Drugs & Aging

, Volume 20, Issue 3, pp 197–208 | Cite as

Treatment of Pruritus Associated with Systemic Disorders in the Elderly

A Review of the Role of New Therapies
  • Ann Lonsdale-Eccles
  • Andrew J. Carmichael
Therapy in Practice


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.


Iron Deficiency Capsaicin Ondansetron Primary Biliary Cirrhosis Naltrexone 
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 received no external funding for the preparation of, and are unaware of any conflicts of interest related to, this manuscript.


  1. 1.
    Lidstone V, Thorns A. Pruritus in cancer patients. Cancer Treat Rev 2001; 27(5): 305–12PubMedGoogle Scholar
  2. 2.
    Greaves MW. Itching — research has barely scratched the surface. N Engl J Med 1992; 326(15): 1016–7PubMedGoogle Scholar
  3. 3.
    Denman ST. A review of pruritus. J Am Acad Dermatol 1986; 14(3): 375–92PubMedGoogle Scholar
  4. 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): 97–100PubMedGoogle Scholar
  5. 5.
    Kantor GR, Lookingbill DP. Generalized pruritus and systemic disease. J Am Acad Dermatol 1983; 9(3): 375–82PubMedGoogle Scholar
  6. 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): 599–609PubMedGoogle Scholar
  7. 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): 396–8PubMedGoogle Scholar
  8. 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, 1967Google Scholar
  9. 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): 157–60PubMedGoogle Scholar
  10. 10.
    Hagermark O, Wahlgren CF. Treatment of itch. Semin Dermatol 1995; 14(4): 320–5PubMedGoogle Scholar
  11. 11.
    Smith EB, King CA, Baker MD. Crotamiton lotion in pruritus. Int J Dermatol 1984; 23(10): 684–5PubMedGoogle Scholar
  12. 12.
    Doxepin cream for eczema?Drug Ther Bull 2000; 38(4): 31–2Google Scholar
  13. 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): 265–70Google Scholar
  14. 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): 1403–8PubMedGoogle Scholar
  15. 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): 613–6PubMedGoogle Scholar
  16. 16.
    Tonnesen MG. Pruritus. In: Fitzpatrick TB, Eisen AZ, Wolff K, editors. Dermatology in general medicine. 2nd ed. New York: McGraw-Hill, 1979: 32–4Google Scholar
  17. 17.
    Isaacs NJ, Ertel NH. Urticaria and pruritus: uncommon manifestations of hyperthyroidism. J Allergy Clin Immunol 1971; 48(2): 73–81PubMedGoogle Scholar
  18. 18.
    Barnes HM, Sarkany I, Calnan CD. Pruritus and thyrotoxicosis. Trans St Johns Hosp Dermatol Soc 1974; 60(1): 59–62PubMedGoogle Scholar
  19. 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): 1575Google Scholar
  20. 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): 237–41PubMedGoogle Scholar
  21. 21.
    Winkelmann RK. Pharmacologic control of pruritus. Med Clin North Am 1982; 66(5): 1119–33PubMedGoogle Scholar
  22. 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: 203–12PubMedGoogle Scholar
  23. 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): 697–700PubMedGoogle Scholar
  24. 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: 273–5PubMedGoogle Scholar
  25. 25.
    Staubli M. Pruritus — a little known iron-deficiency symptom [in German]. Schweiz Med Wochenschr 1981; 111(38): 1394–8PubMedGoogle Scholar
  26. 26.
    Oral iron. In: Mehta DK, editor. British National Formulary. 43th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2002: 437Google Scholar
  27. 27.
    Gilchrest BA. Pruritus: pathogenesis, therapy, and significance in systemic disease states. Arch Intern Med 1982; 142(1): 101–5PubMedGoogle Scholar
  28. 28.
    Wasserman LR. The treatment of polycythemia vera. Semin Hematol 1976; 13(1): 57–78PubMedGoogle Scholar
  29. 29.
    Archer CB, Camp RD, Greaves MW. Polycythaemia vera can present with aquagenic pruritus. Lancet 1988; 1(8600): 1451PubMedGoogle Scholar
  30. 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): 313–8PubMedGoogle Scholar
