Paediatric Palliative Care Guidelines
search     associated sites     
Menu
Index
Related Topics
Archived Topics
Log in
Username:
Password:
You only need to log in if you are an editor.
Preferences
Edition/Revision: 1.0
Archived

Pruritus - Archived

‘An unpleasant sensation, which provokes a desire to scratch’.

Pathophysiology
  • Arises in skin, conjunctivae and mucous membranes.
  • Can be classified as:
    • Cutaneous – arises from skin.
    • Neuropathic – damage to nerves or by direct irritation.
    • Psychological.
  • Transmitted through C fibres (similar to pain).
  • Receptors are more superficial than pain receptors.
  • Fibres respond to pruritogens including histamine, acetylcholine and peripheral serotonin.
  • Pruritus increases with heat, anxiety and boredom.
Causes
  • Opioids – particularly can cause pruritus, and this is more common in children than adults.
  • Drugs – many drugs can cause problems but particularly antibiotics (penicillin) and antiepileptics (phenytoin).
  • Eczema or dry skin.
  • Scabies or lice.
  • Renal failure.
  • Hepatic disease causing jaundice.
  • Haematological disorders particularly leukaemias and lymphomas.
  • AIDS.
  • Psychological.
Management
  • Look at the possible causes and treat appropriately.
  • Simple rehydration of the skin with moisturisers.
  • Cut back nails, consider the use of mittens.
  • Pruritus decreases with cold, distraction and relaxation.
  • Keep the child cool.
  • Wear loose fitting cotton clothes.
  • Calamine lotion.
  • If the skin is inflamed then use mild steroid creams such as hydrocortisone.
  • Oral corticosteroids can be used if the skin is very inflamed or for pruritus in terminal Hodgkin’s lymphoma.
  • NSAIDs can help by reducing prostaglandins, which can sensitise nerve endings to pruritogenic substances.
  • H1 antihistamines are used extensively in most types of pruritus but there will be occasions when they are poorly effective or completely ineffective.
  • Serotonin antagonist (e.g. Ondansetron) can relieve some types of opioid induced and cholestatic pruritus.
Edition/Revision: 1.0
Created 18 Jul 2013 - Archived
Validated 19 Jul 2013 by Ian Back
Last modified 2 Apr 2020
Sat 04 Apr 2020 06:13:21 GMT +0100 (DST)
Last modified 2 Apr 2020