Pruritus in the Elderly: Differential Diagnosis and Management

James WD, Elston DM, Treat JR, Rosenbach MA. Andrews’ Diseases of the Skin. 13th ed. Elsevier.

Xie B, Li X. Inflammatory mediators causing cutaneous chronic itch in some diseases via transient receptor potential channel subfamily V member 1 and subfamily A member 1. J Dermatol. 2019;46(3):177–85.

Article  PubMed  CAS  Google Scholar 

• Caplan Z. 2020 Census: 1 in 6 People in the United States Were 65 and Over [Internet]. United States Census Bureau; 2023. Available from: https://www.census.gov/library/stories/2023/05/2020-census-united-states-older-population-grew.html. Most recent census data suggests that the number of older adults in the US is growing.

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.

Article  PubMed  Google Scholar 

Pruritus in the elderly - ClinicalKey [Internet]. [cited 2024 Jan 31]. Available from: https://www-clinicalkey-com.libproxy.lib.unc.edu/#!/content/playContent/1-s2.0-S0738081X10001173?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0738081X10001173%3Fshowall%3Dtrue&referrer=https:%2F%2Fpubmed.ncbi.nlm.nih.gov%2F.

Causes, pathophysiology, and treatment of pruritus in the mature patient - ClinicalKey [Internet]. [cited 2024 Jan 31]. Available from: https://www-clinicalkey-com.libproxy.lib.unc.edu/#!/content/playContent/1-s2.0-S0738081X17301955?returnurl=null&referrer=null.

Chan LN, Magyari A, Ye M, Al-Alusi NA, Langan SM, Margolis D, et al. The epidemiology of atopic dermatitis in older adults: A population-based study in the United Kingdom. PLoS ONE. 2021;16(10):e0258219.

Article  PubMed  PubMed Central  CAS  Google Scholar 

Frazier W. Bhardwaj N. Atopic Dermatitis: Diagnosis and Treatment afp. 2020;101(10):590–8.

Google Scholar 

Cleveland Clinic [Internet]. [cited 2024 Jan 31]. Medications on the Beers Criteria List. Available from: https://my.clevelandclinic.org/health/articles/24946-beers-criteria.

Tannenbaum C, Paquette A, Hilmer S, Holroyd-Leduc J, Carnahan R. A Systematic Review of Amnestic and Non-Amnestic Mild Cognitive Impairment Induced by Anticholinergic, Antihistamine. GABAergic and Opioid Drugs Drugs Aging. 2012;29(8):639–58.

PubMed  CAS  Google Scholar 

Klein PA, Clark RAF. An Evidence-Based Review of the Efficacy of Antihistamines in Relieving Pruritus in Atopic Dermatitis. Arch Dermatol. 1999;135(12):1522–5.

Article  PubMed  CAS  Google Scholar 

•• Drucker AM, Lam M, Flohr C, Thyssen JP, Kabashima K, Bissonnette R, et al. Systemic therapy for atopic dermatitis in older adults and adults with comorbidities: a scoping review and International Eczema Council survey. Dermatitis. 2022;33(3):200–6. The treatment landscape of atopic dermatitis has shifted significantly since the approval of multiple systemic medications and biologics. This recent review highlights these advances but notes that older adults are often excluded from clinical trials for these therapies due to age or associated comorbidities.

Blauvelt A, Teixeira HD, Simpson EL, Costanzo A, De Bruin-Weller M, Barbarot S, et al. Efficacy and Safety of Upadacitinib vs Dupilumab in Adults With Moderate-to-Severe Atopic Dermatitis: A Randomized Clinical Trial. JAMA Dermatol. 2021;157(9):1047.

Article  PubMed  PubMed Central  Google Scholar 

•• Reich K, Thyssen JP, Blauvelt A, Eyerich K, Soong W, Rice ZP, et al. Efficacy and safety of abrocitinib versus dupilumab in adults with moderate-to-severe atopic dermatitis: a randomised, double-blind, multicentre phase 3 trial. Lancet. 2022;400(10348):273–82. This phase 3 trial demonstrated that abrocitinib 200 mg may be more efficacious than dupilumab for the treatment of moderate to severe atopic dermatitis. This suggests that oral treatment may be possible alternatives to subcutaneous injections for AD.