  31. 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): 91–2Google Scholar
  32. 32.
    Fjellner B, Hagermark O. Pruritus in polycythemia vera: treatment with aspirin and possibility of platelet involvement. Acta Derm Venereol 1979; 59(6): 505–12PubMedGoogle Scholar
  33. 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): 241–2PubMedGoogle Scholar
  34. 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): 112–6PubMedGoogle Scholar
  35. 35.
    Randi ML, Luzzatto G, Fabris F. Danazol in refractory pruritus of myeloproliferative disorders. Am J Hematol 1997; 54(2): 172–3PubMedGoogle Scholar
  36. 36.
    Chanarin I, Szur L. Relief of intractable pruritus in polycythaemia rubra vera with cholestyramine [letter]. Br J Haematol 1975; 29(4): 669–70PubMedGoogle Scholar
  37. 37.
    Steinman HK, Greaves MW. Aquagenic pruritus. J Am Acad Dermatol 1985; 13(1): 91–6PubMedGoogle Scholar
  38. 38.
    Jeanmougin M, Rain JD, Najean Y. Efficacy of photochemotherapy on severe pruritus in polycythemia vera. Ann Hematol 1996; 73(2): 91–3PubMedGoogle Scholar
  39. 39.
    Baldo A, Monfrecola G. Narrowband (TL-01) ultraviolet B phototherapy for pruritus in polycythaemia vera. Br J Dermatol 2002; 147(5): 979–81PubMedGoogle Scholar
  40. 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): 365–75PubMedGoogle Scholar
  41. 41.
    Alexander LL. Pruritus and Hodgkin’s disease. JAMA 1979; 241(24): 2598–9PubMedGoogle Scholar
  42. 42.
    Feiner AS, Mahmood T, Wallner SF. Prognostic importance of pruritus in Hodgkin’s disease. JAMA 1978; 240(25): 2738–40PubMedGoogle Scholar
  43. 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): 1934–6PubMedGoogle Scholar
  44. 44.
    Gobbi PG, Cavalli C, Gendarini A, et al. Reevaluation of prognostic significance of symptoms in Hodgkin’s disease. Cancer 1985; 56(12): 2874–80PubMedGoogle Scholar
  45. 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): 2670–4PubMedGoogle Scholar
  46. 46.
    Gilchrest BA, Stern RS, Steinman TI, et al. Clinical features of pruritus among patients undergoing maintenance hemodialysis. Arch Dermatol 1982; 118(3): 154–6PubMedGoogle Scholar
  47. 47.
    Bencini PL, Montagnino G, Citterio A, et al. Cutaneous abnormalities in uremic patients. Nephron 1985; 40(3): 316–21PubMedGoogle Scholar
  48. 48.
    Southi P, Commens C. Pruritus in dialysis patients. Med J Aust 1987; 146(7): 397, 400PubMedGoogle Scholar
  49. 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): 285–8PubMedGoogle Scholar
  50. 50.
    Stahle-Backdahl M. Uremic pruritus. Clinical and experimental studies. Acta Derm Venereol Suppl 1989; 145: 1–38Google Scholar
  51. 51.
    Ponticelli C, Bencini PL. Uremic pruritus: a review. Nephron 1992; 60(1): 1–5PubMedGoogle Scholar
  52. 52.
    Duo LJ. Electrical needle therapy of uremic pruritus. Nephron 1987; 47(3): 179–83PubMedGoogle Scholar
  53. 53.
    Yatzidis H, Digenis P, Tountas C. Heparin treatment of uremic itching. JAMA 1972; 222(9): 1183PubMedGoogle Scholar
  54. 54.
    Fishman SM, Caneris OA, Stojanovic MP, et al. Intravenous lidocaine for treatment-resistant pruritus. Am J Med 1997; 102(6): 584–5PubMedGoogle Scholar
  55. 55.
    Watson WC. Intravenous lignocaine for relief of intractable itch. Lancet 1973; 1(7796): 211PubMedGoogle Scholar
  56. 56.
    Tapia L, Cheigh JS, David DS, et al. Pruritus in dialysis patients treated with parenteral lidocaine. N Engl J Med 1977; 296(5): 261–2PubMedGoogle Scholar
  57. 57.
    Masi CM, Cohen EP. Dialysis efficacy and itching in renal failure. Nephron 1992; 62(3): 257–61PubMedGoogle Scholar
  58. 58.
    Hiroshige K, Kabashima N, Takasugi M, et al. Optimal dialysis improves uremic pruritus. Am J Kidney Dis 1995; 25(3): 413–9PubMedGoogle Scholar
  59. 59.
    Kyriazis J, Glotsos J. Dialysate calcium concentration of </=1.25 mmol/l: is it effective in suppressing uremic pruritus? Nephron 2000; 84(1): 85–6PubMedGoogle Scholar
