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Etiological and Clinical Evaluation of Elderly Patients with Pruritus: A Retrospective Cross-sectional Analysis of 700 Patients

Yıl 2025, Cilt: 47 Sayı: 2, 233 - 243, 27.02.2025

Öz

Pruritus is one of the most common symptoms in the elderly. It can be associated with dermatological, systemic, neurological, or psychogenic disorders. Identifing the underlying origin and appropriate management of patients are important due to its negative impact on quality of life. We aimed to investigate the demographic and clinical features, etiologies, laboratory work-up, and management of elderly patients with pruritus. A retrospective cross-sectional study was conducted on patients with pruritus aged ≥ 65 years who attended our outpatient clinic between January 2014 and June 2024. Etiological origins were categorized as dermatological, systemic, neurologic, psychogenic, drug-associated, or mixed. A total of 700 patients were included. Pruritus began between the ages of 65-75 years in 69%. Of the patients, 140 (20%) had acute and 560 (80%) had chronic pruritus. Pruritus was localized in 299 (42.7%) and generalized in 401 (57.3%) patients. The trunk, upper and lower extremities were the most common sites of pruritus. The most common causes of pruritus were dermatological (83.6%), followed by systemic (5.6%) and psychogenic (5.1%) origins. The most common dermatological cause of acute pruritus was scabies (20.5%), whereas chronic pruritus was xerosis (32.9%). Chronic renal failure was the leading systemic cause in both acute and chronic pruritus (30% and 42.5%, respectively). In conclusion, the demographics, clinical, and etiological factors of pruritus in the elderly can differ according to the geographic region, sample size, age groups, socioeconomics, lifestyle, and environmental factors. Each patient must be examined and treated individually.

