying disorder alleviates itch. However, when this cannot be achieved, a symptomatic approach is required.

Response to treatment varies enormously and an empirical approach is often required. Topical applications are available to soothe the skin and bandaging techniques may improve their efficacy. A number of more targeted treatments are available for renal and cholestatic pruritus. Novel therapies such as thalidomide, opioid antagonists, ondansetron and phototherapy with ultraviolet (UV)-B radiation are now being used.

Treatment of pruritus needs to be individualised, and the elderly present a particular challenge. Adequate delivery of simple emollients may be impossible because of physical impairment The elderly are more vulnerable to the adverse effects of treatments, comorbidities may alter the pharmacokinetics of drug metabolism and polypharmacy increases the likelihood of adverse drug interactions. Cognitive impairment can lead to poor compliance with treatment.

The patient’s general health, the severity of symptoms and the adverse effects of treatment all need to be considered. Most treatments are of benefit only to some patients; others derive only marginal improvement. Many of the newer treatments are unlicensed for pruritus and should preferably be administered under specialist supervision.

We review the literature concerning the treatment of itch associated with systemic diseases, with particular emphasis on issues relevant to the elderly. Pruritus is a difficult symptom to treat. However, it is hoped that research into the mechanisms underlying the pruritus of systemic disease will allow a better understanding so that we should be able to look forward to more specific and effective therapies in the future.

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References

  1. Lidstone V, Thorns A. Pruritus in cancer patients. Cancer Treat Rev 2001; 27(5): 305–12

    PubMed  CAS  Google Scholar 

  2. Greaves MW. Itching — research has barely scratched the surface. N Engl J Med 1992; 326(15): 1016–7

    PubMed  CAS  Google Scholar 

  3. Denman ST. A review of pruritus. J Am Acad Dermatol 1986; 14(3): 375–92

    PubMed  CAS  Google Scholar 

  4. Potts RO, Buras Jr EM, Chrisman Jr DA. Changes with age in the moisture content of human skin. J Invest Dermatol 1984; 82(1): 97–100

    PubMed  CAS  Google Scholar 

  5. Kantor GR, Lookingbill DP. Generalized pruritus and systemic disease. J Am Acad Dermatol 1983; 9(3): 375–82

    PubMed  CAS  Google Scholar 

  6. Dykes PJ, Marks R. An appraisal of the methods used in the assessment of atrophy from topical corticosteroids. Br J Dermatol 1979; 101(5): 599–609

    PubMed  CAS  Google Scholar 

  7. Reitamo S, Rissanen J, Remitz A, et al. Tacrolimus ointment does not affect collagen synthesis: results of a single-center randomized trial. J Invest Dermatol 1998; 111(3): 396–8

    PubMed  CAS  Google Scholar 

  8. Aioardi C, Dost FH. Menthol and menthol-containing external remedies. International symposium on menthol and menthol-containing external remedies; use, mode of effect and tolerance in children. In: Do Fh, Leiber B, editors. International Symposium; 1966 April; Paris: Stuttgart, George Thieme Verlag, 1967

    Google Scholar 

  9. Bromm B, Scharein E, Darsow U, et al. Effects of menthol and cold on histamine-induced itch and skin reactions in man. Neurosci Lett 1995; 187(3): 157–60

    PubMed  CAS  Google Scholar 

  10. Hagermark O, Wahlgren CF. Treatment of itch. Semin Dermatol 1995; 14(4): 320–5

    PubMed  CAS  Google Scholar 

  11. Smith EB, King CA, Baker MD. Crotamiton lotion in pruritus. Int J Dermatol 1984; 23(10): 684–5

    PubMed  CAS  Google Scholar 

  12. Doxepin cream for eczema?Drug Ther Bull 2000; 38(4): 31–2

    Google Scholar 

  13. Greiding L, Moreno P. Doxepin incorporated into a dermatologic cream: an assessment of both doxepin antipruritic action and doxepin action as an inhibitor of papules, in allergen and histamine-caused pruritus. Allergol Immunopathol (Madr) 1999; 27(5): 265–70

    CAS  Google Scholar 

  14. Drake LA, Millikan LE. The antipruritic effect of 5% doxepin cream in patients with eczematous dermatitis. Doxepin Study Group. Arch Dermatol 1995; 131(12): 1403–8

    PubMed  CAS  Google Scholar 

  15. Drake LA, Fallon JD, Sober A. Relief of pruritus in patients with atopic dermatitis after treatment with topical doxepin cream. The Doxepin Study Group. J Am Acad Dermatol 1994; 31(4): 613–6