  60. 60.
    Schwartz IF, Iaina A. Uraemic pruritus. Nephrol Dial Transplant 1999; 14(4): 834–9PubMedGoogle Scholar
  61. 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): 514–9PubMedGoogle Scholar
  62. 62.
    Morton CA, Lafferty M, Hau C, et al. Pruritus and skin hydration during dialysis. Nephrol Dial Transplant 1996; 11(10): 2031–6PubMedGoogle Scholar
  63. 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): 969–74PubMedGoogle Scholar
  64. 64.
    Balaskas EV, Uldall RP. Erythropoietin treatment does not improve uremic pruritus. Perit Dial Int 1992; 12(3): 330–1PubMedGoogle Scholar
  65. 65.
    Tan JK, Haberman HF, Coldman AJ. Identifying effective treatments for uremic pruritus. J Am Acad Dermatol 1991; 25 (5 Pt 1): 811–8PubMedGoogle Scholar
  66. 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): 17–21PubMedGoogle Scholar
  67. 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): 271–83PubMedGoogle Scholar
  68. 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): 14–6PubMedGoogle Scholar
  69. 69.
    Simpson NB, Davison AM. Ultraviolet phototherapy for uraemic pruritus. Lancet 1981; 1(8223): 781PubMedGoogle Scholar
  70. 70.
    Spiro JG, Scott S, MacMillan J, et al. Treatment of uremic pruritus with blue light. Photodermatol 1985; 2(5): 319–21PubMedGoogle Scholar
  71. 71.
    Silverberg DS, Iaina A, Reisin E, et al. Cholestyramine in uraemic pruritus. Br Med J 1977; 1(6063): 752–3PubMedGoogle Scholar
  72. 72.
    van Leusen R, Kutsch Lojenga JC, Ruben A. Is cholestyramine helpful in uraemic pruritus? Br Med J 1978; 1(6117): 918–9PubMedGoogle Scholar
  73. 73.
    Wrong OM. Cholestyramine in uraemic pruritus. Br Med J 1977; 1(6077): 1662PubMedGoogle Scholar
  74. 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): 446–8PubMedGoogle Scholar
  75. 75.
    Giovannetti S, Barsotti G, Cupisti A, et al. Oral activated charcoal in patients with uremic pruritus. Nephron 1995; 70(2): 193–6PubMedGoogle Scholar
  76. 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): 231–2PubMedGoogle Scholar
  77. 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): 360–5PubMedGoogle Scholar
  78. 78.
    Peer G, Kivity S, Agami O, et al. Randomised crossover trial of naltrexone in uraemic pruritus. Lancet 1996; 348(9041): 1552–4PubMedGoogle Scholar
  79. 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): 14–8PubMedGoogle Scholar
  80. 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): 395–402PubMedGoogle Scholar
  81. 81.
    Ashmore SD, Jones CH, Newstead CG, et al. Ondansetron therapy for uremic pruritus in hemodialysis patients. Am J Kidney Dis 2000; 35(5): 827–31PubMedGoogle Scholar
  82. 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: 34–5Google Scholar
  83. 83.
    Breneman DL, Cardone JS, Blumsack RF, et al. Topical capsaicin for treatment of hemodialysis-related pruritus. J Am Acad Dermatol 1992; 26(1): 91–4PubMedGoogle Scholar
  84. 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): 538–43PubMedGoogle Scholar
  85. 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): 617–22PubMedGoogle Scholar
  86. 86.
    Neiman RS, Bischel MD, Lukes RJ. Uraemia and mast-cell proliferation. Lancet 1972; 1(7757): 959PubMedGoogle Scholar
  87. 87.
    Stockenhuber F, Kurz RW, Serti K, et al. Increased plasma histamine levels in uraemic pruritus. Clin Sci (Colch) 1990; 79(5): 477–82Google Scholar
  88. 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): 136–41PubMedGoogle Scholar
  89. 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): 557–9PubMedGoogle Scholar
  90. 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): 270–3PubMedGoogle Scholar
  91. 91.
    Powell RJ, Gardner-Medwin JM. Guideline for the clinical use and dispensing of thalidomide. Postgrad Med J 1994; 70(830): 901–4PubMedGoogle Scholar
  92. 92.
    Ghent CN. Cholestatic pruritus. In: Bernhard JD, editor. Itch, mechanisms, and management of pruritus. New York: McGraw-Hill, 1994: 229–42Google Scholar