Kaynakça

  • 1. United Nations Department of Economic and Social Affairs. An Ageing World. In: World social report 2023 : leaving no one behind in an ageing World. United Nations, 2023. p. 17-34.
  • 2. Farage MA, Miller KW, Berardesca E, Maibach HI. Clinical implications of aging skin: cutaneous disorders in the elderly. Am J Clin Dermatol. 2009;10(2):73-86.
  • 3. Cao T, Tey HL, Yosipovitch G. Chronic Pruritus in the Geriatric Population. Dermatol Clin. 2018;36(3):199-211.
  • 4. Reich A, Ständer S, Szepietowski JC. Pruritus in the elderly. Clin Dermatol. 2011;29(1):15-23.
  • 5. Steinhoff M, Al-Khawaga S, Buddenkotte J. Itch in elderly patients: Origin, diagnostics, management. J Allergy Clin Immunol. 2023;152(1):42-9.
  • 6. Ständer S, Schäfer I, Phan NQ, Blome C, Herberger K, Heigel H, et al. Prevalence of chronic pruritus in Germany: results of a cross-sectional study in a sample working population of 11,730. Dermatology. 2010;221(3):229-35.
  • 7. Yalçin B, Tamer E, Toy GG, Oztaş P, Hayran M, Alli N. The prevalence of skin diseases in the elderly: analysis of 4099 geriatric patients. Int J Dermatol. 2006;45(6):672-6.
  • 8. Liao YH, Chen KH, Tseng MP, Sun CC. Pattern of skin diseases in a geriatric patient group in Taiwan: a 7-year survey from the outpatient clinic of a university medical center. Dermatology. 2001;203(4):308-13.
  • 9. Weisshaar E, Dalgard F. Epidemiology of itch: adding to the burden of skin morbidity. Acta Derm Venereol. 2009;89(4):339-50.
  • 10. Thaipisuttikul Y. Pruritic skin diseases in the elderly. J Dermatol. 1998;25(3):153-7.
  • 11. Reszke R, Pełka D, Walasek A, Machaj Z, Reich A. Skin disorders in elderly subjects. Int J Dermatol. 2015;54(9):e332-8.
  • 12. Norman RA. Xerosis and pruritus in the elderly: recognition and management. Dermatol Ther. 2003;16(3):254-9.
  • 13. Dyhre-Petersen N, Gazerani P. Presence and characteristics of senile pruritus among Danish elderly living in nursing homes. Future Sci OA. 2019;5(6):FSO399.
  • 14. Ständer S, Weisshaar E, Mettang T, Szepietowski JC, Carstens E, Ikoma A, et al. Clinical classification of itch: a position paper of the International Forum for the Study of Itch. Acta Derm Venereol. 2007;87(4):291-4.
  • 15. Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):230.
  • 16. Novak J, Goldberg A, Dharmarajan K, Amini A, Maggiore RJ, Presley CJ, et al. Polypharmacy in older adults with cancer undergoing radiotherapy: A review. J Geriatr Oncol. 2022;13(6):778-83.
  • 17. Aboeldahab S, Khalil F, Ezz Eldawla R. Clinical and Laboratory Characteristics of Elderly Patients with Pruritus. Clin Cosmet Investig Dermatol. 2021;14:1009-15.
  • 18. Gunes Bilgili S, Karadağ AS, Uce Ozkol H, Calka O, Akdeniz N. The prevalence of skin diseases among the geriatric patients in Eastern Turkey. J Pak Med Assoc. 2012;62(6):535-9.
  • 19. Yorulmaz A, Tabanlıoğlu Onan D, Kulcu Çakmak S, Yalçın B. A retrospective study on the etiologıcal factors of chronic pruritus in the elderly. Turkish Journal of Geriatrics. 2017;20(3):187-93.
  • 20. Darjani A, Mohtasham-Amiri Z, Mohammad Amini K, Golchai J, Sadre-Eshkevari S, Alizade N. Skin Disorders among Elder Patients in a Referral Center in Northern Iran (2011). Dermatol Res Pract. 2013;2013:193205.
  • 21. Valdes-Rodriguez R, Mollanazar NK, González-Muro J, Nattkemper L, Torres-Alvarez B, López-Esqueda FJ, et al. Itch prevalence and characteristics in a Hispanic geriatric population: a comprehensive study using a standardized itch questionnaire. Acta Derm Venereol. 2015;95(4):417-21.
  • 22. Verduzco HA, Shirazian S. CKD-Associated Pruritus: New Insights Into Diagnosis, Pathogenesis, and Management. Kidney Int Rep. 2020;5(9):1387-402.
  • 23. Mettang T, Pauli-Magnus C, Alscher DM. Uraemic pruritus--new perspectives and insights from recent trials. Nephrol Dial Transplant. 2002;17(9):1558-63.
  • 24. Hashimoto T, Yosipovitch G. Itching as a systemic disease. J Allergy Clin Immunol. 2019;144(2):375-80.
  • 25. Beuers U, Wolters F, Oude Elferink RPJ. Mechanisms of pruritus in cholestasis: understanding and treating the itch. Nat Rev Gastroenterol Hepatol. 2023;20(1):26-36.
  • 26. Cavalli F. Rare syndromes in Hodgkin's disease. Ann Oncol. 1998;9 Suppl 5:S109-13
  • 27. Wang H, Yosipovitch G. New insights into the pathophysiology and treatment of chronic itch in patients with end-stage renal disease, chronic liver disease, and lymphoma. Int J Dermatol. 2010;49(1):1-11
  • 28. Kılıc A¸ Gul U, Aslan E, Soylu S. Dermatological findings in the senior population of nursing homes in Turkey. Arch Gerontol and Geriatr. 2008;47:93-8.
  • 29. El-Hamd MA, Abd-Elmaged WM, Mohammed NA. Skin disorders among elderly patients: clinicodemographic characteristics of 808 Egyptian patients. Egyptian Journal of Dermatology and Venerology. 2020;40(1):38-44.
  • 30. Lehmann M, Cazzaniga S, Simon D, Perruchoud DL, Borradori L, Rammlmair A. Patterns among Patients with Chronic Pruritus: A Retrospective Analysis of 170 Patients. Acta Derm Venereol. 2020;100(4):5668.
  • 31. Johannesdottir SA, Farkas DK, Vinding GR, Pedersen L, Lamberg A, Sørensen HT, et al. Cancer incidence among patients with a hospital diagnosis of pruritus: a nationwide Danish cohort study. Br J Dermatol. 2014;171(4):839-46.
  • 32. Buteau A, Reichenberg J. Psychogenic Pruritus and Its Management. Dermatol Clin. 2018;36(3):309-14.
  • 33. Misery L, Alexandre S, Dutray S, Chastaing M, Consoli SG, Audra H, et al. Functional itch disorder or psychogenic pruritus: suggested diagnosis criteria from the French psychodermatology group. Acta Derm Venereol. 2007;87(4):341-4.
  • 34. Kwatra SG, Kambala A, Dong X. Neuropathic pruritus. J Allergy Clin Immunol. 2023;152(1):36-8.
  • 35. Meixiong J, Dong X, Weng HJ. Neuropathic Itch. Cells. 2020;9(10):2263.
  • 36. Stumpf A, Ständer S. Neuropathic itch: diagnosis and management. Dermatol Ther. 2013;26(2):104-9.
  • 37. Pereira MP, Wiegmann H, Agelopoulos K, Ständer S. Neuropathic Itch: Routes to Clinical Diagnosis. Front Med (Lausanne). 2021;8:641746. 38. Reich A, Ständer S, Szepietowski JC. Drug-induced pruritus: a review. Acta Derm Venereol. 2009;89(3):236-44. 39. Grundmann SA, Ständer S. Evaluation of Chronic Pruritus in Older Patients. Aging Health. 2010;6(1):53-66.
  • 40. Weisshaar E, Szepietowski JC, Dalgard FJ, Garcovich S, Gieler U, Giménez-Arnau AM, et al. European S2k Guideline on Chronic Pruritus. Acta Derm Venereol. 2019;99(5):469-506