    PubMed  CAS  Google Scholar 

  16. Tonnesen MG. Pruritus. In: Fitzpatrick TB, Eisen AZ, Wolff K, editors. Dermatology in general medicine. 2nd ed. New York: McGraw-Hill, 1979: 32–4

    Google Scholar 

  17. Isaacs NJ, Ertel NH. Urticaria and pruritus: uncommon manifestations of hyperthyroidism. J Allergy Clin Immunol 1971; 48(2): 73–81

    PubMed  CAS  Google Scholar 

  18. Barnes HM, Sarkany I, Calnan CD. Pruritus and thyrotoxicosis. Trans St Johns Hosp Dermatol Soc 1974; 60(1): 59–62

    PubMed  CAS  Google Scholar 

  19. Carmichael AJ, McHugh MM, Martin AM, et al. Serological markers of renal itch in patients receiving long term haemodialysis. Br Med J (Clin Res Ed) 1988; 296(6636): 1575

    CAS  Google Scholar 

  20. Blachley JD, Blankenship DM, Menter A, et al. Uremic pruritus: skin divalent ion content and response to ultraviolet phototherapy. Am J Kidney Dis 1985; 5(5): 237–41

    PubMed  CAS  Google Scholar 

  21. Winkelmann RK. Pharmacologic control of pruritus. Med Clin North Am 1982; 66(5): 1119–33

    PubMed  CAS  Google Scholar 

  22. Kleeman CR, Massry SG, Popovtzer MM, et al. The disappearance of intractable pruritus after parathyroidectomy in uremic patients with secondary hyperparathyroidism. Trans Assoc Am Physicians 1968; 81: 203–12

    PubMed  CAS  Google Scholar 

  23. Massry SG, Popovtzer MM, Coburn JW, et al. Intractable pruritus as a manifestation of secondary hyperparathyroidism in uremia. Disappearance of itching after subtotal parathyroidectomy. N Engl J Med 1968; 279(13): 697–700

    PubMed  CAS  Google Scholar 

  24. Neilly JB, Martin A, Simpson N, et al. Pruritus in diabetes mellitus: investigation of prevalence and correlation with diabetes control. Diabetes Care 1986; 9: 273–5

    PubMed  CAS  Google Scholar 

  25. Staubli M. Pruritus — a little known iron-deficiency symptom [in German]. Schweiz Med Wochenschr 1981; 111(38): 1394–8

    PubMed  CAS  Google Scholar 

  26. Oral iron. In: Mehta DK, editor. British National Formulary. 43th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2002: 437

  27. Gilchrest BA. Pruritus: pathogenesis, therapy, and significance in systemic disease states. Arch Intern Med 1982; 142(1): 101–5

    PubMed  CAS  Google Scholar 

  28. Wasserman LR. The treatment of polycythemia vera. Semin Hematol 1976; 13(1): 57–78

    PubMed  CAS  Google Scholar 

  29. Archer CB, Camp RD, Greaves MW. Polycythaemia vera can present with aquagenic pruritus. Lancet 1988; 1(8600): 1451

    PubMed  CAS  Google Scholar 

  30. Muller EW, de Wolf JT, Egger R, et al. Long-term treatment with interferon-alpha 2b for severe pruritus in patients with polycythaemia vera. Br J Haematol 1995; 89(2): 313–8

    PubMed  CAS  Google Scholar 

  31. Salem HH, Van der Weyden MB, Young IF, et al. Pruritus and severe iron deficiency in polycythaemia vera. Br Med J (Clin Res Ed) 1982; 285(6335): 91–2

    CAS  Google Scholar 

  32. Fjellner B, Hagermark O. Pruritus in polycythemia vera: treatment with aspirin and possibility of platelet involvement. Acta Derm Venereol 1979; 59(6): 505–12

    PubMed  CAS  Google Scholar 

  33. Weick JK, Donovan PB, Najean Y, et al. The use of cimetidine for the treatment of pruritus in polycythemia vera. Arch Intern Med 1982; 142(2): 241–2

    PubMed  CAS  Google Scholar 

  34. Kolodny L, Horstman LL, Sevin BU, et al. Danazol relieves refractory pruritus associated with myeloproliferative disorders and other diseases. Am J Hematol 1996; 51(2): 112–6

    PubMed  CAS  Google Scholar 

  35. Randi ML, Luzzatto G, Fabris F. Danazol in refractory pruritus of myeloproliferative disorders. Am J Hematol 1997; 54(2): 172–3

