Basic approaches to the diagnosis of skin itching in dermatological practice

Localized itching of the skin usually forms in the area of ​​altered skin with the development of dermatosis and signs of inflammation, and has a well-defined distribution area. If the itching location zone is located on unchanged skin, this only indicates the neurological etiology of the disease. Itching of the skin in the pathology of internal organs also has its own specific localization: the skin of the back and legs – in diseases of the kidneys, hands – in patients with cholestasis. At the same time, a constant form of itching is noted. Widespread pruritus can be caused by localized pruritic dermatosis even without signs of systemic skin involvement, as occurs in patients with psoriasis. However,

Find out in the article on

estet-portal.com about the main causes and pathologies that are accompanied by skin itching in the practice of a dermatologist.

• Chronic itching of the skin in the elderly
• Chronic itchy skin during pregnancy
• Itching of the skin provoked by taking drugs

Chronic itching of the skin in the elderly

Not many modern studies are concerned with elucidating the causes of skin itching 

in the elderly. However, according to the results of the studies, among all the complaints expressed by elderly patients with skin symptoms, itching of the skin – the most common phenomenon noted by 29% of patients.

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At the same time, the frequency of lesions in women is slightly higher than in men. At the same time, in patients aged > 85 years old observe a high prevalence of this condition, which is also characterized by 

seasonality – in winter, the disease manifests itself more often.

 

 

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The most likely factors for the development of chronic skin itching in the elderly include involutive skin changes, dry skin and decreased function of the stratum corneum, a history of non-dermatological chronic diseases, as well as the influence of drugs that elderly patients are forced to use for treatment with

comorbidities.

Chronic itchy skin during pregnancy

From previous studies, it has been established that 18% of pregnant women have manifestations of itching of the skin caused by 

pregnancy. Its manifestations are the main dermatological complaint of pregnant women in the case of the clinical development of specific dermatosis. A particularly severe dermatosis of pregnant women is  pemphigoid preeclampsia. Other causes that may have a likely influence on the development of specific dermatosis of pregnancy caused by gestational changes during pregnancy are intrahepatic cholestasis of pregnancy, pruritic urticarial papules and plaques of pregnancy, and exacerbation of other dermatoses present before pregnancy.

It must be remembered that only one in five pregnant women with itchy skin is associated with the development of specific dermatosis of pregnancy.It is important to note that some diseases are purely endemic. Thus, cholestasis of pregnancy and itching of the skin against this background are more often (12-14%) found in women in South America.

 

Read also: Parapsoriasis: main varieties and their differences

A characteristic feature of the lesion is the absence of primary skin changes, the skin is intact, healthy. For the European population, this figure is 1-2%. However, itching against the background of polymorphic lesions of the skin of pregnancy occurs with a frequency of one in 160 pregnant women. Both conditions are characterized by the development of skin itching in the later stages of pregnancy, in contrast to the development of pemphigoid preeclampsia, which f

is formed in 75% of pregnant women in the first trimester.

Itching of the skin provoked by medication

Medication-induced 

 pruritus of the skin in the absence of primary morphological changes in the skin leads to skin lesions in approximately 5% of patients taking medications. Any drug can cause itchy skin. The mechanisms of its formation are different − from the appearance of rashes and urticaria to the development of its secondary lesion due to the development of cholestasis, hepatotoxicity, xerosis and increased sensitivity to light.

Increased release of biologically active compounds that can cause skin itching (histamine, serotonin and other neuropeptides), neurological changes that occur in response to the toxic effect of drugs as a negative effect, are considered the primary sources 

of the pathogenesis of the development of chronic skin itching.

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A fairly high incidence of chronic skin itching occurs when using preparations based on 

hydroxyethyl starch. The use of these drugs in medical practice is quite common. However, they are able to cause the development of chronic itching due to the long circulation of starch residues in the body, causing generalized and localized skin lesions within 15 months. Note that in approximately 2/3 of patients, induced pruritus of the skin has general manifestations without any morphological changes and is treatable.

Read also: Physiological and pathological skin changes during pregnancy

History and thorough clinical examination – the main factors for clarifying the etiology of skin itching, which, in turn, will allow you to choose an adequate treatment strategy.

 

A number of typical features of the anamnesis can become key factors in determining the nature of pruritus, namely: the duration of manifestations from the time of their onset, localization, duration of itching and the likely influence of pathological factors, as well as a burdened personal and family history.

 

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