  93. 93.
    Ahrens EH, Payne MA, Kunkel HG, et al. Primary biliary cirrhosis. Medicine 1950; 29: 299–364PubMedGoogle Scholar
  94. 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): 65–73Google Scholar
  95. 95.
    Jones EA, Bergasa NV. The pruritus of cholestasis. Hepatology 1999; 29(4): 1003–6PubMedGoogle Scholar
  96. 96.
    Rupp N. Indications and results of percutaneous transhepatic bile-duct drainage [in German]. Chirurg 1979; 50(4): 233–8PubMedGoogle Scholar
  97. 97.
    Bergasa NV, Jones EA. Management of the pruritus of cholestasis: potential role of opiate antagonists. Am J Gastroenterol 1991; 86(10): 1404–12PubMedGoogle Scholar
  98. 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): 211–5PubMedGoogle Scholar
  99. 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): 533–9PubMedGoogle Scholar
  100. 100.
    Thornton JR, Losowsky MS. Opioid peptides and primary biliary cirrhosis. BMJ 1988; 297(6662): 1501–4PubMedGoogle Scholar
  101. 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): 85–90PubMedGoogle Scholar
  102. 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): 544–9PubMedGoogle Scholar
  103. 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): 161–7PubMedGoogle Scholar
  104. 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): 679–84PubMedGoogle Scholar
  105. 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): 431–4PubMedGoogle Scholar
  106. 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): 1264–9PubMedGoogle Scholar
  107. 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): 1022–3PubMedGoogle Scholar
  108. 108.
    Jones EA, Dekker LR. Florid opioid withdrawal-like reaction precipitated by naltrexone in a patient with chronic cholestasis. Gastroenterology 2000; 118(2): 431–2PubMedGoogle Scholar
  109. 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): 488–93PubMedGoogle Scholar
  110. 110.
    Bloomer JR, Boyer JL. Phenobarbital effects in cholestatic liver diseases. Ann Intern Med 1975; 82(3): 310–7PubMedGoogle Scholar
  111. 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): 337–42PubMedGoogle Scholar
  112. 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): 475–7PubMedGoogle Scholar
  113. 113.
    Cynamon HA, Andres JM, Iafrate RP. Rifampin relieves pruritus in children with cholestatic liver disease. Gastroenterology 1990; 98(4): 1013–6PubMedGoogle Scholar
  114. 114.
    Woolf GM, Reynolds TB. Failure of rifampin to relieve pruritus in chronic liver disease. J Clin Gastroenterol 1990; 12(2): 174–7PubMedGoogle Scholar
  115. 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): 574–6PubMedGoogle Scholar
  116. 116.
    Kreek MJ, Garfield JW, Gutjahr CL, et al. Rifampin-induced methadone withdrawal. N Engl J Med 1976; 294(20): 1104–6PubMedGoogle Scholar
  117. 117.
    Prince MI, Jones DE. Primary biliary cirrhosis: new perspectives in diagnosis and treatment. Postgrad Med J 2000; 76(894): 199–206PubMedGoogle Scholar
  118. 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): 33–7PubMedGoogle Scholar
  119. 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): 865–70PubMedGoogle Scholar
  120. 120.
    Larijani GE, Goldberg ME, Rogers KH. Treatment of opioid-induced pruritus with ondansetron: report of four patients. Pharmacotherapy 1996; 16(5): 958–60PubMedGoogle Scholar
  121. 121.
    Crighton IM, Hobbs GJ, Reid MF. Ondansetron for the treatment of pruritus after spinal opioids. Anaesthesia 1996; 51(2): 199–200PubMedGoogle Scholar
  122. 122.
    Borgeat A, Wilder-Smith OH, Mentha G. Subhypnotic doses of propofol relieve pruritus associated with liver disease. Gastroenterology 1993; 104(1): 244–7PubMedGoogle Scholar
  123. 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): 510–2PubMedGoogle Scholar
  124. 124.
    Hanid MA, Levi AJ. Phototherapy for pruritus in primary biliary cirrhosis. Lancet 1980; 2(8193): 530PubMedGoogle Scholar
