Title: Fast Fact and Concept #37: Pruritus
Author(s): Charles von Gunten; Frank Ferris
Pruritus (itching) is a common and often distressing symptom near the end of life. The itch sensation may arise from stimulation of the skin itch receptor via unmyelinated C fibers, or itch may arise as a central phenomenon without skin involvement (e.g. opioid induced pruritus). Although histamine causes pruritus, many patients with pruritis show no signs of histamine release. Besides histamine, serotonin, prostaglandins, kinins, proteases and physical stimuli have all been implicated as mediators of pruritus.
Management of pruritus involves eliminating the cause when possible. Common causes include: Dermatological (dryness, wetness, irritation, eczema, psoriasis), Metabolic (hepatic failure, renal failure, hypothyroidism), Hem/Onc (iron deficiency, polycythemia, thrombocytosis, leukemia, lymphoma), Drugs (opioids, aspirin, drug reactions), Infection (scabies, lice, candida), Allergy (urticaria, contact dermatitis), and Psychogenic.
Alan B. Fleisher, Jr and Jason R. Michaels. Pruritus. In: Principles & Practice of supportive Oncology. Eds: Ann Berger, Russell K. Portenoy, David E. Weissman. Lippincott-Raven Publishers Philadelphia 1998;245-250.
Krajnik M and Zylicz. Understanding pruritis in systemic disease. J Pain Symp Manage 2001;21:151-168.
Wilde MI, Markham A. Ondansetron: a review of its pharmacology and preliminary clinical findings in novel applications. Drugs 1996;52:773-794.
Zylicz Z, Smits C, Chem D and Krajnik M. Paroxetive for pruritis in advanced cancer. J Pain Symptom Manage 1998;16:121-124.
Copyright Notice: Users are free to download and distribute Fast Facts for educational purposes only. Citation for referencing: von Gunten CF, Ferris F, and Weissman DE. Fast Facts and Concepts #37: PRURITUS; March, 2001. End-of-Life Physician Education Resource Center www.eperc.mcw.edu.
Fast Facts and Concepts was originally developed as an end-of-life teaching tool by Eric Warm, MD, U. Cincinnati, Department of Medicine. See: Warm, E. Improving EOL care--internal medicine curriculum project. J Pall Med 1999; 2: 339- 340.
Contact: David E. Weissman, MD, FACP Editor, Journal of Palliative Medicine Palliative Care Program Director Medical College of Wisconsin (P) 414-805-4607 (F) 414-805-4608
Disclaimer: Fast Facts provide educational information, this information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Fact information cites the use of a product in dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.
Creation Date: 3/2001
Purpose: Instructional Aid, Self-Study Guide, Teaching
|Training: Fellows, 3rd/4th Year Medical Students, PGY1 (Interns), PGY2-6, Physicians in Practice|
|Specialty: Anesthesiology, Emergency Medicine, Family Medicine, General Internal Medicine, Geriatrics, Hematology/Oncology, Neurology, OB/GYN, Ophthalmology, Pulmonary/Critical Care, Pediatrics, Psychiatry, Surgery|
ACGME Competencies: Medical Knowledge, Patient Care
Keyword(s): Skin, lymphatic
The Fast Facts series is distributed for educational use only and does not constitute medical advice. For the most current version of Fast Facts visit the EPERC web site at www.eperc.mcw.edu. This mirror version is provided subject to copyright restrictions for educational use within the Inter-Instutional Collaborating Network on End-of-Life Care (IICN).