Within the framework of micronutrient medicine, the following vital substances (micronutrients) are used for supportive therapy: Omega-6 fatty acid gamma-linolenic acid The above vital substance recommendations were created with the help of medical experts. All statements are supported by scientific studies with high levels of evidence. For a therapy recommendation, only clinical studies with the … Itching (Pruritus): Micronutrient Therapy
To prevent pruritus, attention must be paid to reducing individual risk factors. Behavioral risk factors Diet Malnutrition Spices (e.g. chili) Drug use Amphetamines (indirect sympathomimetic): ecstasy (3,4-methylenedioxy-N-methylamphetamine, MDMA), crystal meth (methamphetamine), or methylphenidate (for high doses and prolonged use of methamphetamine) Cocaine Opiates or opioids (alfentanil, apomorphine, buprenorphine, codeine, dihydrocodeine, fentanyl, hydromorphone, loperamide, morphine, methadone, … Itching (Pruritus): Prevention
The following symptoms and complaints may occur with pruritus (itching): Erythema (areal redness of the skin). Xeroderma (dry skin) Papules (skin nodules) Urticaria (hives) Warning signs (red flags) Initial manifestation (first illness) of florid (“flaring”) eczema in elderly patients Persistent fever – think of leukemia (blood cancer) or lymphoma (malignant disease originating in the lymphatic … Itching (Pruritus): Symptoms, Complaints, Signs
Pathogenesis (development of disease) Many different causes of pruritus can be distinguished. In older age, due to the reduction of lipid production (sebostasis) in the stratus corneum (horny cell layer), xeroderma (xerosis cuti: “dry skin“) results in chronic pruritus (pruritus senilis; most common cause of pruritus in old age). The loss of lipids leads to … Itching (Pruritus): Causes
General measures Avoiding factors that promote skin dryness. Frequent washing, showering, or bathing (bath time maximum 20 minutes/in chronic pruritus: full bath maximum 5 minutes; bathe in cool or lukewarm water rather than hot)Note: After water contact, dab skin. Climate / room temperature (see also under “Avoiding environmental pollution”). Dry, hot or very cold climate. … Itching (Pruritus): Therapy
Laboratory parameters of the 1st order – obligatory laboratory tests. Small blood count Differential blood count Ferritin – in suspected iron deficiency anemia [↓↓]Note: Ferritin can be measured elevated as a so-called acute phase protein in the context of infections, liver cirrhosis, tumor disease or other inflammatory processes. Inflammatory parameters – CRP (C-reactive protein) or … Itching (Pruritus): Test and Diagnosis
Therapeutic target Elimination or improvement/relief of symptoms. Therapy recommendations First search for the cause and adequate treatment of the same. General therapeutic measures: Basic therapeutics for pruritus (greasing and hydrating the skin in xerosis cutis/dry skin); the following classes are distinguished: Rehydrating Natural Moisturizing Factor (NMF; natural moisturizing factor): urea, lactic acid derivatives, pyrrolidone carboxylic … Itching (Pruritus): Drug Therapy
Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics, and obligatory medical device diagnostics – for differential diagnostic clarification. Abdominal sonography (ultrasound examination of abdominal organs) – for basic diagnostics. X-ray of the thorax (X-ray thorax/chest), in two planes. Computed tomography (CT; sectional imaging procedure (X-ray images from … Itching (Pruritus): Diagnostic Tests
Medical history (history of illness) represents an important component in the diagnosis of pruritus (itching). Family history Social history What is your occupation? Are you exposed to harmful working substances in your profession? Is there any evidence of psychosocial stress or strain due to your family situation? Current medical history/systemic history (somatic and psychological complaints). … Itching (Pruritus): Medical History
Pruritus is a symptom that can occur in many different conditions. Respiratory System (J00-J99). Allergic rhinitis (hay fever). Blood, blood-forming organs – immune system (D50-D90). Iron deficiency anemia (anemia due to iron deficiency) – Note: In generalized pruritus, iron deficiency is present in up to 40% of cases. Endocrine, nutritional and metabolic diseases (E00-E90). Iron … Itching (Pruritus): Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be contributed to by pruritus (itching): Skin and subcutaneous (L00-L99). Desiccation Eczema (synonyms: Desiccation eczema; Asteatosis cutis; Asteatotic eczema; Desiccation eczema; Dermatitis sicca; Eczema craquelée; Desiccation dermatitis; Desiccation eczematid; Xerotic eczema); clinical presentation: reticular tears of the cornea resembling a dried riverbed and subsequent … Itching (Pruritus): Complications
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body temperature, body weight, body height; furthermore: Inspection (viewing) of the entire skin not just the itchy area! Skin and sclerae (white part of the eye) [erythema (areal redness of the skin), xeroderma (dry skin), … Itching (Pruritus): Examination
