Tom 2, Nr 1 (2024)
Artykuł przeglądowy
Opublikowany online: 2023-06-28
Wyświetlenia strony 6
Wyświetlenia/pobrania artykułu 0

Eksport do Mediów Społecznościowych

Eksport do Mediów Społecznościowych

Świąd u pacjentów w podeszłym wieku: przegląd piśmiennictwa

Paula Mazan1, Aleksandra Lesiak12, Joanna Narbutt1
Dermatologia w Praktyce Klinicznej 2024;2(1):1-10.

Streszczenie

Świąd jest najczęstszym objawem zgłaszanym przez pacjentów dermatologicznych, również wśród geriatrycznej populacji chorych. Z powodu starzenia się społeczeństwa stanowi on coraz powszechniejszą przyczynę konsultacji lekarskich. Może dotyczyć skóry uprzednio zmienionej, jak i niezmienionej chorobowo, występując jako jedyna manifestacja choroby. Przewlekły świąd trwający powyżej sześciu tygodni ma istotny wpływ na jakość życia chorych, często doprowadzając do zaburzeń snu i zaburzeń depresyjno-lękowych. Wśród mechanizmów odpowiedzialnych za występowanie świądu u osób starszych wymienia się dysfunkcję bariery skórno-naskórkowej, związane z wiekiem zmiany zachodzące w układzie immunologicznym oraz ośrodkową i obwodową neuropatię. Za najczęstszą przyczynę świądu u pacjentów geriatrycznych uważa się kserozę. Przewlekły świąd skóry występuje w przebiegu wielu schorzeń dermatologicznych, a także internistycznych, neurologicznych czy zaburzeń natury psychiatrycznej. Leczenie przewlekłego świądu u starszych pacjentów bywa wyzwaniem terapeutycznym z uwagi na choroby współistniejące czy złożoność mechanizmów prowadzących do jego powstania. Każdy chory wymaga indywidualnego i nierzadko multidyscyplinarnego podejścia, uwzględniającego schorzenia współistniejące i polipragmazję. Poza emolientacją skóry, stanowiącą podstawę pielęgnacji, oraz miejscowymi preparatami o działaniu przeciwzapalnym w przypadku zapalnych schorzeń skóry w terapii świądu coraz częściej wykorzystuje się leki biologiczne, a także leki o działaniu przeciwdepresyjnym i przeciwpadaczkowym.

Artykuł dostępny w formacie PDF

Dodaj do koszyka: 49,00 PLN

Posiadasz dostęp do tego artykułu?