    PubMed  CAS  Google Scholar 

  36. Chanarin I, Szur L. Relief of intractable pruritus in polycythaemia rubra vera with cholestyramine [letter]. Br J Haematol 1975; 29(4): 669–70

    PubMed  CAS  Google Scholar 

  37. Steinman HK, Greaves MW. Aquagenic pruritus. J Am Acad Dermatol 1985; 13(1): 91–6

    PubMed  CAS  Google Scholar 

  38. Jeanmougin M, Rain JD, Najean Y. Efficacy of photochemotherapy on severe pruritus in polycythemia vera. Ann Hematol 1996; 73(2): 91–3

    PubMed  CAS  Google Scholar 

  39. Baldo A, Monfrecola G. Narrowband (TL-01) ultraviolet B phototherapy for pruritus in polycythaemia vera. Br J Dermatol 2002; 147(5): 979–81

    PubMed  CAS  Google Scholar 

  40. Gaudin P, Rozand Y, Fauconnier J, et al. Rheumatic manifestations at presentation of Hodgkin’s disease and non-Hodgkin’s malignant lymphoma: a national survey of one hundred fortysix patients. Rev Rhum Engl Ed 1995; 62(5): 365–75

    PubMed  CAS  Google Scholar 

  41. Alexander LL. Pruritus and Hodgkin’s disease. JAMA 1979; 241(24): 2598–9

    PubMed  CAS  Google Scholar 

  42. Feiner AS, Mahmood T, Wallner SF. Prognostic importance of pruritus in Hodgkin’s disease. JAMA 1978; 240(25): 2738–40

    PubMed  CAS  Google Scholar 

  43. Gobbi PG, Attardo-Parrinello G, Lattanzio G, et al. Severe pruritus should be a B-symptom in Hodgkin’s disease. Cancer 1983; 51(10): 1934–6

    PubMed  CAS  Google Scholar 

  44. Gobbi PG, Cavalli C, Gendarini A, et al. Reevaluation of prognostic significance of symptoms in Hodgkin’s disease. Cancer 1985; 56(12): 2874–80

    PubMed  CAS  Google Scholar 

  45. Young Jr AW, Sweeney EW, David DS, et al. Dermatologic evaluation of pruritus in patients on hemodialysis. N Y State J Med 1973; 73(22): 2670–4

    PubMed  Google Scholar 

  46. Gilchrest BA, Stern RS, Steinman TI, et al. Clinical features of pruritus among patients undergoing maintenance hemodialysis. Arch Dermatol 1982; 118(3): 154–6

    PubMed  CAS  Google Scholar 

  47. Bencini PL, Montagnino G, Citterio A, et al. Cutaneous abnormalities in uremic patients. Nephron 1985; 40(3): 316–21

    PubMed  CAS  Google Scholar 

  48. Southi P, Commens C. Pruritus in dialysis patients. Med J Aust 1987; 146(7): 397, 400

    PubMed  CAS  Google Scholar 

  49. Matsumoto M, Ichimaru K, Horie A. Pruritus and mast cell proliferation of the skin in end stage renal failure. Clin Nephrol 1985; 23(6): 285–8

    PubMed  CAS  Google Scholar 

  50. Stahle-Backdahl M. Uremic pruritus. Clinical and experimental studies. Acta Derm Venereol Suppl 1989; 145: 1–38

    CAS  Google Scholar 

  51. Ponticelli C, Bencini PL. Uremic pruritus: a review. Nephron 1992; 60(1): 1–5

    PubMed  CAS  Google Scholar 

  52. Duo LJ. Electrical needle therapy of uremic pruritus. Nephron 1987; 47(3): 179–83

    PubMed  CAS  Google Scholar 

  53. Yatzidis H, Digenis P, Tountas C. Heparin treatment of uremic itching. JAMA 1972; 222(9): 1183

    PubMed  CAS  Google Scholar 

  54. Fishman SM, Caneris OA, Stojanovic MP, et al. Intravenous lidocaine for treatment-resistant pruritus. Am J Med 1997; 102(6): 584–5

    PubMed  CAS  Google Scholar 

  55. Watson WC. Intravenous lignocaine for relief of intractable itch. Lancet 1973; 1(7796): 211

    PubMed  CAS  Google Scholar 

  56. Tapia L, Cheigh JS, David DS, et al. Pruritus in dialysis patients treated with parenteral lidocaine. N Engl J Med 1977; 296(5): 261–2

