Evaluation and treatment of "psychogenic" pruritus and self-excoriation.
ABSTRACT Psychogenic pruritus and self-excoriation are diagnoses of exclusion. Elimination of traditional organic causes often leads the clinician to label a symptom as psychogenic in origin and limits treatment options. This article examines the organic and psychologic causes and concomitants of dermatologic conditions associated with pruritus and self-excoriation. An organized cognitive framework is presented to guide the clinician in the evaluation and treatment of these patients. Specific treatment options are offered and relevant psychopharmacologic agents are reviewed.
Article: Psychosomatic factors in pruritus.[Show abstract] [Hide abstract]
ABSTRACT: Pruritus and psyche are intricately and reciprocally related, with psychophysiological evidence and psychopathological explanations helping us to understand their complex association. Their interaction may be conceptualized and classified into 3 groups: pruritic diseases with psychiatric sequelae, pruritic diseases aggravated by psychosocial factors, and psychiatric disorders causing pruritus. Management of chronic pruritus is directed at treating the underlying causes and adopting a multidisciplinary approach to address the dermatologic, somatosensory, cognitive, and emotional aspects. Pharmcotherapeutic agents that are useful for chronic pruritus with comorbid depression and/or anxiety comprise selective serotonin reuptake inhibitors, mirtazapine, tricyclic antidepressants (amitriptyline and doxepin), and anticonvulsants (gabapentin, pregabalin); the role of neurokinin receptor-1 antagonists awaits verification. Antipsychotics are required for treating itch and formication associated with schizophrenia and delusion of parasitosis (including Morgellons disease).Clinics in dermatology 01/2013; 31(1):31-40. · 3.11 Impact Factor
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ABSTRACT: Generalised pruritus is common in the elderly. Idiopathic 'senile pruritus' is a diagnosis of exclusion, and an underlying systemic disorder should be sought. Thyroid disease, haematological malignancy, iron deficiency, cholestasis or renal impairment may be responsible for pruritus. Rarely pruritus may occur after cerebral infarction or as a paraneoplastic phenomenon. The mechanisms of pruritus are poorly understood. In systemic disorders, correction of the underlying disorder alleviates itch. However, when this cannot be achieved, a symptomatic approach is required. Response to treatment varies enormously and an empirical approach is often required. Topical applications are available to soothe the skin and bandaging techniques may improve their efficacy. A number of more targeted treatments are available for renal and cholestatic pruritus. Novel therapies such as thalidomide, opioid antagonists, ondansetron and phototherapy with ultraviolet (UV)-B radiation are now being used. Treatment of pruritus needs to be individualised, and the elderly present a particular challenge. Adequate delivery of simple emollients may be impossible because of physical impairment The elderly are more vulnerable to the adverse effects of treatments, comorbidities may alter the pharmacokinetics of drug metabolism and polypharmacy increases the likelihood of adverse drug interactions. Cognitive impairment can lead to poor compliance with treatment. The patient's general health, the severity of symptoms and the adverse effects of treatment all need to be considered. Most treatments are of benefit only to some patients; others derive only marginal improvement. Many of the newer treatments are unlicensed for pruritus and should preferably be administered under specialist supervision. We review the literature concerning the treatment of itch associated with systemic diseases, with particular emphasis on issues relevant to the elderly. Pruritus is a difficult symptom to treat. However, it is hoped that research into the mechanisms underlying the pruritus of systemic disease will allow a better understanding so that we should be able to look forward to more specific and effective therapies in the future.Drugs & Aging 02/2003; 20(3):197-208. · 2.50 Impact Factor
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ABSTRACT: I would like to propose my opinions regarding whether psychogenic pruritus exists and how it could be defined. I also consider whether `functional itch disorder' or `somatoform itch' are more appropriate terms. In addition, we address how it can be understood, whether similar disorders exist, whether it is related to pleasure and how to diagnose and treat the patient. In our opinion, psychogenic pruritus does exist and is different from the aggravation of itch from other origins. It is aggravated by psychological factors and, therefore, it is necessary to separate the two terms. We believe that the major role of the brain in itch explains its pathophysiogeny.Expert Review of Dermatology 01/2008; 3(1):49-53.