The anamnesis (medical history) represents an important component in the diagnosis of pruritus senilis (pruritus of old age). 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).
- How long has the itching existed?
- Where does it itch?
- In one place? If so, in which part of the body does the itching occur?
- Entire body?
- At what time of day does the itching occur?
- Is the itching stronger at night than during the day?
- Do you have prickly itching after contact with water (aquagenic pruritus)?
- Are there any skin lesions?
- Pustules (pustules)?
- Vesicles?
- Redness of the skin?
- Jaundice?
- Do you have a fever?
- Do you suffer from dry skin?
- Is the itching reduced or increased by daily skin care?
- Does the itching occur more after taking medication?
Vegetative anamnesis incl. nutritional anamnesis.
- Have you lost body weight?
- Has your appetite changed?
- Have your bowel movements and/or urination changed? In quantity, consistency, admixtures?
- Do you use any drugs? If yes, what drugs and how often per day or per week?
Self history incl. medication history.
- Pre-existing conditions (infections, metabolic diseases, liver disease, kidney disease).
- Operations
- Allergies
- Pregnancies
Medication history
- Α4β7-integrin antagonist (vedolizumab).
- ACE inhibitors (benazepril, captopril, cilazapril, enalapril, fosinopril, lisinopril, moexipril, peridopril, quinapril, ramipril, spirapril).
- Allopurinol
- Analgesics
- NSAID (nonsteroidal anti-inflammatory drug (NSAID); also nonsteroidal anti-inflammatory drug (NSAP) or NSAID, non steroidal anti- inflammatory drugs) – acetylsalicylic acid (ASA; 1-5% of those exposed).
- Paracetamol
- Angiogenesis inhibitors (sorafenib, sunitinib).
- Antiarrhythmics (amiodarone, quinidine).
- Antibiotics
- Aminopenicillins (amoxicillin); esp. as amoxicillin/clavulanic acid combination (frequency: very low).
- Β-Lactam antibiotics (aminopenicillins) – ampicillin.
- Beomycin (> 5% of those exposed).
- Macrolide antibiotics (erythromycin).
- Nitroimidazoles (metronidazole)
- Sulfonamides
- Tetracyclines (minocycline)
- Trimethoprim and sulfamethoxazole
- Antidepressants
- Antiepileptic drugs
- Aromatic anticonvulsants (carbamazepine, lamotrigine, phenobarbital).
- Functionalized amino acid (lacosamide).
- Phenytoin
- Selective dopamine and norepinephrine (marginally also serotonin) reuptake inhibitor (NDRI) – bupropion [aquagenic pruritus].
- Valproic acid/valproate
- Antihypotensives: α-adrenoceptor agonist (midodrine).
- Antimalarials (artesunate, chloroquine, primaquine) [aquagenic pruritus].
- Antifungal agents, local
- Imidazole derivatives (clotrimazole, econazole, ketoconazole, miconazole).
- Morpholine (amorolfine)
- Antipsychotics (neuroleptics) – chlorpromazine, phenothiazines.
- Antirheumatic drugs
- NSAID (nonsteroidal anti-inflammatory drug (NSAID); also nonsteroidal anti-inflammatory drug (NSAP) or NSAID, non steroidal anti- inflammatory drugs) – acetylsalicylic acid (ASA; 1-5% of those exposed).
- Antisympathotonic drug (clonidine).
- Arsenic trioxide
- Α2-agonists (apraclonidine, brimonidine, clonidine).
- Beta-blockers
- Non-selective beta-blockers (e.g., carvedilol, propranolol, soltalol).
- Selective beta-blockers (e.g., atenolol, bisoprolol, metoprolol).
- Biologicals (etanercept, infliximab, secukinumab, ustekinumab).
- Intestinal therapeutics, anti-inflammatory (mesalazine).
- Dicarboxylic acid
- Direct Factor Xa inhibitor (rivaroxaban).
- Fibrate (Clofibrate)
- Gold preparations (gold salts)
- Glutamate modulator (acamprosate)
- Hormones
- Anabolic steroids
- Glucocorticoids (betamethasone dipropionate, mometasone furoate, clobetasol).
- Estrogens (ethinyl estradiol, estradiol).
- Prostaglandin (alprostadil)
- Selective estrogen receptor modulator (SERM) – tamoxifen
- Testosterone
- Hydroxyethyl starch (pruritus often persists for months after infusion) [median latency between hydroxyethyl starch administration and onset of pruritus is 3 weeks].
- Hypnotics/sedatives (clomethiazole).
- Intestinal anti-inflammatory (sulfasalcin).
- Insecticides and acaricides
- Pyrethroids (allethrin, permethrin)
- Pyrethrins (pyrethrum)
- Colloids (colloidal solution)
- Lithium
- Monoclonal antibodies
- Anti-CD25 antibody daclizumab (DAC).
- IgG1 antibody pertuzumab
- PD-1 immune checkpoint inhibitors: Nivolumab
- Trastuzumab
- Mucolytics (acetylcysteine (ACC); N-acetylcysteine (NAC); N-acetyl-L-cysteine).
- Narcotics (halothane)
- Nicotinic acid derivatives (nicotinic acid)
- Norepinephrine reuptake inhibitor (atomoxetine).
- Opiates or opioids (alfentanil, apomorphine, buprenorphine, codeine, dihydrocodeine, fentanyl, hydromorphone, loperamide, morphine, methadone, nalbuphine, naloxone, naltrexone, oxycodone, pentazocine, pethidine, piritramide, remifentanil, sufentanil, tapentadol, tilidine, tramadol).
- Peroxides (benzoyl peroxide).
- Phytotherapeutics (horse chestnut (triterpene glycoside).
- Proton pump inhibitors (proton pump inhibitors, PPI; acid blockers) – esomeprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole.
- Quaternary amonium compounds (dequalinium.
- Retinoids (alitretinoin, tazarotene)
- X-ray contrast agents (as an immediate reaction).
- Statins – lovastatin, simvastatin
- Sulfasalazine (INN), also salazosulfapyridine.
- Topical calcineurin inhibitors (pimecrolimus, tacrolimus).
- Tuberculostat (isoniazid).
- Vasodilators (diazoxide)
- Antivirals (aciclovir, brivudine, famciclovir, simeprevir, valaciclovir).
- Non-nucleoside reverse transcriptase inhibitors (NNRTIs) – efavirenz, nevirapine, rilpivirine.
- NS5A inhibitors (daclatasvir, ledipasvir, ombitasvir).
- Protease inhibitors (PI; protease inhibitors) – boceprevir, paritaprevir, telaprevir (anal pruritus).
- Cytostatic drugs (busulfan, ingenol mebutate, methotrexate (MTX), sunitinib, temodal).
- See also under “Photosensitizing drugs“.
Environmental history
- Irritants (chemicals, solvents)
- Air conditioning (dry air)
- Overheated rooms
- Dry room climate
- Sun (frequent sunbathing)
- Winter (cold) → reduction of sebaceous gland secretion.