Referencje

  1. Hawro T, Przybyłowicz K, Spindler M, et al. The characteristics and impact of pruritus in adult dermatology patients: A prospective, cross-sectional study. J Am Acad Dermatol. 2021; 84(3): 691–700.
  2. Valdes-Rodriguez R, Mollanazar NK, González-Muro J, 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): 417–421.
  3. Silverberg JI, Hinami K, Trick WE, et al. Itch in the general internal medicine setting: a cross-sectional study of prevalence and quality-of-life effects. Am J Clin Dermatol. 2016; 17(6): 681–690.
  4. Dalgard F, Dawn AG, Yosipovitch G. Are itch and chronic pain associated in adults? Results of a large population survey in Norway. Dermatology. 2007; 214(4): 305–309.
  5. Matterne U, Strassner T, Apfelbacher CJ, et al. Measuring the prevalence of chronic itch in the general population: development and validation of a questionnaire for use in large-scale studies. Acta Derm Venereol. 2009; 89(3): 250–256.
  6. Ständer S, Schäfer I, Phan NQ, 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): 229–235.
  7. Dalgard F, Svensson A, Holm JØ, et al. Self-reported skin morbidity in Oslo. Associations with sociodemographic factors among adults in a cross-sectional study. Br J Dermatol. 2004; 151(2): 452–457.
  8. Weisshaar E, Dalgard F. Epidemiology of itch: adding to the burden of skin morbidity. Acta Derm Venereol. 2009; 89(4): 339–350.
  9. Thaipisuttikul Y. Pruritic skin diseases in the elderly. J Dermatol. 1998; 25(3): 153–157.
  10. Beauregard S, Gilchrest BA. A survey of skin problems and skin care regimens in the elderly. Arch Dermatol. 1987; 123(12): 1638–1643.
  11. Yalçin B, Tamer E, Toy GG, et al. The prevalence of skin diseases in the elderly: analysis of 4099 geriatric patients. Int J Dermatol. 2006; 45(6): 672–676.
  12. Gunalan P, Indradevi R, Oudeacoumar P. Pattern of skin diseases in geriatric patients attending tertiary care centre. J Evol Med Dent Sci. 2017; 6(20): 1566–1570.
  13. Key findings & advance tables, World population prospects 2017 Revision, United Nations. https://esa.un.org/unpd/wpp/Publications/Files/WPP2017_KeyFindings.pdf (27.09.2017).
  14. Shevchenko A, Valdes-Rodriguez R, Yosipovitch G. Causes, pathophysiology, and treatment of pruritus in the mature patient. Clin Dermatol. 2018; 36(2): 140–151.
  15. Moniaga CS, Tominaga M, Takamori K. Mechanisms and management of itch in dry skin. Acta Derm Venereol. 2020; 100(2): adv00024.
  16. Candore G, Caruso C, Jirillo E, et al. Low grade inflammation as a common pathogenetic denominator in age-related diseases: novel drug targets for anti-ageing strategies and successful ageing achievement. Curr Pharm Des. 2010; 16(6): 584–596.
  17. Pawelec G, Larbi A, Derhovanessian E. Senescence of the human immune system. J Comp Pathol. 2010; 142 Suppl 1: S39–S44.
  18. Ferrando-Martínez S, Franco JM, Hernandez A, et al. Thymopoiesis in elderly human is associated with systemic inflammatory status. Age (Dordr). 2009; 31(2): 87–97.
  19. Weiskopf D, Weinberger B, Grubeck-Loebenstein B. The aging of the immune system. Transpl Int. 2009; 22(11): 1041–1050.
  20. Berger TG, Steinhoff M. Pruritus in elderly patients — eruptions of senescence. Semin Cutan Med Surg. 2011; 30(2): 113–117.
  21. Berger TG, Shive M, Harper GM. Pruritus in the older patient: a clinical review. JAMA. 2013; 310(22): 2443–2450.
  22. Schmidt T, Sitaru C, Amber K, et al. BP180- and BP230-specific IgG autoantibodies in pruritic disorders of the elderly: a preclinical stage of bullous pemphigoid? Br J Dermatol. 2014; 171(2): 212–219.
  23. Haynes L, Maue AC. Effects of aging on T cell function. Curr Opin Immunol. 2009; 21(4): 414–417.
  24. Sandmand M, Bruunsgaard H, Kemp K, et al. Is ageing associated with a shift in the balance between Type 1 and Type 2 cytokines in humans? Clin Exp Immunol. 2002; 127(1): 107–114.
  25. Xu AZ, Tripathi SV, Kau AL, et al. Immune dysregulation underlies a subset of patients with chronic idiopathic pruritus. J Am Acad Dermatol. 2016; 74(5): 1017–1020.
