Chronic itch in the elderly is a common problem, with a significant impact on quality of life and sleep in elderly patients. Chronic itch may be attributable to several causes, including dry skin, immunosenescence and neural degeneration. Itch may also be caused by skin diseases, such as seborrhoeic dermatitis and stasis dermatitis; systemic conditions, such as end-stage renal disease and diabetes; and psychogenic conditions, such as depression and anxiety. The use of polypharmacy may also cause itch, with or without a rash. Specifically, thiazides and calcium channel blockers have been known to cause itch in elderly patients. Management should be tailored according to the underlying dermatological or systemic aetiology of itch. Topical treatment is the mainstay of therapy, providing special emphasis on skin hydration and barrier repair. In addition, topical and oral medications that target the nervous system and reduce neuronal hypersensitization, such as gabapentin and selective antidepressants, have a role in treating patients with severe chronic itch. Furthermore, management must account for changes in metabolism and pharmacokinetics of drugs in the aging population in order to prevent the occurrence of adverse effects.

Chronic pruritus in the elderly: pathophysiology, diagnosis and management.

Scalp dysaesthesia, considered a variant of the cutaneous dysaesthesia syndrome, is characterized by chronic sensory symptoms, including pruritus, pain, burning and stinging in a well-defined location, without objective findings. Its aetiology is not well elucidated and treatment options are limited, thus it can be challenging and frustrating for both patient and physician. It can be associated with lichen simplex chronicus. In this paper, we review the literature on the pathogenetic factors, diagnostic methods and therapeutic options in the management of scalp dysaesthesia. Dissociation, cervical spine disease and muscle tension seem to be the most important pathogenetic factors. Trichoscopy, reflectance confocal microscopy and biopsy are all helpful for the diagnosis of the disease. Therapies include high-potency topical or intralesional corticosteroids, capsaicin and topical anaesthetics, sedative antihistamines, tricyclic antidepressants, transcutaneous electric nerve stimulation, botulinum toxin and vitamin B12.

Scalp dysaesthesia and lichen simplex chronicus: diagnostic and therapeutic update with literature review

Latar Belakang: Liken Simpleks Kronikus (LSK) merupakan peradangan kulit kronis, gatal, sirkumskripta yang mengalami peningkatan insiden akhir-akhir ini, namun pada penelitian sebelumnya masih terdapat perbedaan mengenai profil LSK sehingga pentingnya pembaharuan epidemiologi LSK agar dapat dijadikan landasan teori terbaru bagi penelitian, pendidikan, institusi kesehatan dan masyarakat. Tujuan:  Penelitian ini bertujuan untuk mengetahui profil penderita Liken Simpleks Kronikus di Puskesmas Padang Pasir tahun 2017 yang mencakup distribusi frekuensi berdasarkan usia, jenis kelamin, keluhan utama, lokasi lesi dan terapi. Metode: Penelitian ini merupakan penelitian deskriptif yang menggunakan data sekunder yang berasal dari rekam medis pasien LSK di Puskesmas Padang Pasir Kota Padang pada tahun 2017. Sampel penelitian sebanyak 70 orang yang diperoleh dengan teknik total sampling dan rumus slovin. H asil penelitian diperoleh distribusi frekuensi penderita LSK berdasarkan kelompok usia terbanyak adalah 56-65 tahun (34,3%) dengan jumlah pasien perempuan lebih banyak (51,4%) daripada laki-laki (48,6%). Keluhan utama terbanyak yaitu gatal (82,9%), lokasi lesi yang tersering adalah kaki (54,3%) dan terapi antihistamin oral yang paling banyak diberikan adalah Klorferamini Maleat (CTM) 4mg (72,9%), terapi steroid oral terbanyak Dexametason 0,5 mg (28,6%) dan terapi topikal terbanyak adalah Betametason 0,1% krim (51,4%). Kesimpulan: Distribusi frekuensi penderita LSK berdasarkan usia didapatkan kelompok usia terbanyak kasus LSK adalah 56 - 65 tahun berjumlah 24 (34,3%) orang pasien, hal ini terjadi karena pada periode ini penderita cenderung mengalami gangguan psikologis dan psikiatri

/pdf/profil-penderita-liken-simpleks-kronikus-di-puskesmas-padang-3z0tr5yqv4.pdf

Profil Penderita Liken Simpleks Kronikus di Puskesmas Padang Pasir Kota Padang Tahun 2017