    PubMed  CAS  Google Scholar 

  57. Masi CM, Cohen EP. Dialysis efficacy and itching in renal failure. Nephron 1992; 62(3): 257–61

    PubMed  CAS  Google Scholar 

  58. Hiroshige K, Kabashima N, Takasugi M, et al. Optimal dialysis improves uremic pruritus. Am J Kidney Dis 1995; 25(3): 413–9

    PubMed  CAS  Google Scholar 

  59. Kyriazis J, Glotsos J. Dialysate calcium concentration of </=1.25 mmol/l: is it effective in suppressing uremic pruritus? Nephron 2000; 84(1): 85–6

    PubMed  CAS  Google Scholar 

  60. Schwartz IF, Iaina A. Uraemic pruritus. Nephrol Dial Transplant 1999; 14(4): 834–9

    PubMed  CAS  Google Scholar 

  61. Pauli-Magnus C, Mikus G, Alscher DM, et al. Naltrexone does not relieve uremic pruritus: results of a randomized, double-blind, placebo-controlled crossover study. J Am Soc Nephrol 2000; 11(3): 514–9

    PubMed  CAS  Google Scholar 

  62. Morton CA, Lafferty M, Hau C, et al. Pruritus and skin hydration during dialysis. Nephrol Dial Transplant 1996; 11(10): 2031–6

    PubMed  CAS  Google Scholar 

  63. De Marchi S, Cecchin E, Villalta D, et al. Relief of pruritus and decreases in plasma histamine concentrations during erythropoietin therapy in patients with uremia. N Engl J Med 1992; 326(15): 969–74

    PubMed  Google Scholar 

  64. Balaskas EV, Uldall RP. Erythropoietin treatment does not improve uremic pruritus. Perit Dial Int 1992; 12(3): 330–1

    PubMed  CAS  Google Scholar 

  65. Tan JK, Haberman HF, Coldman AJ. Identifying effective treatments for uremic pruritus. J Am Acad Dermatol 1991; 25 (5 Pt 1): 811–8

    PubMed  CAS  Google Scholar 

  66. Gilchrest BA, Rowe JW, Brown RS, et al. Ultraviolet phototherapy of uremic pruritus. Long-term results and possible mechanism of action. Ann Intern Med 1979; 91(1): 17–21

    PubMed  CAS  Google Scholar 

  67. Slaper H, Schothorst AA, van der Leun JC. Risk evaluation of UVB therapy for psoriasis: comparison of calculated risk for UVB therapy and observed risk in PUVA-treated patients. Photodermatol 1986; 3(5): 271–83

    PubMed  CAS  Google Scholar 

  68. Taylor R, Taylor AE, Diffey BL, et al. A placebo-controlled trial of UV-A phototherapy for the treatment of uraemic pruritus. Nephron 1983; 33(1): 14–6

    PubMed  CAS  Google Scholar 

  69. Simpson NB, Davison AM. Ultraviolet phototherapy for uraemic pruritus. Lancet 1981; 1(8223): 781

    PubMed  CAS  Google Scholar 

  70. Spiro JG, Scott S, MacMillan J, et al. Treatment of uremic pruritus with blue light. Photodermatol 1985; 2(5): 319–21

    PubMed  CAS  Google Scholar 

  71. Silverberg DS, Iaina A, Reisin E, et al. Cholestyramine in uraemic pruritus. Br Med J 1977; 1(6063): 752–3

    PubMed  CAS  Google Scholar 

  72. van Leusen R, Kutsch Lojenga JC, Ruben A. Is cholestyramine helpful in uraemic pruritus? Br Med J 1978; 1(6117): 918–9

    PubMed  Google Scholar 

  73. Wrong OM. Cholestyramine in uraemic pruritus. Br Med J 1977; 1(6077): 1662

    PubMed  CAS  Google Scholar 

  74. Pederson JA, Matter BJ, Czerwinski AW, et al. Relief of idiopathic generalized pruritus in dialysis patients treated with activated oral charcoal. Ann Intern Med 1980; 93(3): 446–8

    PubMed  CAS  Google Scholar 

  75. Giovannetti S, Barsotti G, Cupisti A, et al. Oral activated charcoal in patients with uremic pruritus. Nephron 1995; 70(2): 193–6

    PubMed  CAS  Google Scholar 

  76. Mettang T, Fischer FP, Dollenbacher U, et al. Uraemic pruritus is not related to beta-endorphin serum levels in haemodialysis patients. Nephrol Dial Transplant 1998; 13(1): 231–2