  26. Beauregard S, Gilchrest BA. A survey of skin problems and skin care regimens in the elderly. Arch Dermatol. 1987; 123(12): 1638–1643.
  27. Polat M, Yalçin B, Calişkan D, et al. Complete dermatological examination in the elderly: an exploratory study from an outpatient clinic in Turkey. Gerontology. 2009; 55(1): 58–63.
  28. Paul C, Maumus-Robert S, Mazereeuw-Hautier J, et al. Prevalence and risk factors for xerosis in the elderly: a cross-sectional epidemiological study in primary care. Dermatology. 2011; 223(3): 260–265.
  29. White-Chu EF, Reddy M. Dry skin in the elderly: complexities of a common problem. Clin Dermatol. 2011; 29(1): 37–42.
  30. Yosipovitch G. Dry skin and impairment of barrier function associated with itch — new insights. Int J Cosmet Sci. 2004; 26(1): 1–7.
  31. Choi EH, Man MQ, Xu Pu, et al. Stratum corneum acidification is impaired in moderately aged human and murine skin. J Invest Dermatol. 2007; 127(12): 2847–2856.
  32. Choi EHo. Gender, age, and ethnicity as factors that can influence skin pH. Curr Probl Dermatol. 2018; 54: 48–53.
  33. Lambers H, Piessens S, Bloem A, et al. Natural skin surface pH is on average below 5, which is beneficial for its resident flora. Int J Cosmet Sci. 2006; 28(5): 359–370.
  34. Jensen JM, Förl M, Winoto-Morbach S, et al. Acid and neutral sphingomyelinase, ceramide synthase, and acid ceramidase activities in cutaneous aging. Exp Dermatol. 2005; 14(8): 609–618.
  35. Ali SM, Yosipovitch G. Skin pH: from basic science to basic skin care. Acta Derm Venereol. 2013; 93(3): 261–267.
  36. Andersen HH, Elberling J, Sølvsten H, et al. Nonhistaminergic and mechanical itch sensitization in atopic dermatitis. Pain. 2017; 158(9): 1780–1791.
  37. Seyfarth F, Schliemann S, Antonov D, et al. Dry skin, barrier function, and irritant contact dermatitis in the elderly. Clin Dermatol. 2011; 29(1): 31–36.
  38. Simon M, Bernard D, Minondo AM, et al. Persistence of both peripheral and non-peripheral corneodesmosomes in the upper stratum corneum of winter xerosis skin versus only peripheral in normal skin. J Invest Dermatol. 2001; 116(1): 23–30.
  39. Long CC, Marks R. Stratum corneum changes in patients with senile pruritus. J Am Acad Dermatol. 1992; 27(4): 560–564.
  40. Elias PM, Ghadially R. The aged epidermal permeability barrier: basis for functional abnormalities. Clin Geriatr Med. 2002; 18(1): 103–120, vii.
  41. Pappas A. Epidermal surface lipids. Dermatoendocrinol. 2009; 1(2): 72–76.
  42. Balato A, Balato N, Di Costanzo L, et al. Contact sensitization in the elderly. Clin Dermatol. 2011; 29(1): 24–30.
  43. Lima AL, Timmermann V, Illing T, et al. Contact dermatitis in the elderly: predisposing factors, diagnosis, and management. Drugs Aging. 2019; 36(5): 411–417.
  44. Theodosat A. Skin diseases of the lower extremities in the elderly. Dermatol Clin. 2004; 22(1): 13–21.
  45. Fenske NA, Lober CW. Structural and functional changes of normal aging skin. J Am Acad Dermatol. 1986; 15(4 Pt 1): 571–585.
  46. Thornton MJ. Estrogens and aging skin. Dermatoendocrinol. 2013; 5(2): 264–270.
  47. Steinhoff M, Schmelz M, Szabó IL, et al. Clinical presentation, management, and pathophysiology of neuropathic itch. Lancet Neurol. 2018; 17(8): 709–720.
  48. Canavero S, Bonicalzi V, Massa-Micon B. Central neurogenic pruritus: a literature review. Acta Neurol Belg. 1997; 97(4): 244–247.
  49. Liao YH, Chen KH, Tseng MP, et al. 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): 308–313.
  50. Liddell K. Letter: Post-herpetic pruritus. Br Med J. 1974; 4(5937): 165.
  51. Oaklander AL. Mechanisms of pain and itch caused by herpes zoster (shingles). J Pain. 2008; 9(1 Suppl 1): S10–S18.
  52. Yamaoka H, Sasaki H, Yamasaki H, et al. Truncal pruritus of unknown origin may be a symptom of diabetic polyneuropathy. Diabetes Care. 2010; 33(1): 150–155.
