General principles and guidelines

Abstract

General standardized recommendations for pruritus therapy do not exist and should not be given, considering the diversity of the underlying causes of pruritus. According to recent neurophysiologic findings, antipruritic therapies aim to influence both, cutaneous and central mechanisms of pruritus. Topical and systemic antipruritic therapies have to be worked out individually in recognition of age, preexisting diseases, medications, allergies, severity of pruritus, and impact on quality of life. The first step is to identify any underlying disease and its causative therapy. Depending on the underlying cause this may range from a specific treatment of an underlying dermatosis, avoidance of a contact allergen, discontinuation of a medication, specific internal, neurological, and psychiatric therapies up to a surgical therapy of an underlying tumor.1,2 The early start of the therapy aims to prevent the sensitization of the nerve system and thereby chronification of pruritus. The second step is to advise the patient about the general, pruritus-relieving measures (Table 38.1) followed by a step by step, symptomatic, antipruritic treatment (Table 38.2). Pruritus often stops quickly when the underlying disease improves, e.g., removal of an underlying tumor. It should be considered that especially chronic pruritus is frequently caused by several factors and may be supported by cofactors suggesting a multifactorial origin.3,4 Especially in the elderly, several factors causing pruritus may be identified.3 © 2010 Springer-Verlag London.