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Review
. 2017 Jan-Feb;62(1):7-17.
doi: 10.4103/0019-5154.198036.

Diagnosis and Management of Chronic Pruritus: An Expert Consensus Review

Murlidhar Rajagopalan  1 , Abir Saraswat  2 , Kiran Godse  3 , D S Krupa Shankar  4 , Sanjiv Kandhari  5 , Shrutakirthi D Shenoi  6 , Sushil Tahiliani  7 , V Vijay Zawar  8
Affiliations
Free PMC article
Review

Diagnosis and Management of Chronic Pruritus: An Expert Consensus Review

Murlidhar Rajagopalan et al. Indian J Dermatol. 2017 Jan-Feb.
Free PMC article

Abstract

The aim of this study is to formulate the best clinical practice in the diagnosis and management of chronic pruritus (CP). We searched PubMed, EMBASE, Scopus, Web of Science, and the WHO's regional databases, for studies on "Diagnosis and management of chronic pruritus" from January 1, 2014, to July 31, 2015. We included programmatic reports and hand-searched references of published reviews and articles. Two independent reviewers screened articles and extracted data. We screened 87 of 95 studies that contained qualitative data. Avoid: Dry climate, heat, alcohol compress, ice packs, frequent bathing and washing, intake of very hot and spicy food, intake of alcohol, contact with irritant substances, excitement, strain and stress, and allergens. Using: Mild nonalkaline soaps, moisturizers, bathing oils, lukewarm water while bathing, soft cotton clothing and night creams/lotions, relaxation therapy, autogenic training, psychosocial education, educating patients to cope with itching and scratching, and educational programs. Especially use of moisturizers is considered important. In addition, symptomatic treatment options include systemic H1 antihistamines and topical corticosteroids. Symptomatic therapy directed toward the cause (hepatic, renal, atopic, polycythemia, etc.). If refractory or cause is unknown, consider capsaicin, calcineurin inhibitors for localized pruritus and naltrexone, pregabalin, ultraviolet therapy, Cyclosporine for generalized itching. CP is quite frequent finding associated with skin and systemic diseases in the overall population. It is known to significantly affect quality life score of an individual and also adds burden on the health-care cost. A specific recommendation for treatment of CP is difficult as a result of varied and diverse possibility of underlying diseases associated with CP.

Keywords: Chronic pruritus; Consensus; Management of Chronic pruritus.

Conflict of interest statement

There are no conflicts of interest. What is new? Chronic pruritus is quite frequent finding associated with skin and systemic diseases in the overall population. It is known to significantly affect quality life score of an individual and also adds burden on the healthcare cost. A specific recommendation for treatment of CP is difficult as a result of varied and diverse possibility of underlying diseases associated with CP. The recommendations in this guideline are offered with a view to reduce the burden on the physicians and assist in effective management of CP.

Figures

Figure 1
Figure 1
Clinical classification of patients with chronic pruritus
Figure 2
Figure 2
The diagnostic approach for chronic pruritus
Figure 3
Figure 3
Stepwise approach for the management of chronic pruritus
See this image and copyright information in PMC

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