1 / 4

Brachioradial Pruritus NHS | A4 Medicine

Brachioradial Pruritus NHS is defined as an unpleasant sensation of the skin leading to the desire to scratch ( itch )<br><br>

a4medicineuk
Download Presentation

Brachioradial Pruritus NHS | A4 Medicine

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. A4 Medicine Chronic Pruritus a4medicine.co.uk

  2. A4 Medicine Pruritus (lat. prurigo ) is defined as an unpleasant sensation of skin leading
 to the desire to scratch ( itch ) Common dermatological problem Often intractable with a high impact on quality of life Increases with age
Estimated that 60 % of people > 65 suffer from mild to severe occasional pruritus each week Exact prevalence is not known Can be caused by both skin and systemic problems International forum for the study of Itch has suggested a classification which considers clinical as well as differential diagnostic reasons Systemic causes- Metabolic and Endocrine
♦ Chronic renal insufficiency
♦ hyperparathyroidism
♦ hyper & hypothyroidism
♦ Carcinoid syndrome
♦ Diabetes
 Hepatic
♦ PBC
♦ Extrahepatic biliary obstruction
♦ Cholestasis of pregnancy
♦ Hepatitis
♦ Oral contraceptives
♦ Drug ingestion
 Infective disease
♦ HIV and AIDS
♦ Parasitoses including Helminthosis
 Haematological
♦ Polycythemia vera
♦ Myelodisplastic syndrome
♦ Lymphoma eg Hodgkins lymphoma
♦ Multiple myeloma
♦ Iron deficiency
 Neurological disorders
♦ Multiple sclerosis
♦ Brain tumours ( eg gliomas )
♦ Notalgia paraesthetica
♦ Brachioradial pruritus
♦ Peripheral neuropathy
 Psychiatric or Psychosomatic diseases
♦ Depression
♦ Affective disorders
♦ Hallucinosis
♦ OCD
♦ Schizophrenia
♦ Eating disorders a4medicine.co.uk

  3. A4 Medicine Dermatological causes-Xerosis Scabies Dermatitis herpetiformis Atopic dermatitis Lichen simplex Psoriasis Lichen planus Contact dermatitis Miliaria Drug reactions Insect bites Pruritic urticarial papules and plaques of pregnancy Peduculosis Urticaria Folliculitis Sunburn Polymorphous light eruption Bullous pemphigoid Pemphigus foliaceus Pityriasis rosea Fiberglass dermatitis Fungal infections Mycosis fungoides Seborrhoeic dermatitis history-Onset , duration Intensity Timing Itch characteristic for eg
prickling
crawling
burning Rash ? Site eg
entire skin
palpebral conjunctiva
perianal / perogenital
ear canals , eyelids, nostrils Associated symptoms Disturbing sleep ? Relieving factors Medical history Drug history , cosmetics , creams ? Blood transfusions Others itching ? ( scabies ) Alcohol abuse , sexual hx , drug abuse Dietary history Examination Assess severity for eg using an visual analogue score ( VAS ) Skin examination Mucous membranes Scalp Hair Nails Anogenital region Distribution of primary and secondary skin lesions Skin signs of systemic disease Palpation of liver , kidneys , spleen and lymph nodes Mental state – psychological impact a4medicine.co.uk

  4. A4 Medicine Testing- Renal function FBC , ESR LFTs , Bone profile , Vit D , Bl glucose , HbA1c TFTs Iron studies Blood morphology , LDH ANA HIV and hepatitis A, B and C serology Electrophoresis IgE serum levels ( total and sllergen specific ) Stool test for ova , parasites or blood Prick tests with specific allergens Microscopy of skin scrapings Dermoscopy Skin biopsy CXR CT scan of neck , thorax , abdomen and pelvis MRI of brain and spinal cord Red flags- Bullous pemphigoid Hodgkins lymphoma Polycythemia vera HIV Infection / AIDS Paraneoplastic pruritis Brain tumour Stroke management- Where possible manage underlying cause Discontinue drugs where possible Emollients with active ingredients for eg Menthol 0.5 % or 1 % , phenol
or camphor Treat skin infections Topical therapy Capsaican particularly renal ( poor pt compliance ) , topical doxepin , crotamion cream Systemic therapy ( seek adv from dermatology where appropriate )
♦ sedating anti-histamines eg hydroxyzine ( Atarax ) 10-25 mg nocte
♦ Non sedating anti histamines eg Fexofenadine 180 mg
♦ Anti- depressants eg Tricyclics ( amitriptyline , doxepin ) , SSRIs ( paroxetine ) , Mirtazepine @ 15 mg
♦ Anti-convulsants and pain modulators – eg gabapentin or pregabalin
♦ Opioid receptor antagonists ; agonists eg Naltrexone
♦ Rifampicin ( hepatic pruritus ) , Cholestyramine
♦ Ondansetron , NSAIDs , H1 and H2 antagonists in combination for eg fexofenadine and cimetidine UV phototherapy Psychosomatic therapy a4medicine.co.uk

More Related