Diagnosis and Treatment of Pruritus

Diagnosis

The location and persistence of the itching are checked, and any history of taking medications that may cause itching is identified. For itching caused by skin diseases as well as itching associated with systemic diseases, it is most important to find and treat the cause of the itching. After checking for the presence of an underlying cause through examination, including a rectal and anal examination and a pelvic examination, as well as complete blood tests, chest radiography, stool tests, and thyroid, liver, and kidney function tests, and blood glucose tests, treatment is provided.

Treatment

Systemic administration of adrenocortical hormones or local application to specific areas (topical application) is effective for itching caused by inflammation or lichenification. Cooling the skin with calamine lotion or menthol lotion is also helpful. For oral medications, various first- or second-generation antihistamines are commonly used. For itching that does not respond well to treatment, antidepressants or anti-anxiety medications may be helpful.

1. Itching Associated with Skin Diseases Winter itching is effectively managed by applying moisturizer to dry skin several times a day. Avoid rubbing off dead skin or using excessive soap, and apply moisturizer immediately after bathing to prevent the skin from drying out. Topical steroids are helpful, and the surrounding temperature and humidity should be controlled. For anal itching, it is necessary to check for rectal and anal diseases or infections and avoid irritating foods and medications. It is essential not to scratch the area around the anus and to keep it clean.

If there is no fungal infection, dermatitis accompanied by itching can be effectively treated with antihistamines and topical steroid ointments. After bowel movements, wipe with soft tissue, and if possible, wash with water using a non-irritating soap. Candida vaginitis is well treated with antifungal vaginal suppositories, and Trichomonas infection can be treated by taking antibiotics orally or inserting them into the vagina. Phototherapy may also be helpful.

2. Itching Associated with Systemic Diseases The fundamental principle is to treat the underlying systemic disease causing it. For example, in patients with obstructive jaundice accompanied by jaundice, itching can be treated with antihistamines and cholestyramine, and phototherapy, plasmapheresis, or surgical/procedural treatment to relieve biliary obstruction may be necessary.

3. Itching Associated with Psychiatric Disorders In chronic lichen simplex, the most important thing is to improve the itching by using antihistamines and anti-anxiety medications. Because the skin has become thickened, steroid ointments should be used as high-potency preparations. Patients with trichotillomania, who pull out their own hair, and patients with factitious dermatitis should undergo psychiatric medication and behavioral therapy along with treatment of skin lesions.

So far, we have explained the diagnosis and treatment of pruritus. In the next installment, we will look at the causes of asthma.

Source: Korea Centers for Disease Control and Prevention, National Health Information Portal