[Recommended Diagnostics for Pruritus Affecting Primary Non-lesional Skin]

Overview

Journal Dermatologie (Heidelb)

Specialty Dermatology

Date 2024 Jun 28

PMID 38940941

Authors

M M Dull

A E Kremer

Affiliations

Soon will be listed here.

Abstract

Background: Chronic pruritus affecting primary non-lesional skin (CPNL) manifests as a common symptom across a spectrum of diseases spanning various medical specialties. Given the diverse etiological factors involved, diagnosing the underlying condition poses a significant challenge.

Objectives: To provide a comprehensive overview of clinical, laboratory, and imaging diagnostics for CPNL.

Materials And Methods: A thorough literature search on the diagnostics of chronic pruritus was conducted using PubMed with specific keywords "chronic pruritus AND non-lesional skin", "chronic itch AND non-lesional skin", "chronic pruritus AND diagnostics", "chronic itch AND diagnostics", "CKD-aP", "hepatic pruritus", "cholestatic pruritus", and "myeloproliferative neoplasms AND pruritus".

Results: A systematic diagnostic approach is recommended for patients with CPNL, guided by the prevalence of pruritus-associated diseases. Initial basic diagnostics facilitate a cost-effective and focused evaluation during the initial medical assessment. Information pertaining to underlying diseases can be further refined through specialized diagnostic procedures.

Conclusions: CPNL often presents a diagnostic dilemma. Adopting a stepwise diagnostic strategy facilitates the identification of underlying etiologies, which is crucial for recognizing diseases and administering pruritus-specific pharmacotherapy.

References

Fett N, Haynes K, Propert K, Margolis D . Five-year malignancy incidence in patients with chronic pruritus: a population-based cohort study aimed at limiting unnecessary screening practices. J Am Acad Dermatol. 2014; 70(4):651-658. PMC: 3959616. DOI: 10.1016/j.jaad.2013.11.045. View

Stander S, Schafer I, Phan N, Blome C, Herberger K, Heigel H . 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. DOI: 10.1159/000319862. View

Kirito K, Suzuki K, Miyamura K, Takeuchi M, Handa H, Okamoto S . Ruxolitinib is effective and safe in Japanese patients with hydroxyurea-resistant or hydroxyurea-intolerant polycythemia vera with splenomegaly. Int J Hematol. 2017; 107(2):173-184. DOI: 10.1007/s12185-017-2333-y. View

Weisshaar E, Szepietowski J, Dalgard F, Garcovich S, Gieler U, Gimenez-Arnau A . European S2k Guideline on Chronic Pruritus. Acta Derm Venereol. 2019; 99(5):469-506. DOI: 10.2340/00015555-3164. View

Gonzales E, Hardikar W, Stormon M, Baker A, Hierro L, Gliwicz D . Efficacy and safety of maralixibat treatment in patients with Alagille syndrome and cholestatic pruritus (ICONIC): a randomised phase 2 study. Lancet. 2021; 398(10311):1581-1592. DOI: 10.1016/S0140-6736(21)01256-3. View

Weisshaar E, Stander S, Gieler U, Matterne U, Darsow U . [Development of a German language questionnaire for assessing chronic pruritus (AGP-questionnaire): background and first results]. Hautarzt. 2011; 62(12):914-27. DOI: 10.1007/s00105-011-2236-4. View

Kowdley K, Bowlus C, Levy C, Akarca U, Alvares-da-Silva M, Andreone P . Efficacy and Safety of Elafibranor in Primary Biliary Cholangitis. N Engl J Med. 2023; 390(9):795-805. DOI: 10.1056/NEJMoa2306185. View

Zeidler C, Raap U, Witte F, Stander S . Clinical aspects and management of chronic itch. J Allergy Clin Immunol. 2023; 152(1):1-10. DOI: 10.1016/j.jaci.2023.04.018. View

Hirschfield G, Bowlus C, Mayo M, Kremer A, Vierling J, Kowdley K . A Phase 3 Trial of Seladelpar in Primary Biliary Cholangitis. N Engl J Med. 2024; 390(9):783-794. DOI: 10.1056/NEJMoa2312100. View

10.

Stander S, Weisshaar E, Mettang T, Szepietowski J, Carstens E, Ikoma A . Clinical classification of itch: a position paper of the International Forum for the Study of Itch. Acta Derm Venereol. 2007; 87(4):291-4. DOI: 10.2340/00015555-0305. View

11.

Stander S, Zeidler C, Augustin M, Darsow U, Kremer A, Legat F . S2k Leitlinie: Diagnostik und Therapie des chronischen Pruritus. J Dtsch Dermatol Ges. 2022; 20(10):1386-1402. DOI: 10.1111/ddg.14830_g. View

12.

Kopyciok M, Stander H, Osada N, Steinke S, Stander S . Prevalence and Characteristics of Pruritus: A One-Week Cross-sectional Study in a German Dermatology Practice. Acta Derm Venereol. 2015; 96(1):50-5. DOI: 10.2340/00015555-2166. View

13.

Stander S, Blome C, Breil B, Bruland P, Darsow U, Dugas M . [Assessment of pruritus - current standards and implications for clinical practice : consensus paper of the Action Group Pruritus Parameter of the International Working Group on Pruritus Research (AGP)]. Hautarzt. 2012; 63(7):521-2, 524-31. DOI: 10.1007/s00105-011-2318-3. View

14.

Dull M, Kremer A . Evaluation and Management of Pruritus in Primary Biliary Cholangitis. Clin Liver Dis. 2022; 26(4):727-745. DOI: 10.1016/j.cld.2022.06.009. View

15.

Heitkemper T, Hofmann T, Phan N, Stander S . Aquagenic pruritus: associated diseases and clinical pruritus characteristics. J Dtsch Dermatol Ges. 2010; 8(10):797-804. DOI: 10.1111/j.1610-0387.2010.07463.x. View

16.

Matterne U, Apfelbacher C, Loerbroks A, Schwarzer T, Buttner M, Ofenloch R . Prevalence, correlates and characteristics of chronic pruritus: a population-based cross-sectional study. Acta Derm Venereol. 2011; 91(6):674-9. DOI: 10.2340/00015555-1159. View

17.

Johannesdottir S, Farkas D, Vinding G, Pedersen L, Lamberg A, Sorensen H . Cancer incidence among patients with a hospital diagnosis of pruritus: a nationwide Danish cohort study. Br J Dermatol. 2014; 171(4):839-46. DOI: 10.1111/bjd.13157. View

18.

Sommer F, Hensen P, Bockenholt B, Metze D, Luger T, Stander S . Underlying diseases and co-factors in patients with severe chronic pruritus: a 3-year retrospective study. Acta Derm Venereol. 2007; 87(6):510-6. DOI: 10.2340/00015555-0320. View

19.

Fishbane S, Jamal A, Munera C, Wen W, Menzaghi F . A Phase 3 Trial of Difelikefalin in Hemodialysis Patients with Pruritus. N Engl J Med. 2019; 382(3):222-232. DOI: 10.1056/NEJMoa1912770. View

20.

Brand M, Kremer A . [Systemic pruritus: what is new in diagnosis and treatment?]. Dermatologie (Heidelb). 2022; 73(8):600-608. PMC: 9358966. DOI: 10.1007/s00105-022-05027-z. View