pruritus in the elderly

Etiology

• xerosis due to aging (senile pruritus) is the most common cause
• neurogenic pruritus
  • result of stroke
  • presence of a brain tumor
  • following neurosurgery
  • opioid-containing medications may also induce neurogenic pruritus
• psychogenic pruritus is also common
  • psychosis with parasitophobia
  • part of anxiety-depression syndromes
• drug-related causes
• also see differental diagnosis

Clinical manifestations

• see xerosis
• drug-induced pruritus can occur even if the medication was started several months or years prior
• neurogenic pruritus can present as contralateral pruritus

Laboratory

• complete blood count (CBC)
• liver function tests
• renal function tests
• thyroid function tests
• as indicates
  • syphlis serology
  • HIV testing
  • beta-2 microglobulin in serum

Radiology

• as indicated if suspected neoplasm

Differential diagnosis

• autoimmune bullous dermatoses
  • bullous pemphigoid
• metabolic disorders
• cutaneous T-cell lymphoma
  • paraneoplastic pruritus can occur, particularly those linked to hematological disorders
    • lymphomas, polycythemia, myeloma
• infestations: scabies, lice
• HIV infection

Management

• supportive measures
  • moisturizing emollient
• topical glucocorticoids for localised inflammatory disorders
• antihistamines for histamine-mediated pruritus
• capsaicin may be useful for localized neuropathic pruritus
• gabapentin or pregabalin may be useful for neurogenic pruritus
• acupuncture, cryotherapy, relaxation, hypnosis, psychotherapy, or music therapy may be useful in patients with treatment failure
• dermatology consult for dupilumab

More general terms

• pruritus (itching)