  125. 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): 607Google Scholar
  126. 126.
    Lloyd-Thomas HGL, Sherlock S. Testosterone therapy for the pruritus of obstructive jaundice. BMJ 1952; 2: 1289–91PubMedGoogle Scholar
  127. 127.
    Whitmore SE. Treatment of hepatobiliary pruritus. J Am Acad Dermatol 1997; 36 (2 Pt 1): 279PubMedGoogle Scholar
  128. 128.
    Poupon R, Chretien Y, Poupon RE, et al. Is ursodeoxycholic acid an effective treatment for primary biliary cirrhosis? Lancet 1987; 1(8537): 834–6PubMedGoogle Scholar
  129. 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): 15–23PubMedGoogle Scholar
  130. 130.
    Koeppel MC, Bramont C, Ceccaldi M, et al. Paroxysmal pruritus and multiple sclerosis. Br J Dermatol 1993; 129(5): 597–8PubMedGoogle Scholar
  131. 131.
    Kimyai-Asadi A, Nousari HC, Kimyai-Asadi T, et al. Poststroke pruritus. Stroke 1999; 30(3): 692–3PubMedGoogle Scholar
  132. 132.
    Osterman PO. Paroxysmal itching in multiple sclerosis. Br J Dermatol 1976; 95(5): 555–8PubMedGoogle Scholar
  133. 133.
    Canavero S, Bonicalzi V, Massa-Micon B. Central neurogenic pruritus: a literature review. Acta Neurol Belg 1997; 97(4): 244–7PubMedGoogle Scholar
  134. 134.
    Massey EW. Unilateral neurogenic pruritus following stroke. Stroke 1984; 15(5): 901–3PubMedGoogle Scholar
  135. 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, 1994Google Scholar
  136. 136.
    Zylicz Z, Smits C, Krajnik M. Paroxetine for pruritus in advanced cancer. J Pain Symptom Manage 1998; 16(2): 121–4PubMedGoogle Scholar
  137. 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): 74–86PubMedGoogle Scholar
  138. 138.
    Kovacs SO, Kovacs SC. Dermatomyositis. J Am Acad Dermatol 1998; 39(6): 899–920PubMedGoogle Scholar
  139. 139.
    Thaipisuttikul Y. Pruritic skin diseases in the elderly. J Dermatol 1998; 25(3): 153–7PubMedGoogle Scholar
  140. 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): 483–5PubMedGoogle Scholar
  141. 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): 507–12PubMedGoogle Scholar
  142. 142.
    Long CC, Marks R. Stratum corneum changes in patients with senile pruritus. J Am Acad Dermatol 1992; 27(4): 560–4PubMedGoogle Scholar
  143. 143.
    Hunter JA. Seventh age itch. Br Med J (Clin Res Ed) 1985; 291(6499): 842Google Scholar
  144. 144.
    Waisman M. A clinical look at the aging skin. Postgrad Med 1979; 66(1): 87–93, 96PubMedGoogle Scholar
  145. 145.
    Bernhard JD. Phantom itch, pseudophantom itch, and senile pruritus. Int J Dermatol 1992; 31(12): 856–7PubMedGoogle Scholar
  146. 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–LIIIPubMedGoogle Scholar
  147. 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): 1179–82PubMedGoogle Scholar
  148. 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): 232PubMedGoogle Scholar
  149. 149.
    Ungvari G, Vladar K. Pimozide treatment for delusion of infestation. Act Nerv Super (Praha) 1986; 28(2): 103–7Google Scholar
  150. 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): 940–3PubMedGoogle Scholar
  151. 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): 683–6PubMedGoogle Scholar
  152. 152.
    Fawcett RG. Olanzapine for the treatment of monosymptomatic hypochondriacal psychosis. J Clin Psychiatry 2002; 63(2): 169PubMedGoogle Scholar
  153. 153.
    Weintraub E, Robinson C. A case of monosymptomatic hypochondriacal psychosis treated with olanzapine. Ann Clin Psychiatry 2000; 12(4): 247–9PubMedGoogle Scholar
  154. 154.
    Fried RG. Evaluation and treatment of “psychogenic” pruritus and self-excoriation. J Am Acad Dermatol 1994; 30(6): 993–9PubMedGoogle Scholar

Copyright information

© Adis International Limited 2003

Authors and Affiliations

  1. 1.Department of DermatologyThe James Cook University HospitalMiddlesbroughUK

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