Wollenberg A, Howell MD, Guttman-Yassky E, Silverberg JI, Kell C, Ranade K, et al. Treatment of atopic dermatitis with tralokinumab, an anti–IL-13 mAb. Journal of Allergy and Clinical Immunology. 2019;143(1):135–41.

Article  PubMed  CAS  Google Scholar 

Lam M, Zhu JW, Maqbool T, Adam G, Tadrous M, Rochon P, et al. Inclusion of Older Adults in Randomized Clinical Trials for Systemic Medications for Atopic Dermatitis: A Systematic Review. JAMA Dermatol. 2020;156(11):1240–5.

Article  PubMed  Google Scholar 

Ständer S, Augustin M, Berger T, Elmariah S, Korman NJ, Weisshaar E, et al. Prevalence of prurigo nodularis in the United States of America: A retrospective database analysis. JAAD Int. 2020;1(2):28–30.

Google Scholar 

Williams KA, Huang AH, Belzberg M, Kwatra SG. Prurigo nodularis: Pathogenesis and management. J Am Acad Dermatol. 2020;83(6):1567–75.

Article  PubMed  Google Scholar 

Iking A, Grundmann S, Chatzigeorgakidis E, Phan NQ, Klein D, Ständer S. Prurigo as a symptom of atopic and non-atopic diseases: aetiological survey in a consecutive cohort of 108 patients. J Eur Acad Dermatol Venereol. 2013;27(5):550–7.

Article  PubMed  CAS  Google Scholar 

Pereira MP, Steinke S, Zeidler C, Forner C, Riepe C, Augustin M, et al. European academy of dermatology and venereology European prurigo project: expert consensus on the definition, classification and terminology of chronic prurigo. J Eur Acad Dermatol Venereol. 2018;32(7):1059–65.

Article  PubMed  CAS  Google Scholar 

Fostini AC, Girolomoni G, Tessari G. Prurigo nodularis: an update on etiopathogenesis and therapy. J Dermatol Treat. 2013;24(6):458–62.

Article  CAS  Google Scholar 

Ständer S, Luger T, Metze D. Treatment of prurigo nodularis with topical capsaicin. J Am Acad Dermatol. 2001;44(3):471–8.

Article  PubMed  Google Scholar 

Ständer S, Schürmeyer-Horst F, Luger TA, Weisshaar E. Treatment of pruritic diseases with topical calcineurin inhibitors. Ther Clin Risk Manag. 2006;2(2):213–8.

Article  PubMed  PubMed Central  Google Scholar 

Siepmann D, Lotts T, Blome C, Braeutigam M, Phan NQ, Butterfass-Bahloul T, et al. Evaluation of the Antipruritic Effects of Topical Pimecrolimus in Non-Atopic Prurigo Nodularis: Results of a Randomized, Hydrocortisone-Controlled. Double-Blind Phase II Trial Dermatology. 2013;227(4):353–60.

PubMed  CAS  Google Scholar 

Wong SS, Goh CL. Double-blind, Right/Left Comparison of Calcipotriol Ointment and Betamethasone Ointment in the Treatment of Prurigo Nodularis. Arch Dermatol. 2000;136(6):807–8.

Article  PubMed  CAS  Google Scholar 

Tamagawa-Mineoka R, Katoh N, Ueda E, Kishimoto S. Narrow-band ultraviolet B phototherapy in patients with recalcitrant nodular prurigo. J Dermatol. 2007;34(10):691–5.

Article  PubMed  CAS  Google Scholar 

Karvonen J, Hannuksela M. Long term results of topical trioxsalen PUVA in lichen planus and nodular prurigo. Acta Derm Venereol Suppl (Stockh). 1985;120:53–5.

PubMed  CAS  Google Scholar 

•• Yosipovitch G, Mollanazar N, Ständer S, Kwatra SG, Kim BS, Laws E, et al. Dupilumab in patients with prurigo nodularis: two randomized, double-blind, placebo-controlled phase 3 trials. Nat Med. 2023;29(5):1180–90. These trials demonstrate that dupilumab may be an effective treatment for prurigo nodularis with an acceptable safety profile.