  53. Fitzpatrick JE. Common inflammatory skin diseases of the elderly. Geriatrics. 1989; 44(7): 40–46.
  54. Ward JR, Bernhard JD. Willan's itch and other causes of pruritus in the elderly. Int J Dermatol. 2005; 44(4): 267–273.
  55. Cömert A, Akbaş B, Kılıç EZ, et al. Psychiatric comorbidities and alexithymia in patients with seborrheic dermatitis: a questionnaire study in Turkey. Am J Clin Dermatol. 2013; 14(4): 335–342.
  56. Arsic Arsenijevic VS, Milobratovic D, Barac AM, et al. A laboratory-based study on patients with Parkinson's disease and seborrheic dermatitis: the presence and density of Malassezia yeasts, their different species and enzymes production. BMC Dermatol. 2014; 14: 5.
  57. Tanner C, Albers K, Goldman S, et al. Seborrheic dermatitis and risk of future parkinson's disease (PD) (S42.001). Neurology. 2012; 78(1).
  58. Arlian LG, Estes SA, Vyszenski-Moher DL. Prevalence of Sarcoptes scabiei in the homes and nursing homes of scabietic patients. J Am Acad Dermatol. 1988; 19(5 Pt 1): 806–811.
  59. Hopper AH, Salisbury J, Jegadeva AN, et al. Epidemic Norwegian scabies in a geriatric unit. Age Ageing. 1990; 19(2): 125–127.
  60. Pereira MP, Ständer S. How to define chronic prurigo? Exp Dermatol. 2019; 28(12): 1455–1460.
  61. Kwon CD, Khanna R, Williams KA, et al. Diagnostic workup and evaluation of patients with prurigo nodularis. Medicines (Basel). 2019; 6(4).
  62. Balato A, Balato N, Di Costanzo L, et al. Contact sensitization in the elderly. Clin Dermatol. 2011; 29(1): 24–30.
  63. Seyfarth F, Schliemann S, Antonov D, et al. Dry skin, barrier function, and irritant contact dermatitis in the elderly. Clin Dermatol. 2011; 29(1): 31–36.
  64. Ozkaya E. Adult-onset atopic dermatitis. J Am Acad Dermatol. 2005; 52(4): 579–582.
  65. Kwon HH, Kwon InHo, Youn JIl. Clinical study of psoriasis occurring over the age of 60 years: is elderly-onset psoriasis a distinct subtype? Int J Dermatol. 2012; 51(1): 53–58.
  66. Grozdev IS, Van Voorhees AS, Gottlieb AB, et al. Psoriasis in the elderly: from the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol. 2011; 65(3): 537–545.
  67. Meeuwis KAP, van de Kerkhof PCM, Massuger LF, et al. Patients' experience of psoriasis in the genital area. Dermatology. 2012; 224(3): 271–276.
  68. Parsons JM. Transient acantholytic dermatosis (Grover's disease): a global perspective. J Am Acad Dermatol. 1996; 35(5 Pt 1): 653–66; quiz 667.
  69. Horn TD, Groleau GE. Transient acantholytic dermatosis in immunocompromised febrile patients with cancer. Arch Dermatol. 1987; 123(2): 238–240.
  70. Manteaux AM, Rapini RP. Transient acantholytic dermatosis in patients with cancer. Cutis. 1990; 46(6): 488–490.
  71. De Argila D, Ortiz-Frutos J, Vanaclocha F. Transient acantholytic dermatosis (Grover's disease) in a patient with gastric carcinoma. Acta Derm Venereol. 1997; 77(3): 245–246.
  72. Singer EM, Shin DB, Nattkemper LA, et al. IL-31 is produced by the malignant T-cell population in cutaneous T-Cell lymphoma and correlates with CTCL pruritus. J Invest Dermatol. 2013; 133(12): 2783–2785.
  73. Bigby M, Jick S, Jick H, et al. Drug-induced cutaneous reactions. A report from the Boston Collaborative Drug Surveillance Program on 15,438 consecutive inpatients, 1975 to 1982. JAMA. 1986; 256(24): 3358–3363.
  74. Raksha MP, Marfatia YS. Clinical study of cutaneous drug eruptions in 200 patients. Indian J Dermatol Venereol Leprol. 2008; 74(1): 80.
  75. Maleki K, Weisshaar E. [Drug-induced pruritus]. Hautarzt. 2014; 65(5): 436–442.
  76. Schmidt E, Zillikens D. Pemphigoid diseases. Lancet. 2013; 381(9863): 320–332.
  77. Försti AK, Jokelainen J, Ansakorpi H, et al. Psychiatric and neurological disorders are associated with bullous pemphigoid — a nationwide Finnish Care Register study. Sci Rep. 2016; 6: 37125.
  78. Meijer JM, Diercks GFH, de Lang EWG, et al. Assessment of diagnostic strategy for early recognition of bullous and nonbullous variants of pemphigoid. JAMA Dermatol. 2019; 155(2): 158–165.
