Pruritus medical term
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Understanding Pruritus: Medical Term and Clinical Implications
Definition and Classification of Pruritus
Pruritus, commonly known as itch, is defined as an unpleasant sensation that provokes the desire to scratch 125. This sensation can be acute or chronic, with chronic pruritus lasting more than six weeks 15. Historically, pruritus was considered a subtype of pain until the late 1990s when specific nerve fibers responsible for itch were identified .
Pathophysiology of Pruritus
The pathogenesis of pruritus is multifactorial, involving various neuromediators and cytokines. It primarily involves the peripheral and central nervous systems 17. The sensation is conducted through unmyelinated C fibers and the anterolateral spinothalamic tract to the central nervous system . Recent research has highlighted the role of neuron-skin interactions, ion channels, neuropeptides, and other mediators in the development of pruritus .
Pruritus as a Symptom of Systemic Diseases
Pruritus is not only associated with dermatological conditions but also with systemic diseases such as renal, hepatic, hematologic, and oncologic disorders . It can be the first or only manifestation of an underlying systemic disease, making it a significant clinical symptom for physicians to consider . Chronic kidney disease-associated pruritus (CKD-aP) is a notable example, affecting a significant percentage of patients with end-stage renal disease and advanced chronic kidney disease .
Drug-Induced Pruritus
Pruritus can also be induced by drug administration, accounting for approximately 5% of all skin adverse reactions to drugs . The categorization of drug-induced pruritus includes both acute and chronic forms, with a focus on therapeutic approaches to manage this side effect .
Clinical Approach and Diagnosis
Diagnosing pruritus involves a detailed history and physical examination, often supplemented by laboratory or imaging tests when the cause is unknown . The International Forum for the Study of Itch (IFSI) has developed a classification system that divides pruritus into three subgroups based on clinical signs: pruritus on diseased skin, pruritus on non-diseased skin, and chronic secondary scratch lesions . This classification helps in planning uniform clinical trials and improving patient care.
Treatment and Management
Treatment of pruritus remains challenging, with many current therapies providing only partial relief . Antihistamines are commonly used but are often insufficient for complete symptom control . Recent advancements in understanding the neuroimmune interactions in pruritus have opened new therapeutic avenues, including antagonists of T-helper 2 cytokines, κ-opioids, and Janus kinase inhibitors .
Conclusion
Pruritus is a complex and multifaceted symptom with significant implications for patient quality of life. Its association with various systemic diseases and drug reactions underscores the importance of a thorough diagnostic approach. Advances in the understanding of its pathophysiology are paving the way for more effective treatments, offering hope for better management of this distressing condition.
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