    PubMed  CAS  Google Scholar 

  77. Hwang JC, Hsu KT, Tsai HC, et al. Serum endorphin levels in uremic patients under maintenance hemodialysis. Taiwan Yi Xue Hui Za Zhi 1989; 88(4): 360–5

    PubMed  CAS  Google Scholar 

  78. Peer G, Kivity S, Agami O, et al. Randomised crossover trial of naltrexone in uraemic pruritus. Lancet 1996; 348(9041): 1552–4

    PubMed  CAS  Google Scholar 

  79. Kerr PG, Argiles A, Mion C. Whole blood serotonin levels are markedly elevated in patients on dialytic therapy. Am J Nephrol 1992; 12(1–2): 14–8

    PubMed  CAS  Google Scholar 

  80. Balaskas EV, Bamihas GI, Karamouzis M, et al. Histamine and serotonin in uremic pruritus: effect of ondansetron in CAPD-pruritic patients. Nephron 1998; 78(4): 395–402

    PubMed  CAS  Google Scholar 

  81. Ashmore SD, Jones CH, Newstead CG, et al. Ondansetron therapy for uremic pruritus in hemodialysis patients. Am J Kidney Dis 2000; 35(5): 827–31

    PubMed  CAS  Google Scholar 

  82. Murphy M, Reaich D, Finn P, et al. A randomised, placebo-controlled, double-blind trial of ondansetron in renal itch. Br J Dermatol 2001; 145: 34–5

    Google Scholar 

  83. Breneman DL, Cardone JS, Blumsack RF, et al. Topical capsaicin for treatment of hemodialysis-related pruritus. J Am Acad Dermatol 1992; 26(1): 91–4

    PubMed  CAS  Google Scholar 

  84. Cho YL, Liu HN, Huang TP, et al. Uremic pruritus: roles of parathyroid hormone and substance P. J Am Acad Dermatol 1997; 36(4): 538–43

    PubMed  CAS  Google Scholar 

  85. Tarng DC, Cho YL, Liu HN, et al. Hemodialysis-related pruritus: a double-blind, placebo-controlled, crossover study of capsaicin 0.025% cream. Nephron 1996; 72(4): 617–22

    PubMed  CAS  Google Scholar 

  86. Neiman RS, Bischel MD, Lukes RJ. Uraemia and mast-cell proliferation. Lancet 1972; 1(7757): 959

    PubMed  CAS  Google Scholar 

  87. Stockenhuber F, Kurz RW, Serti K, et al. Increased plasma histamine levels in uraemic pruritus. Clin Sci (Colch) 1990; 79(5): 477–82

    CAS  Google Scholar 

  88. Mettang T, Fritz P, Weber J, et al. Uremic pruritus in patients on hemodialysis or continuous ambulatory peritoneal dialysis (CAPD). The role of plasma histamine and skin mast cells. Clin Nephrol 1990; 34(3): 136–41

    PubMed  CAS  Google Scholar 

  89. Klein LR, Klein JB, Hanno R, et al. Cutaneous mast cell quantity in pruritic and nonpruritic hemodialysis patients. Int J Dermatol 1988; 27(8): 557–9

    PubMed  CAS  Google Scholar 

  90. Silva SR, Viana PC, Lugon NV, et al. Thalidomide for the treatment of uremic pruritus: a crossover randomized double-blind trial. Nephron 1994; 67(3): 270–3

    PubMed  CAS  Google Scholar 

  91. Powell RJ, Gardner-Medwin JM. Guideline for the clinical use and dispensing of thalidomide. Postgrad Med J 1994; 70(830): 901–4

    PubMed  CAS  Google Scholar 

  92. Ghent CN. Cholestatic pruritus. In: Bernhard JD, editor. Itch, mechanisms, and management of pruritus. New York: McGraw-Hill, 1994: 229–42

    Google Scholar 

  93. Ahrens EH, Payne MA, Kunkel HG, et al. Primary biliary cirrhosis. Medicine 1950; 29: 299–364

    PubMed  Google Scholar 

  94. Bartholomew TC, Summerfield JA, Billing BH, et al. Bile acid profiles of human serum and skin interstitial fluid and their relationship to pruritus studied by gas chromatography-mass spectrometry. Clin Sci (Colch) 1982; 63(1): 65–73

    CAS  Google Scholar 

  95. Jones EA, Bergasa NV. The pruritus of cholestasis. Hepatology 1999; 29(4): 1003–6

    PubMed  CAS  Google Scholar 

  96. Rupp N. Indications and results of percutaneous transhepatic bile-duct drainage [in German]. Chirurg 1979; 50(4): 233–8