  79. Lamberts A, Meijer JM, Jonkman MF. Nonbullous pemphigoid: a systematic review. J Am Acad Dermatol. 2018; 78(5): 989–995.e2.
  80. Bakker CV, Terra JB, Pas HH, et al. Bullous pemphigoid as pruritus in the elderly: a common presentation. JAMA Dermatol. 2013; 149(8): 950–953.
  81. Lamb PM, Abell E, Tharp M, et al. Prodromal bullous pemphigoid. Int J Dermatol. 2006; 45(3): 209–214.
  82. Zhang Yu, Luo Y, Han Y, et al. Non-bullous lesions as the first manifestation of bullous pemphigoid: a retrospective analysis of 181 cases. J Dermatol. 2017; 44(7): 742–746.
  83. Meijer JM, Lamberts A, Luijendijk HJ, et al. Prevalence of pemphigoid as a potentially unrecognized cause of pruritus in nursing home residents. JAMA Dermatol. 2019; 155(12): 1423–1424.
  84. Lamberts A, Meijer JM, Pas HH, et al. Nonbullous pemphigoid: Insights in clinical and diagnostic findings, treatment responses, and prognosis. J Am Acad Dermatol. 2019; 81(2): 355–363.
  85. Levine N. Pruritic lesions on extremities. Could this persistent eruption be related to hypertension medication? Geriatrics. 1997; 52(9): 89.
  86. Rinderknecht JD, Goldinger SM, Rozati S, et al. RASopathic skin eruptions during vemurafenib therapy. PLoS One. 2013; 8(3): e58721.
  87. Hodi FS, O'Day SJ, McDermott DF, et al. Improved survival with ipilimumab in patients with metastatic melanoma. N Engl J Med. 2010; 363(8): 711–723.
  88. Cao T, Tey HL, Yosipovitch G. Chronic pruritus in the geriatric population. Dermatol Clin. 2018; 36(3): 199–211.
  89. Misery L, Alexandre S, Dutray S, et al. Functional itch disorder or psychogenic pruritus: suggested diagnosis criteria from the French psychodermatology group. Acta Derm Venereol. 2007; 87(4): 341–344.
  90. Patel T, Yosipovitch G. The management of chronic pruritus in the elderly. Skin Therapy Lett. 2010; 15(8): 5–9.
  91. Yamaura K, Doi R, Suwa E, et al. Repeated application of glucocorticoids exacerbate pruritus via inhibition of prostaglandin D2 production of mast cells in a murine model of allergic contact dermatitis. J Toxicol Sci. 2012; 37(6): 1127–1134.
  92. Papier A, Strowd LC. Atopic dermatitis: a review of topical nonsteroid therapy. Drugs Context. 2018; 7: 212521.
  93. Ständer S, Schürmeyer-Horst F, Luger TA, et al. Treatment of pruritic diseases with topical calcineurin inhibitors. Ther Clin Risk Manag. 2006; 2(2): 213–218.
  94. Arana A, Pottegård A, Kuiper JG, et al. Long-Term risk of skin cancer and lymphoma in users of topical tacrolimus and pimecrolimus: final results from the extension of the cohort study protopic joint european longitudinal lymphoma and skin cancer evaluation (JOELLE). Clin Epidemiol. 2021; 13: 1141–1153.
  95. Margolis DJ, Abuabara K, Hoffstad OJ, et al. Association between malignancy and topical use of pimecrolimus. JAMA Dermatol. 2015; 151(6): 594–599.
  96. Lam M, Zhu JW, Tadrous M, et al. Association between topical calcineurin inhibitor use and risk of cancer, including lymphoma, keratinocyte carcinoma, and melanoma: a systematic review and meta-analysis. JAMA Dermatol. 2021; 157(5): 549–558.
  97. Endo JO, Wong JW, Norman RA, et al. Geriatric dermatology: Part I. Geriatric pharmacology for the dermatologist. J Am Acad Dermatol. 2013; 68(4): 521.e1–521.e10.
  98. Gray SL, Anderson ML, Dublin S, et al. Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA Intern Med. 2015; 175(3): 401–407.
  99. Matsuda KM, Sharma D, Schonfeld AR, et al. Gabapentin and pregabalin for the treatment of chronic pruritus. J Am Acad Dermatol. 2016; 75(3): 619–625.e6.
  100. Legat FJ. [Importance of phototherapy in the treatment of chronic pruritus]. Hautarzt. 2018; 69(8): 631–640.
  101. Weisshaar E, Szepietowski JC, Darsow U, et al. European guideline on chronic pruritus. Acta Derm Venereol. 2012; 92(5): 563–581.
  102. Beck LA, Thaçi D, Hamilton JD, et al. Dupilumab treatment in adults with moderate-to-severe atopic dermatitis. N Engl J Med. 2014; 371(2): 130–139.