Ständer S, Yosipovitch G, Legat FJ, Lacour JP, Paul C, Narbutt J, et al. Trial of Nemolizumab in Moderate-to-Severe Prurigo Nodularis. N Engl J Med. 2020;382(8):706–16.

Article  PubMed  Google Scholar 

• Yin M, Wu R, Chen J, Dou X. Successful treatment of refractory prurigo nodularis with baricitinib. Dermatol Ther [Internet]. 2022. https://doi.org/10.1111/dth.15642. Cited 1 Feb 2024. Baricitinib has been explored as a potential treatment for prurigo nodularis. However findings are based on a case report and not randomized clinical trials.

• Liu T, Chu Y, Wang Y, Zhong X, Yang C, Bai J, et al. Successful treatment of prurigo nodularis with tofacitinib: The experience from a single center. Int J Dermatol [Internet]. 2023. https://doi.org/10.1111/ijd.16568. Cited 1 Feb 2024. The JAK inhibitor tofacitinib may be an experimental treatment option for prurigo nodularis.

Bolognia JL. Dermatology: ExpertConsult. 3rd ed. Edinburgh: Elsevier; 2012.

Google Scholar 

Szepietowski JC, Reich A, Wiśnicka B. Itching in patients suffering from psoriasis. Acta Dermatovenerol Croat. 2002;10(4):221–6.

PubMed  Google Scholar 

Swanbeck G, Inerot A, Martinsson T, Wahlström J. A population genetic study of psoriasis. Br J Dermatol. 1994;131(1):32–9.

Article  PubMed  CAS  Google Scholar 

McFadden N, Hande KO. A survey of elderly new patients at a dermatology outpatient clinic. Acta Derm Venereol. 1989;69(3):260–2.

PubMed  CAS  Google Scholar 

Yap KB, Siew MG, Goh CL. Pattern of skin diseases in the elderly seen at the National Skin Centre (Singapore) 1990. Singapore Med J. 1994;35(2):147–50.

PubMed  CAS  Google Scholar 

Scarpa R, Oriente P, Pucino A, Torella M, Vignone L, Riccio A, et al. Psoriatic arthritis in psoriatic patients. Rheumatology. 1984;23(4):246–50.

Article  CAS  Google Scholar 

Bakshi H, Nagpal M, Singh M, Dhingra GA, Aggarwal G. Treatment of Psoriasis: A Comprehensive Review of Entire Therapies. Curr Drug Saf. 2020;15(2):82–104.

Article  PubMed  Google Scholar 

• Lebwohl MG, Stein Gold L, Strober B, Papp KA, Armstrong AW, Bagel J, et al. Phase 3 trials of tapinarof cream for plaque psoriasis. N Engl J Med. 2021;385(24):2219–29. Tapinarof is a newer agent available for long term topical use with excellent Phase 3 data regarding efficacy and safety for the treatment for plaque psoriasis.

• Lebwohl MG, Kircik LH, Moore AY, Stein Gold L, Draelos ZD, Gooderham MJ, et al. Effect of roflumilast cream vs vehicle cream on chronic plaque psoriasis: the DERMIS-1 and DERMIS-2 randomized clinical trials. JAMA. 2022;328(11):1073. Similar to tapinarof, roflumilast cream has also demonstrated excellent efficacy and safety for the topical treatment of chronic plaque psoriasis.

Psoriasis treatment: Biologics [Internet]. Available from: https://www.aad.org/public/diseases/psoriasis/treatment/medications/biologics. Cited 1 Feb 2024.

Sbidian E, Chaimani A, Guelimi R, Garcia-Doval I, Hua C, Hughes C, et al. Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis. Cochrane Database Syst Rev. 2023;7(7):CD011535. 

PubMed  Google Scholar 

Yosipovitch G, Tang MBY. Practical Management of Psoriasis in the Elderly: Epidemiology, Clinical Aspects, Quality of Life, Patient Education and Treatment Options. Drugs Aging. 2002;19(11):847–63.

Article  PubMed  Google Scholar 

Pariser DM, Bagel J, Lebwohl M, Yosipovitch G, Chien E, Spellman MC. Serlopitant for psoriatic pruritus: A phase 2 randomized, double-blind, placebo-controlled clinical trial. J Am Acad Dermatol. 2020;82(

留言 (0)

沒有登入
gif