    PubMed  CAS  Google Scholar 

  97. Bergasa NV, Jones EA. Management of the pruritus of cholestasis: potential role of opiate antagonists. Am J Gastroenterol 1991; 86(10): 1404–12

    PubMed  CAS  Google Scholar 

  98. Frezza M, Surrenti C, Manzillo G, et al. Oral S-adenosylmethionine in the symptomatic treatment of intrahepatic cholestasis: a double-blind, placebo-controlled study. Gastroenterology 1990; 99(1): 211–5

    PubMed  CAS  Google Scholar 

  99. Metze D, Reimann S, Beissert S, et al. Efficacy and safety of naltrexone, an oral opiate receptor antagonist, in the treatment of pruritus in internal and dermatological diseases. J Am Acad Dermatol 1999; 41(4): 533–9

    PubMed  CAS  Google Scholar 

  100. Thornton JR, Losowsky MS. Opioid peptides and primary biliary cirrhosis. BMJ 1988; 297(6662): 1501–4

    PubMed  CAS  Google Scholar 

  101. Bergasa NV, Ailing DW, Vergalla J, et al. Cholestasis in the male rat is associated with naloxone-reversible antinociception. J Hepatol 1994; 20(1): 85–90

    PubMed  CAS  Google Scholar 

  102. Bergasa NV, Talbot TL, Ailing DW, et al. A controlled trial of naloxone infusions for the pruritus of chronic cholestasis. Gastroenterology 1992; 102(2): 544–9

    PubMed  CAS  Google Scholar 

  103. Bergasa NV, Ailing DW, Talbot TL, et al. Effects of naloxone infusions in patients with the pruritus of cholestasis: a double-blind, randomized, controlled trial. Ann Intern Med 1995; 123(3): 161–7

    PubMed  CAS  Google Scholar 

  104. Bergasa NV, Schmitt JM, Talbot TL, et al. Open-label trial of oral nalmefene therapy for the pruritus of cholestasis. Hepatology 1998; 27(3): 679–84

    PubMed  CAS  Google Scholar 

  105. Bergasa NV, Ailing DW, Talbot TL, et al. Oral nalmefene therapy reduces scratching activity due to the pruritus of cholestasis: a controlled study. J Am Acad Dermatol 1999; 41 (3 Pt 1): 431–4

    PubMed  CAS  Google Scholar 

  106. Wolfhagen FH, Sternieri E, Hop WC, et al. Oral naltrexone treatment for cholestatic pruritus: a double-blind, placebo-controlled study. Gastroenterology 1997; 113(4): 1264–9

    PubMed  CAS  Google Scholar 

  107. Carson KL, Tran TT, Cotton P, et al. Pilot study of the use of naltrexone to treat the severe pruritus of cholestatic liver disease. Am J Gastroenterol 1996; 91(5): 1022–3

    PubMed  CAS  Google Scholar 

  108. Jones EA, Dekker LR. Florid opioid withdrawal-like reaction precipitated by naltrexone in a patient with chronic cholestasis. Gastroenterology 2000; 118(2): 431–2

    PubMed  CAS  Google Scholar 

  109. Ghent CN, Carruthers SG. Treatment of pruritus in primary biliary cirrhosis with rifampin. Results of a double-blind, crossover, randomized trial. Gastroenterology 1988; 94(2): 488–93

    PubMed  CAS  Google Scholar 

  110. Bloomer JR, Boyer JL. Phenobarbital effects in cholestatic liver diseases. Ann Intern Med 1975; 82(3): 310–7

    PubMed  CAS  Google Scholar 

  111. Turner IB, Rawlins MD, Wood P, et al. Flumecinol for the treatment of pruritus associated with primary biliary cirrhosis. Aliment Pharmacol Ther 1994; 8(3): 337–42

    PubMed  CAS  Google Scholar 

  112. Hoensch HP, Balzer K, Dylewizc P, et al. Effect of rifampicin treatment on hepatic drug metabolism and serum bile acids in patients with primary biliary cirrhosis. Eur J Clin Pharmacol 1985; 28(4): 475–7

    PubMed  CAS  Google Scholar 

  113. Cynamon HA, Andres JM, Iafrate RP. Rifampin relieves pruritus in children with cholestatic liver disease. Gastroenterology 1990; 98(4): 1013–6

    PubMed  CAS  Google Scholar 

  114. Woolf GM, Reynolds TB. Failure of rifampin to relieve pruritus in chronic liver disease. J Clin Gastroenterol 1990; 12(2): 174–7