Prurituslu Yaşlı Hastaların Etiyolojik ve Klinik Olarak Değerlendirmesi: 700 Hastanın Retrospektif Kesitsel Bir Analizi

Yıl 2025, Cilt: 47 Sayı: 2, 233 - 243, 27.02.2025

Öz

Pruritus yaşlılarda en sık görülen semptomlardan biridir. Dermatolojik, sistemik, nörolojik veya psikojenik bozukluklarla ilişkili olabilir. Yaşam kalitesi üzerindeki olumsuz etkisi nedeniyle, altta yatan nedenin belirlenmesi ve hastaların uygun şekilde tedavi edilmesi önemlidir. Bu çalışmada, pruritusu olan yaşlı hastaların demografik ve klinik özelliklerini, etyolojilerini, laboratuvar çalışmalarını ve tedavilerini araştırmayı amaçladık. Ocak 2014 ile Haziran 2024 arasında polikliniğimize başvuran ≥ 65 yaş prurituslu hastalar üzerinde retrospektif kesitsel bir çalışma yürütüldü. Etiyolojik faktörler; dermatolojik, sistemik, nörolojik, psikojenik, ilaç ilişkili veya mikst olarak kategorize edildi. Toplam 700 hasta çalışmaya dahil edildi. Pruritus hastaların %69'unda 65-75 yaşları arasında başlamıştı. Hastaların 140'ında (%20) akut, 560'ında (%80) kronik pruritus vardı. Pruritus 299 (%42,7) hastada lokalize iken 401 (%57,3) hastada jeneralizeydi. Gövde, üst ve alt ekstremiteler pruritusun en sık görülen yerleriydi. Pruritusun en sık görülen nedenleri dermatolojik (%83,6) iken, bunu sistemik (%5,6) ve psikojenik (%5,1) nedenler izliyordu. Akut pruritusun en sık görülen dermatolojik nedeni skabiyez (%20,5) iken, kronik pruritusta kserozis (%32,9) idi. Kronik böbrek yetmezliği hem akut hem de kronik pruritusta en sık sistemik nedendi (%30 ve %42,5). Sonuç olarak, yaşlılarda pruritusun demografik, klinik ve etiyolojik faktörleri coğrafi bölgeye, örneklem büyüklüğüne, yaş gruplarına, sosyoekonomiye, yaşam tarzına ve çevresel faktörlere göre farklılık gösterebilir. Her hasta, bireysel olarak değerlendirilmeli ve tedavi edilmelidir.

