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Title: Pruritus in the Elderly: Differential Diagnosis and Management

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Abstract

Purpose of Review

Pruritis is a highly prevalent symptom in older adults significantly impacting their quality of life. It can manifest in the geriatric population due to a spectrum of etiologies including dermatological, systemic, psychological, medication-induced, and idiopathic causes. The purpose of this review was to explore pruritus in older adults with a discussion of common causes and current standards of management with a focus on the latest innovations within the last five years.

Recent Findings

Common dermatological causes of pruritus in the elderly are atopic dermatitis, prurigo nodularis, psoriasis, seborrheic dermatitis, and transient Acantholytic Dermatosis also known as Grover’s disease. Noteworthy systemic causes are uremic or chronic kidney disease-associated pruritus, cholestatic disease, and paraneoplastic causes although additional etiologies such as neuropathic, psychogenic, drug-induced, or idiopathic itch must also be considered. Topical emollients and gentle cleansers are the foundation of managing pruritus in the elderly with adjuvant therapy focused on addressing the underlying trigger. Recent findings demonstrate immunobiologics having a greater role in treating skin conditions that cause pruritus although a variety of topical formulations are being investigated. The latest research on systemic causes of pruritus in the elderly is focused on addressing the underlying condition. Psychiatric medications and behavioral interventions are being explored for neuropathic and idiopathic causes of itch respectively.

Summary

Given the significant impact of pruritus on the quality of life of older adults, there is a need for further research on effective interventions for pruritus specifically among the elderly.

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Data Availability

No datasets were generated or analysed during the current study.

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  1. University of North Carolina School of Medicine, 321 S Columbia St, Chapel Hill, NC, 27599, USA

    Rayad B. Shams

  2. Department of Dermatology, University of North Carolina, 410 Market Street Suite 400A, Chapel Hill, NC, 27516, USA

    Rayad B. Shams, Matthew B. Lipner & Christopher J. Sayed

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RBS performed the literature review and drafted the manuscript. MBL and CJS critically reviewed the manuscript and provided their clinical expertise and input. All authors contributed substantially to the manuscript.

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RBS and MBL report no conflict of interests. CJS reports being an investigator for AbbVie, ChemoCentryx, Incyte, InflaRx, Novartis and UCB Pharma; consultancy fees from AbbVie, Alumis, Astrazeneca, InflaRx, Sandoz, Incyte, Logical Images, Sonoma Biotherapeutics and UCB Pharma; speaker for AbbVie and Novartis. CJS also reports being a section editor for the Dermatology and Wound Care section of Current Geriatrics Report 2024 volume.

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Shams, R.B., Lipner, M.B. & Sayed, C.J. Title: Pruritus in the Elderly: Differential Diagnosis and Management. Curr Geri Rep (2024). https://doi.org/10.1007/s13670-024-00418-7

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