Introduction: Lichen Simplex Chronicus is characterized by circumscribed, lichenified, prutitic patches that may develop on the neck, upper thigh, lower legs, ankles, extensor surface of forearms, back, scalp, vulva, pubis, and scrotum.
Aim of Study: To assess the efficacy of capsaicin phonophoresis and the efficacy of transcutaneous electrical nerve stimulation in treatment of pruritus in Lichen Simplex Chronicus and to compare between both modalities which is more effective.
Methodology: Study Design: A prospective, randomized controlled trial. Sample size: 30 Patients; Each group-15. Study setting: Physical therapy department of New Kasr El-Aini Teaching Hospital, Cairo University, Egypt. Duration of Study: The total duration was 8 months. In group 1 patients received capsaicin phonophoresis and in group 2 patients received transcutaneous electrical nerve stimulation, both modalities were applied 3 treatment sessions per week for one month (12 sessions). Outcome measures: 5- D itch scale and Dermatology Life Quality Index which have been collected pre-treatment, post-treatment and follow-up (one month).
Results: Results of within group analysis, showed significant improvement (P ˂ 0. 05) in both outcome measures in both groups (pre-treatment, post-treatment and after one month). Results of between groups analysis showed no significant improvement (P ˃ 0. 05) in both outcome measures between both groups (post-treatment and after one month). 
Conclusion: Capsaicin phonophoresis as well as transcutaneous electrical nerve stimulation may prove to be a useful modality for the treatment of pruritus in Lichen simplex chronicus with no significant difference between them.

Capsaicin Phonophoresis versus Transcutaneous Electrical Nerve Stimulation in the Treatment of Pruritus in Lichen Simplex Chronicus: A Prospective Randomized Controlled Study. -

Chronic pruritus may be caused by dysfunction in cutaneous receptors, arise from peripheral nerve damage or have its genesis in the central nervous system. In combination with a detailed clinical history, neurophysiological examinations allow physicians to objectively confirm a lesion in the somatosensory system and detect its origin. Moreover, the assessment of the sensory function is important to achieve a precise characterization of the sensory dysfunction and to monitor the response to treatment. Nerve conduction studies and somatosensory evoked potentials are routinely used in the examination of large myelinated fibers, whereas quantitative sensory testing is used to evaluate the function of small myelinated and unmyelinated peripheral nerve fibers. The quantification of intraepidermal nerve fiber density, by analysis of skin biopsies, or assessments of corneal nerves by corneal confocal microscopy allow the study of morphological changes. These structural diagnostic tools do not assess sensory function directly, but are valuable in predicting sensory dysfunction. A combination of neurophysiological examinations is often necessary to obtain a comprehensive sensory profile of the individual patient and thus better guide therapy. Other specialized methodologies as microneurography and nociceptive evoked potentials have yet limited clinical application and are mainly used for research purposes. Aim of this chapter is to give an overview of neurophysiological examinations used to assess sensory function and to briefly discuss their role in the assessment of chronic itch. Three clinical cases are presented at the end of this chapter to illustrate the practical application of these examinations.

Measurement of Sensory Function in Chronic Pruritus

Background Localized itch of non-pruritoceptive origin is often neuropathic and may be referred to as neuropathic itch syndrome. Objectives To describe the results of nerve conduction studies in patients with anogenital pruritus, brachioradial pruritus and scalp dysesthesia, and compare these sites to typical sites of lichen simplex chronicus (LSC). Methods The study summarizes previously published data combined with unpublished data of patients with scalp dysesthesia. Nerve conduction studies included measurements of distal sensory and motor latency, conduction velocity and F-responses. Results A neuropathy was demonstrated in 29 of 36 patients with anogenital pruritus (80.5%), 8/14 with brachioradial pruritus (57.1%) and 4/9 with scalp dysesthesia (44.4%). The typical sites overlapped with some but not all LSC sites. Conclusions A considerable proportion of patients with brachioradial pruritus, anogenital pruritus and scalp dysesthesia have abnormal nerve conduction findings, suggesting a neuropathic origin. The skin sites overlap with some common LSC sites, suggesting that in some cases of LSC a local neuropathy could be a possible cause.

Israel D Andrews

Papers

Similarities between neuropathic pruritus sites and lichen simplex chronicus sites.