Kaynakça

  • 1. United Nations Department of Economic and Social Affairs. An Ageing World. In: World social report 2023 : leaving no one behind in an ageing World. United Nations, 2023. p. 17-34.
  • 2. Farage MA, Miller KW, Berardesca E, Maibach HI. Clinical implications of aging skin: cutaneous disorders in the elderly. Am J Clin Dermatol. 2009;10(2):73-86.
  • 3. Cao T, Tey HL, Yosipovitch G. Chronic Pruritus in the Geriatric Population. Dermatol Clin. 2018;36(3):199-211.
  • 4. Reich A, Ständer S, Szepietowski JC. Pruritus in the elderly. Clin Dermatol. 2011;29(1):15-23.
  • 5. Steinhoff M, Al-Khawaga S, Buddenkotte J. Itch in elderly patients: Origin, diagnostics, management. J Allergy Clin Immunol. 2023;152(1):42-9.
  • 6. Ständer S, Schäfer I, Phan NQ, Blome C, Herberger K, Heigel H, et al. Prevalence of chronic pruritus in Germany: results of a cross-sectional study in a sample working population of 11,730. Dermatology. 2010;221(3):229-35.
  • 7. Yalçin B, Tamer E, Toy GG, Oztaş P, Hayran M, Alli N. The prevalence of skin diseases in the elderly: analysis of 4099 geriatric patients. Int J Dermatol. 2006;45(6):672-6.
  • 8. Liao YH, Chen KH, Tseng MP, Sun CC. Pattern of skin diseases in a geriatric patient group in Taiwan: a 7-year survey from the outpatient clinic of a university medical center. Dermatology. 2001;203(4):308-13.
  • 9. Weisshaar E, Dalgard F. Epidemiology of itch: adding to the burden of skin morbidity. Acta Derm Venereol. 2009;89(4):339-50.
  • 10. Thaipisuttikul Y. Pruritic skin diseases in the elderly. J Dermatol. 1998;25(3):153-7.
  • 11. Reszke R, Pełka D, Walasek A, Machaj Z, Reich A. Skin disorders in elderly subjects. Int J Dermatol. 2015;54(9):e332-8.
  • 12. Norman RA. Xerosis and pruritus in the elderly: recognition and management. Dermatol Ther. 2003;16(3):254-9.
  • 13. Dyhre-Petersen N, Gazerani P. Presence and characteristics of senile pruritus among Danish elderly living in nursing homes. Future Sci OA. 2019;5(6):FSO399.
  • 14. Ständer S, Weisshaar E, Mettang T, Szepietowski JC, Carstens E, Ikoma A, et al. Clinical classification of itch: a position paper of the International Forum for the Study of Itch. Acta Derm Venereol. 2007;87(4):291-4.
  • 15. Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):230.
  • 16. Novak J, Goldberg A, Dharmarajan K, Amini A, Maggiore RJ, Presley CJ, et al. Polypharmacy in older adults with cancer undergoing radiotherapy: A review. J Geriatr Oncol. 2022;13(6):778-83.
  • 17. Aboeldahab S, Khalil F, Ezz Eldawla R. Clinical and Laboratory Characteristics of Elderly Patients with Pruritus. Clin Cosmet Investig Dermatol. 2021;14:1009-15.
  • 18. Gunes Bilgili S, Karadağ AS, Uce Ozkol H, Calka O, Akdeniz N. The prevalence of skin diseases among the geriatric patients in Eastern Turkey. J Pak Med Assoc. 2012;62(6):535-9.
  • 19. Yorulmaz A, Tabanlıoğlu Onan D, Kulcu Çakmak S, Yalçın B. A retrospective study on the etiologıcal factors of chronic pruritus in the elderly. Turkish Journal of Geriatrics. 2017;20(3):187-93.
  • 20. Darjani A, Mohtasham-Amiri Z, Mohammad Amini K, Golchai J, Sadre-Eshkevari S, Alizade N. Skin Disorders among Elder Patients in a Referral Center in Northern Iran (2011). Dermatol Res Pract. 2013;2013:193205.
  • 21. Valdes-Rodriguez R, Mollanazar NK, González-Muro J, Nattkemper L, Torres-Alvarez B, López-Esqueda FJ, et al. Itch prevalence and characteristics in a Hispanic geriatric population: a comprehensive study using a standardized itch questionnaire. Acta Derm Venereol. 2015;95(4):417-21.