  103. Simpson EL, Bieber T, Guttman-Yassky E, et al. SOLO 1 and SOLO 2 Investigators. Two phase 3 trials of dupilumab versus placebo in atopic dermatitis. N Engl J Med. 2016; 375(24): 2335–2348.
  104. Beck KM, Yang EJ, Sekhon S, et al. Dupilumab treatment for generalized prurigo nodularis. JAMA Dermatol. 2019; 155(1): 118–120.
  105. Mollanazar NK, Elgash M, Weaver L, et al. Reduced itch associated with dupilumab treatment in 4 patients with prurigo nodularis. JAMA Dermatol. 2019; 155(1): 121–122.
  106. Lee JK, Simpson RS. Dupilumab as a novel therapy for difficult to treat chronic spontaneous urticaria. J Allergy Clin Immunol Pract. 2019; 7(5): 1659–1661.e1.
  107. Machler BC, Sung CT, Darwin E, et al. Dupilumab use in allergic contact dermatitis. J Am Acad Dermatol. 2019; 80(1): 280–281.e1.
  108. Seidman JS, Eichenfield DZ, Orme CM. Dupilumab for bullous pemphigoid with intractable pruritus. Dermatol Online J. 2019; 25(11).
  109. Zhang Y, Xu Q, Chen L, et al. Efficacy and safety of dupilumab in moderate-to-severe bullous pemphigoid. Front Immunol. 2021; 12: 738907.
  110. Nemoto O, Furue M, Nakagawa H, et al. The first trial of CIM331, a humanized antihuman interleukin-31 receptor A antibody, in healthy volunteers and patients with atopic dermatitis to evaluate safety, tolerability and pharmacokinetics of a single dose in a randomized, double-blind, placebo-controlled study. Br J Dermatol. 2016; 174(2): 296–304.
  111. Guttman-Yassky E, Teixeira HD, Simpson EL, et al. Once-daily upadacitinib versus placebo in adolescents and adults with moderate-to-severe atopic dermatitis (Measure Up 1 and Measure Up 2): results from two replicate double-blind, randomised controlled phase 3 trials. Lancet. 2021; 397(10290): 2151–2168.
  112. Simpson EL, Sinclair R, Forman S, et al. Efficacy and safety of abrocitinib in adults and adolescents with moderate-to-severe atopic dermatitis (JADE MONO-1): a multicentre, double-blind, randomised, placebo-controlled, phase 3 trial. Lancet. 2020; 396(10246): 255–266.
  113. Saini SS, Bindslev-Jensen C, Maurer M, et al. Efficacy and safety of omalizumab in patients with chronic idiopathic/spontaneous urticaria who remain symptomatic on H1 antihistamines: a randomized, placebo-controlled study. J Invest Dermatol. 2015; 135(1): 67–75.
  114. Kremer N, Snast I, Cohen ES, et al. Rituximab and omalizumab for the treatment of bullous pemphigoid: a systematic review of the literature. Am J Clin Dermatol. 2019; 20(2): 209–216.
  115. Seyed Jafari SM, Feldmeyer L, Bossart S, et al. Case report: combination of omalizumab and dupilumab for recalcitrant bullous pemphigoid. Front Immunol. 2020; 11: 611549.
  116. Kapruvia European Medicines Agency. https://www.ema.europa.eu/en/medicines/human/EPAR/kapruvia (22.05.2022).
  117. Dawn AG, Yosipovitch G. Butorphanol for treatment of intractable pruritus. J Am Acad Dermatol. 2006; 54(3): 527–531.
  118. Patel P, Patel K, Pandher K, et al. The role of psychiatric, analgesic, and antiepileptic medications in chronic pruritus. Cureus. 2021; 13(8): e17260.
  119. Biondi M, Arcangeli T, Petrucci RM. Paroxetine in a case of psychogenic pruritus and neurotic excoriations. Psychother Psychosom. 2000; 69(3): 165–166.
  120. Patel P, Patel K, Pandher K, et al. The role of psychiatric, analgesic, and antiepileptic medications in chronic pruritus. Cureus. 2021; 13(8): e17260.
  121. Saguil A, Kane S, Mercado M, et al. Herpes zoster and postherpetic neuralgia: prevention and management. Am Fam Physician. 2017; 96(10): 656–663.
  122. Gunal AI, Ozalp G, Yoldas TK, et al. Gabapentin therapy for pruritus in haemodialysis patients: a randomized, placebo-controlled, double-blind trial. Nephrol Dial Transplant. 2004; 19(12): 3137–3139.
  123. Simonsen E, Komenda P, Lerner B, et al. Treatment of uremic pruritus: a systematic review. Am J Kidney Dis. 2017; 70(5): 638–655.