    PubMed  CAS  Google Scholar 

  115. Bachs L, Pares A, Elena M, et al. Comparison of rifampicin with phenobarbitone for treatment of pruritus in biliary cirrhosis. Lancet 1989; 1(8638): 574–6

    PubMed  CAS  Google Scholar 

  116. Kreek MJ, Garfield JW, Gutjahr CL, et al. Rifampin-induced methadone withdrawal. N Engl J Med 1976; 294(20): 1104–6

    PubMed  CAS  Google Scholar 

  117. Prince MI, Jones DE. Primary biliary cirrhosis: new perspectives in diagnosis and treatment. Postgrad Med J 2000; 76(894): 199–206

    PubMed  CAS  Google Scholar 

  118. Schworer H, Hartmann H, Ramadori G. Relief of cholestatic pruritus by a novel class of drugs: 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists: effectiveness of ondansetron. Pain 1995; 61(1): 33–7

    PubMed  CAS  Google Scholar 

  119. Muller C, Pongratz S, Pidlich J, et al. Treatment of pruritus in chronic liver disease with the 5-hydroxytryptamine receptor type 3 antagonist ondansetron: a randomized, placebo-controlled, double-blind cross-over trial. Eur J Gastroenterol Hepatol 1998; 10(10): 865–70

    PubMed  CAS  Google Scholar 

  120. Larijani GE, Goldberg ME, Rogers KH. Treatment of opioid-induced pruritus with ondansetron: report of four patients. Pharmacotherapy 1996; 16(5): 958–60

    PubMed  CAS  Google Scholar 

  121. Crighton IM, Hobbs GJ, Reid MF. Ondansetron for the treatment of pruritus after spinal opioids. Anaesthesia 1996; 51(2): 199–200

    PubMed  CAS  Google Scholar 

  122. Borgeat A, Wilder-Smith OH, Mentha G. Subhypnotic doses of propofol relieve pruritus associated with liver disease. Gastroenterology 1993; 104(1): 244–7

    PubMed  CAS  Google Scholar 

  123. Borgeat A, Wilder-Smith OH, Saiah M, et al. Subhypnotic doses of propofol relieve pruritus induced by epidural and intrathecal morphine. Anesthesiology 1992; 76(4): 510–2

    PubMed  CAS  Google Scholar 

  124. Hanid MA, Levi AJ. Phototherapy for pruritus in primary biliary cirrhosis. Lancet 1980; 2(8193): 530

    PubMed  CAS  Google Scholar 

  125. Walt RP, Daneshmend TK, Fellows IW, et al. Effect of stanozolol on itching in primary biliary cirrhosis. Br Med J (Clin Res Ed) 1988; 296(6622): 607

    CAS  Google Scholar 

  126. Lloyd-Thomas HGL, Sherlock S. Testosterone therapy for the pruritus of obstructive jaundice. BMJ 1952; 2: 1289–91

    PubMed  CAS  Google Scholar 

  127. Whitmore SE. Treatment of hepatobiliary pruritus. J Am Acad Dermatol 1997; 36 (2 Pt 1): 279

    PubMed  CAS  Google Scholar 

  128. Poupon R, Chretien Y, Poupon RE, et al. Is ursodeoxycholic acid an effective treatment for primary biliary cirrhosis? Lancet 1987; 1(8537): 834–6

    PubMed  CAS  Google Scholar 

  129. Matsuzaki Y, Tanaka N, Osuga T, et al. Improvement of biliary enzyme levels and itching as a result of long-term administration of ursodeoxycholic acid in primary biliary cirrhosis. Am J Gastroenterol 1990; 85(1): 15–23

    PubMed  CAS  Google Scholar 

  130. Koeppel MC, Bramont C, Ceccaldi M, et al. Paroxysmal pruritus and multiple sclerosis. Br J Dermatol 1993; 129(5): 597–8

    PubMed  CAS  Google Scholar 

  131. Kimyai-Asadi A, Nousari HC, Kimyai-Asadi T, et al. Poststroke pruritus. Stroke 1999; 30(3): 692–3

    PubMed  CAS  Google Scholar 

  132. Osterman PO. Paroxysmal itching in multiple sclerosis. Br J Dermatol 1976; 95(5): 555–8

    PubMed  CAS  Google Scholar 

  133. Canavero S, Bonicalzi V, Massa-Micon B. Central neurogenic pruritus: a literature review. Acta Neurol Belg 1997; 97(4): 244–7