  • 22. Verduzco HA, Shirazian S. CKD-Associated Pruritus: New Insights Into Diagnosis, Pathogenesis, and Management. Kidney Int Rep. 2020;5(9):1387-402.
  • 23. Mettang T, Pauli-Magnus C, Alscher DM. Uraemic pruritus--new perspectives and insights from recent trials. Nephrol Dial Transplant. 2002;17(9):1558-63.
  • 24. Hashimoto T, Yosipovitch G. Itching as a systemic disease. J Allergy Clin Immunol. 2019;144(2):375-80.
  • 25. Beuers U, Wolters F, Oude Elferink RPJ. Mechanisms of pruritus in cholestasis: understanding and treating the itch. Nat Rev Gastroenterol Hepatol. 2023;20(1):26-36.
  • 26. Cavalli F. Rare syndromes in Hodgkin's disease. Ann Oncol. 1998;9 Suppl 5:S109-13
  • 27. Wang H, Yosipovitch G. New insights into the pathophysiology and treatment of chronic itch in patients with end-stage renal disease, chronic liver disease, and lymphoma. Int J Dermatol. 2010;49(1):1-11
  • 28. Kılıc A¸ Gul U, Aslan E, Soylu S. Dermatological findings in the senior population of nursing homes in Turkey. Arch Gerontol and Geriatr. 2008;47:93-8.
  • 29. El-Hamd MA, Abd-Elmaged WM, Mohammed NA. Skin disorders among elderly patients: clinicodemographic characteristics of 808 Egyptian patients. Egyptian Journal of Dermatology and Venerology. 2020;40(1):38-44.
  • 30. Lehmann M, Cazzaniga S, Simon D, Perruchoud DL, Borradori L, Rammlmair A. Patterns among Patients with Chronic Pruritus: A Retrospective Analysis of 170 Patients. Acta Derm Venereol. 2020;100(4):5668.
  • 31. Johannesdottir SA, Farkas DK, Vinding GR, Pedersen L, Lamberg A, Sørensen HT, et al. Cancer incidence among patients with a hospital diagnosis of pruritus: a nationwide Danish cohort study. Br J Dermatol. 2014;171(4):839-46.
  • 32. Buteau A, Reichenberg J. Psychogenic Pruritus and Its Management. Dermatol Clin. 2018;36(3):309-14.
  • 33. Misery L, Alexandre S, Dutray S, Chastaing M, Consoli SG, Audra H, et al. Functional itch disorder or psychogenic pruritus: suggested diagnosis criteria from the French psychodermatology group. Acta Derm Venereol. 2007;87(4):341-4.
  • 34. Kwatra SG, Kambala A, Dong X. Neuropathic pruritus. J Allergy Clin Immunol. 2023;152(1):36-8.
  • 35. Meixiong J, Dong X, Weng HJ. Neuropathic Itch. Cells. 2020;9(10):2263.
  • 36. Stumpf A, Ständer S. Neuropathic itch: diagnosis and management. Dermatol Ther. 2013;26(2):104-9.
  • 37. Pereira MP, Wiegmann H, Agelopoulos K, Ständer S. Neuropathic Itch: Routes to Clinical Diagnosis. Front Med (Lausanne). 2021;8:641746. 38. Reich A, Ständer S, Szepietowski JC. Drug-induced pruritus: a review. Acta Derm Venereol. 2009;89(3):236-44. 39. Grundmann SA, Ständer S. Evaluation of Chronic Pruritus in Older Patients. Aging Health. 2010;6(1):53-66.
  • 40. Weisshaar E, Szepietowski JC, Dalgard FJ, Garcovich S, Gieler U, Giménez-Arnau AM, et al. European S2k Guideline on Chronic Pruritus. Acta Derm Venereol. 2019;99(5):469-506
Toplam 38 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Dermatoloji
Bölüm ORİJİNAL MAKALELER / ORIGINAL ARTICLES
Yazarlar

Özge Zorlu 0000-0001-5555-130X

Umut Günal 0009-0005-8872-5165

Hülya Albayrak 0000-0002-2022-578X

Sema Aytekin 0000-0003-1376-1573

Yayımlanma Tarihi 27 Şubat 2025
Gönderilme Tarihi 19 Ocak 2025
Kabul Tarihi 3 Şubat 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 47 Sayı: 2

Kaynak Göster

Vancouver Zorlu Ö, Günal U, Albayrak H, Aytekin S. Etiological and Clinical Evaluation of Elderly Patients with Pruritus: A Retrospective Cross-sectional Analysis of 700 Patients. Osmangazi Tıp Dergisi. 2025;47(2):233-4.


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