GUIDELINES IN DERMATOLOGY

gdkapak

CHRONIC PRURITUS

Nilgün Şentürk

Ondokuz Mayıs University, Faculty of Medicine, Department of Dermatology, Samsun, Türkiye

Şentürk N. Chronic Pruritus. In: Kutlubay Z, editor. Guidelines in Dermatology. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.121-130.

ABSTRACT

Pruritus, which may be localized or generalized, is a common symptom and associated with various dermatologic or systemic diseases. It is usually classified according to disease duration, clinical manifestations, or etiology. While acute pruritus lasts for less than six weeks, it is considered as chronic lasting longer than six weeks. Localized pruritus in the absence of skin eruption, which may be of neuropathic or psychogenic origin, should be taken into consideration. A comprehensive physical examination and patient history are the key components of evaluation of patients. The presence or absence of primary skin lesions should be examined and, if any, diagnostic interventions such as skin biopsy, bacteriological/mycological swabs, dermoscopy for scabies, or tests for physical urticaria is recommended. A proper approach in combination with basic and specific therapeutic measures provides an adequate relief. For the management of chronic pruritus step-wise approach is recommended. General measures including use of emollients and elimination of triggering factors (gentle cleansers for bathing, avoidance from irritantsand stress etc) should be preferred as the first-line treatment. Non-sedative antihistamines can be used as first step especially in urticarial, aquagenic pruritus or chronic prurigo. Various dermatological, systemic, neurological and/or psychosomatic/psychiatric diseases, may play a role in the development of chronic pruritus. While several factors can often be identified in the same patient, in up to 10% of patients no cause can be found. If the etiologic factor was determined and the pruritus persists despite the general measures, symptomatic therapy should be aimed to treat underlying condition such as immunosuppressive drugs, gabapentinoids, and/or antidepressants. Phototherapy has usually been used for inflammatory dermatoses, but it may also effective for uremic and psychogenic pruritus, prurigo nodularis, polycythemia vera and notalgia paresthetica. If these agents fail, novel targeted therapies such as agents targeting interleukin-17 and interleukin-23, dupilumab or JAK inhibitors in the case atopic dermatitis, nemolizumab or neurokinin 1 receptor antagonist serlopitant should be considered.

Keywords: Chronic pruritus; Etiologic factors; Antihistamines; Phoptptherapy; Antidepressants; Gabapentin; JAK inhibitors

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