    PubMed  CAS  Google Scholar 

  134. Massey EW. Unilateral neurogenic pruritus following stroke. Stroke 1984; 15(5): 901–3

    PubMed  CAS  Google Scholar 

  135. Bernhard JD. Neurogenic pruritus and strange skin sensations. In: Bernhard JD, editor. Itch: mechanisms and management of pruritus. 1st ed. New York (NY): McGraw-Hill, 1994

    Google Scholar 

  136. Zylicz Z, Smits C, Krajnik M. Paroxetine for pruritus in advanced cancer. J Pain Symptom Manage 1998; 16(2): 121–4

    PubMed  CAS  Google Scholar 

  137. Feuerman EJ. Sjogren’s syndrome presenting as recalcitrant generalized pruritus. Some remarks about its relation to collagen diseases and the connection of rheumatoid arthritis with the Sicca syndrome. Dermatologica 1968; 137(2): 74–86

    PubMed  CAS  Google Scholar 

  138. Kovacs SO, Kovacs SC. Dermatomyositis. J Am Acad Dermatol 1998; 39(6): 899–920

    PubMed  CAS  Google Scholar 

  139. Thaipisuttikul Y. Pruritic skin diseases in the elderly. J Dermatol 1998; 25(3): 153–7

    PubMed  CAS  Google Scholar 

  140. Jacobsen E, Billings JK, Frantz RA, et al. Age-related changes in sebaceous wax ester secretion rates in men and women. J Invest Dermatol 1985; 85(5): 483–5

    PubMed  CAS  Google Scholar 

  141. Yamamoto A, Serizawa S, Ito M, et al. Effect of aging on sebaceous gland activity and on the fatty acid composition of wax esters. J Invest Dermatol 1987; 89(5): 507–12

    PubMed  CAS  Google Scholar 

  142. Long CC, Marks R. Stratum corneum changes in patients with senile pruritus. J Am Acad Dermatol 1992; 27(4): 560–4

    PubMed  CAS  Google Scholar 

  143. Hunter JA. Seventh age itch. Br Med J (Clin Res Ed) 1985; 291(6499): 842

    CAS  Google Scholar 

  144. Waisman M. A clinical look at the aging skin. Postgrad Med 1979; 66(1): 87–93, 96

    PubMed  CAS  Google Scholar 

  145. Bernhard JD. Phantom itch, pseudophantom itch, and senile pruritus. Int J Dermatol 1992; 31(12): 856–7

    PubMed  CAS  Google Scholar 

  146. Polenghi M, Colombo MD, Barcella ML, et al. A thioridazine-dihydroergotoxine combination in the treatment of senile pruritus [in Italian]. G Ital Dermatol Venereol 1989; 124(9): LI–LIII

    PubMed  CAS  Google Scholar 

  147. 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

    PubMed  CAS  Google Scholar 

  148. Teofoli P, De Pita O, Frezzolini A, et al. Antipruritic effect of oral cyclosporin A in essential senile pruritus. Acta Derm Venereol 1998; 78(3): 232

    PubMed  CAS  Google Scholar 

  149. Ungvari G, Vladar K. Pimozide treatment for delusion of infestation. Act Nerv Super (Praha) 1986; 28(2): 103–7

    CAS  Google Scholar 

  150. Munro A. Monosymptomatic hypochondriacal psychosis manifesting as delusions of parasitosis: a description of four cases successfully treated with pimozide. Arch Dermatol 1978; 114(6): 940–3

    PubMed  CAS  Google Scholar 

  151. Elmer KB, George RM, Peterson K. Therapeutic update: use of risperidone for the treatment of monosymptomatic hypochondriacal psychosis. J Am Acad Dermatol 2000; 43(4): 683–6

    PubMed  CAS  Google Scholar 

  152. Fawcett RG. Olanzapine for the treatment of monosymptomatic hypochondriacal psychosis. J Clin Psychiatry 2002; 63(2): 169

    PubMed  Google Scholar 

  153. Weintraub E, Robinson C. A case of monosymptomatic hypochondriacal psychosis treated with olanzapine. Ann Clin Psychiatry 2000; 12(4): 247–9

    PubMed  CAS  Google Scholar 

  154. Fried RG. Evaluation and treatment of “psychogenic” pruritus and self-excoriation. J Am Acad Dermatol 1994; 30(6): 993–9

    PubMed  CAS  Google Scholar 

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Lonsdale-Eccles, A., Carmichael, A.J. Treatment of Pruritus Associated with Systemic Disorders in the Elderly. Drugs Aging 20, 197–208 (2003). https://doi.org/10.2165/00002512-200320030-00004

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