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Blog articles are provided as informational purposes only and are not intended to constitute medical advice. Medication protocols are subject to patient’s medical provider’s authorization.

 

Pruritus, also known as itching, is not the most common symptom seen in our patients at end of life, but it can be distressing and adversely affect quality of life. Pruritus can be described as an unpleasant sensation of the skin or mucous membranes that provokes the desire to scratch or rub. There are several chemical mediators, known as “pruritogens,” that are involved in the pathophysiology of itching. Although histamine is the best known pruritogen, there are several others, including serotonin, cytokines and opioids, that can play a role. This helps explain why not all itching sensations respond to treatment with antihistamines.

Common disease states/conditions seen in the hospice setting that are usually associated with pruritus include chronic renal failure, cholestasis due to liver disease, malignancy, opioid-induced pruritis, and senility (i.e. senile itch).

SSRIs = Select Serotonin Receptor Inhibitors

General skin care measures are recommended for all patients, regardless of the cause of pruritus. Dry skin can accompany and exacerbate all causes of pruritus; therefore, measures to regularly lubricate the skin with nonfragrant topical emollients, especially after bathing, are important. Patients should be educated on wearing nonirritating and loose clothing, avoiding skin irritants such as perfumes, and maintaining a cool, humidified environment.

To help identify and determine how to manage causes of pruritis in your patient, our clinical pharmacists are available to assist 24/7/365. We look forward to hearing from you!

 

Written by: Kiran Hamid, R.Ph.

 

References:

1.  Dalal, S. Overview of pruritus in palliative care. In: UpToDate, Givens, J (Ed), UpToDate, Waltham, MA, 2021.

2.  Seccareccia D, Gebara N. Pruritus in palliative care: Getting up to scratch. Can Fam Physician. 2011;57(9):1010-e319.

3.  Andreas E. Kremer, et al. (2014). Receptors, cells and circuits involved in pruritus of systemic disorders. Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease, Volume 1842 (Issue 7) Pages 869-892. Retrieved from https://doi.org/10.1016/j.bbadis.2014.02.007

4.  Berger TG, Steinhoff M. Pruritus and renal failure. Semin Cutan Med Surg. 2011;30(2):99-100. doi:10.1016/j.sder.2011.04.005

5.  Tajiri K, Shimizu Y. Recent advances in the management of pruritus in chronic liver diseases. World J Gastroenterol. 2017;23(19):3418-3426. doi:10.3748/wjg.v23.i19.3418

6.  Yosipovitch G. Chronic pruritus: a paraneoplastic sign. Dermatol Ther. 2010;23(6):590-596. doi:10.1111/j.1529-8019.2010.01366.x

7.  Singh F, Rudikoff D. HIV-associated pruritus: etiology and management. Am J Clin Dermatol. 2003;4(3):177-88. doi: 10.2165/00128071-200304030-00004. PMID: 12627993.

8.  Cohen KR, Frank J, Salbu RL, Israel I. Pruritus in the elderly: clinical approaches to the improvement of quality of life. P T. 2012;37(4):227-239

 

ANCC Accreditation

ProCare HospiceCare is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.